|
PR REPAIR CARDIAC WOUND W/O BYPASS
|
Professional
|
Both
|
$4,597.00
|
|
|
Service Code
|
HCPCS 33300
|
| Min. Negotiated Rate |
$1,537.22 |
| Max. Negotiated Rate |
$3,818.50 |
| Rate for Payer: Aetna Commercial |
$3,144.97
|
| Rate for Payer: Aetna Medicare |
$2,440.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,144.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,379.67
|
| Rate for Payer: BCBS Complete |
$1,614.08
|
| Rate for Payer: BCBS MAPPO |
$2,346.99
|
| Rate for Payer: BCBS Trust/PPO |
$2,283.84
|
| Rate for Payer: BCN Commercial |
$3,485.73
|
| Rate for Payer: BCN Medicare Advantage |
$2,346.99
|
| Rate for Payer: Cash Price |
$3,677.60
|
| Rate for Payer: Cash Price |
$3,677.60
|
| Rate for Payer: Cofinity Commercial |
$3,144.97
|
| Rate for Payer: Cofinity Commercial |
$3,379.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,346.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,464.34
|
| Rate for Payer: Meridian Medicaid |
$1,614.08
|
| Rate for Payer: Nomi Health Commercial |
$2,816.39
|
| Rate for Payer: PACE SWMI |
$2,346.99
|
| Rate for Payer: PHP Commercial |
$3,285.79
|
| Rate for Payer: PHP Medicare Advantage |
$2,346.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,537.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,988.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,818.50
|
| Rate for Payer: Priority Health Medicare |
$2,346.99
|
| Rate for Payer: Priority Health Narrow Network |
$3,818.50
|
| Rate for Payer: Priority Health SBD |
$3,818.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,346.99
|
| Rate for Payer: UHC Medicare Advantage |
$2,346.99
|
| Rate for Payer: UHCCP Medicaid |
$1,537.22
|
| Rate for Payer: UMR Bronson Commercial |
$2,114.62
|
|
|
PR REPAIR CHOANAL ATRESIA INTRANASAL
|
Professional
|
Both
|
$1,227.00
|
|
|
Service Code
|
HCPCS 30540
|
| Min. Negotiated Rate |
$472.43 |
| Max. Negotiated Rate |
$1,096.60 |
| Rate for Payer: Aetna Commercial |
$919.43
|
| Rate for Payer: Aetna Medicare |
$713.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$919.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$988.04
|
| Rate for Payer: BCBS Complete |
$496.05
|
| Rate for Payer: BCBS MAPPO |
$686.14
|
| Rate for Payer: BCBS Trust/PPO |
$614.94
|
| Rate for Payer: BCN Commercial |
$1,096.60
|
| Rate for Payer: BCN Medicare Advantage |
$686.14
|
| Rate for Payer: Cash Price |
$981.60
|
| Rate for Payer: Cash Price |
$981.60
|
| Rate for Payer: Cofinity Commercial |
$919.43
|
| Rate for Payer: Cofinity Commercial |
$988.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.45
|
| Rate for Payer: Meridian Medicaid |
$496.05
|
| Rate for Payer: Nomi Health Commercial |
$823.37
|
| Rate for Payer: PACE SWMI |
$686.14
|
| Rate for Payer: PHP Commercial |
$960.60
|
| Rate for Payer: PHP Medicare Advantage |
$686.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$797.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,036.31
|
| Rate for Payer: Priority Health Medicare |
$686.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,036.31
|
| Rate for Payer: Priority Health SBD |
$1,036.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.14
|
| Rate for Payer: UHC Medicare Advantage |
$686.14
|
| Rate for Payer: UHCCP Medicaid |
$472.43
|
| Rate for Payer: UMR Bronson Commercial |
$564.42
|
|
|
PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM
|
Professional
|
Both
|
$928.00
|
|
|
Service Code
|
HCPCS 13151
|
| Min. Negotiated Rate |
$177.86 |
| Max. Negotiated Rate |
$1,139.30 |
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Aetna Commercial |
$352.70
|
| Rate for Payer: Aetna Medicare |
$273.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.02
|
| Rate for Payer: BCBS Complete |
$186.75
|
| Rate for Payer: BCBS MAPPO |
$263.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,139.30
|
| Rate for Payer: BCN Commercial |
$622.09
|
| Rate for Payer: BCN Medicare Advantage |
$263.21
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cofinity Commercial |
$352.70
|
| Rate for Payer: Cofinity Commercial |
$379.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$276.37
|
| Rate for Payer: Meridian Medicaid |
$186.75
|
| Rate for Payer: Nomi Health Commercial |
$315.85
|
| Rate for Payer: PACE SWMI |
$263.21
|
| Rate for Payer: PHP Commercial |
$368.49
|
| Rate for Payer: PHP Medicare Advantage |
$263.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$177.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$603.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$373.86
|
| Rate for Payer: Priority Health Medicare |
$263.21
|
| Rate for Payer: Priority Health Narrow Network |
$373.86
|
| Rate for Payer: Priority Health SBD |
$373.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.21
|
| Rate for Payer: UHC Medicare Advantage |
$263.21
|
| Rate for Payer: UHCCP Medicaid |
$177.86
|
| Rate for Payer: UMR Bronson Commercial |
$426.88
|
|
|
PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM
|
Professional
|
Both
|
$1,232.00
|
|
|
Service Code
|
HCPCS 13152
|
| Min. Negotiated Rate |
$213.64 |
| Max. Negotiated Rate |
$2,272.50 |
| Rate for Payer: Aetna Commercial |
$423.92
|
| Rate for Payer: Aetna Medicare |
$329.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$423.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.56
|
| Rate for Payer: BCBS Complete |
$224.32
|
| Rate for Payer: BCBS MAPPO |
$316.36
|
| Rate for Payer: BCBS Trust/PPO |
$2,272.50
|
| Rate for Payer: BCN Commercial |
$729.10
|
| Rate for Payer: BCN Medicare Advantage |
$316.36
|
| Rate for Payer: Cash Price |
$985.60
|
| Rate for Payer: Cash Price |
$985.60
|
| Rate for Payer: Cofinity Commercial |
$423.92
|
| Rate for Payer: Cofinity Commercial |
$455.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$316.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$332.18
|
| Rate for Payer: Meridian Medicaid |
$224.32
|
| Rate for Payer: Nomi Health Commercial |
$379.63
|
| Rate for Payer: PACE SWMI |
$316.36
|
| Rate for Payer: PHP Commercial |
$442.90
|
| Rate for Payer: PHP Medicare Advantage |
$316.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$213.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$800.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$450.61
|
| Rate for Payer: Priority Health Medicare |
$316.36
|
| Rate for Payer: Priority Health Narrow Network |
$450.61
|
| Rate for Payer: Priority Health SBD |
$450.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$316.36
|
| Rate for Payer: UHC Medicare Advantage |
$316.36
|
| Rate for Payer: UHCCP Medicaid |
$213.64
|
| Rate for Payer: UMR Bronson Commercial |
$566.72
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM
|
Professional
|
Both
|
$605.00
|
|
|
Service Code
|
HCPCS 13131
|
| Min. Negotiated Rate |
$5.64 |
| Max. Negotiated Rate |
$570.29 |
| Rate for Payer: Aetna Commercial |
$307.30
|
| Rate for Payer: Aetna Medicare |
$238.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.24
|
| Rate for Payer: BCBS Complete |
$162.81
|
| Rate for Payer: BCBS MAPPO |
$229.33
|
| Rate for Payer: BCBS Trust/PPO |
$5.64
|
| Rate for Payer: BCN Commercial |
$570.29
|
| Rate for Payer: BCN Medicare Advantage |
$229.33
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cofinity Commercial |
$307.30
|
| Rate for Payer: Cofinity Commercial |
$330.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$229.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$240.80
|
| Rate for Payer: Meridian Medicaid |
$162.81
|
| Rate for Payer: Nomi Health Commercial |
$275.20
|
| Rate for Payer: PACE SWMI |
$229.33
|
| Rate for Payer: PHP Commercial |
$321.06
|
| Rate for Payer: PHP Medicare Advantage |
$229.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$325.54
|
| Rate for Payer: Priority Health Medicare |
$229.33
|
| Rate for Payer: Priority Health Narrow Network |
$325.54
|
| Rate for Payer: Priority Health SBD |
$325.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$229.33
|
| Rate for Payer: UHC Medicare Advantage |
$229.33
|
| Rate for Payer: UHCCP Medicaid |
$155.06
|
| Rate for Payer: UMR Bronson Commercial |
$278.30
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM
|
Professional
|
Both
|
$1,306.00
|
|
|
Service Code
|
HCPCS 13132
|
| Min. Negotiated Rate |
$192.98 |
| Max. Negotiated Rate |
$848.90 |
| Rate for Payer: Aetna Commercial |
$382.44
|
| Rate for Payer: Aetna Medicare |
$296.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$410.98
|
| Rate for Payer: BCBS Complete |
$202.63
|
| Rate for Payer: BCBS MAPPO |
$285.40
|
| Rate for Payer: BCBS Trust/PPO |
$349.63
|
| Rate for Payer: BCN Commercial |
$691.96
|
| Rate for Payer: BCN Medicare Advantage |
$285.40
|
| Rate for Payer: Cash Price |
$1,044.80
|
| Rate for Payer: Cash Price |
$1,044.80
|
| Rate for Payer: Cofinity Commercial |
$382.44
|
| Rate for Payer: Cofinity Commercial |
$410.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$299.67
|
| Rate for Payer: Meridian Medicaid |
$202.63
|
| Rate for Payer: Nomi Health Commercial |
$342.48
|
| Rate for Payer: PACE SWMI |
$285.40
|
| Rate for Payer: PHP Commercial |
$399.56
|
| Rate for Payer: PHP Medicare Advantage |
$285.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$848.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$406.37
|
| Rate for Payer: Priority Health Medicare |
$285.40
|
| Rate for Payer: Priority Health Narrow Network |
$406.37
|
| Rate for Payer: Priority Health SBD |
$406.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$285.40
|
| Rate for Payer: UHC Medicare Advantage |
$285.40
|
| Rate for Payer: UHCCP Medicaid |
$192.98
|
| Rate for Payer: UMR Bronson Commercial |
$600.76
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 13133
|
| Min. Negotiated Rate |
$79.45 |
| Max. Negotiated Rate |
$1,316.25 |
| Rate for Payer: Aetna Commercial |
$158.91
|
| Rate for Payer: Aetna Medicare |
$123.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.77
|
| Rate for Payer: BCBS Complete |
$83.42
|
| Rate for Payer: BCBS MAPPO |
$118.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,316.25
|
| Rate for Payer: BCN Commercial |
$245.80
|
| Rate for Payer: BCN Medicare Advantage |
$118.59
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$158.91
|
| Rate for Payer: Cofinity Commercial |
$170.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.52
|
| Rate for Payer: Meridian Medicaid |
$83.42
|
| Rate for Payer: Nomi Health Commercial |
$142.31
|
| Rate for Payer: PACE SWMI |
$118.59
|
| Rate for Payer: PHP Commercial |
$166.03
|
| Rate for Payer: PHP Medicare Advantage |
$118.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$167.96
|
| Rate for Payer: Priority Health Medicare |
$118.59
|
| Rate for Payer: Priority Health Narrow Network |
$167.96
|
| Rate for Payer: Priority Health SBD |
$167.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.59
|
| Rate for Payer: UHC Medicare Advantage |
$118.59
|
| Rate for Payer: UHCCP Medicaid |
$79.45
|
| Rate for Payer: UMR Bronson Commercial |
$187.68
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
HCPCS 13120
|
| Min. Negotiated Rate |
$84.02 |
| Max. Negotiated Rate |
$522.88 |
| Rate for Payer: Aetna Commercial |
$290.65
|
| Rate for Payer: Aetna Medicare |
$225.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.34
|
| Rate for Payer: BCBS Complete |
$154.99
|
| Rate for Payer: BCBS MAPPO |
$216.90
|
| Rate for Payer: BCBS Trust/PPO |
$84.02
|
| Rate for Payer: BCN Commercial |
$522.88
|
| Rate for Payer: BCN Medicare Advantage |
$216.90
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Cofinity Commercial |
$290.65
|
| Rate for Payer: Cofinity Commercial |
$312.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$227.74
|
| Rate for Payer: Meridian Medicaid |
$154.99
|
| Rate for Payer: Nomi Health Commercial |
$260.28
|
| Rate for Payer: PACE SWMI |
$216.90
|
| Rate for Payer: PHP Commercial |
$303.66
|
| Rate for Payer: PHP Medicare Advantage |
$216.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$147.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$355.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.00
|
| Rate for Payer: Priority Health Medicare |
$216.90
|
| Rate for Payer: Priority Health Narrow Network |
$312.00
|
| Rate for Payer: Priority Health SBD |
$312.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$216.90
|
| Rate for Payer: UHC Medicare Advantage |
$216.90
|
| Rate for Payer: UHCCP Medicaid |
$147.61
|
| Rate for Payer: UMR Bronson Commercial |
$251.62
|
|
|
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 |
$165.08 |
| Max. Negotiated Rate |
$624.53 |
| Rate for Payer: Aetna Commercial |
$327.01
|
| Rate for Payer: Aetna Medicare |
$253.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$351.42
|
| Rate for Payer: BCBS Complete |
$173.33
|
| Rate for Payer: BCBS MAPPO |
$244.04
|
| Rate for Payer: BCBS Trust/PPO |
$347.82
|
| Rate for Payer: BCN Commercial |
$624.53
|
| 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 |
$351.42
|
| Rate for Payer: Cofinity Commercial |
$327.01
|
| 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: Meridian Medicaid |
$173.33
|
| 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 Choice Medicaid |
$165.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$346.77
|
| Rate for Payer: Priority Health Medicare |
$244.04
|
| Rate for Payer: Priority Health Narrow Network |
$346.77
|
| Rate for Payer: Priority Health SBD |
$346.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$244.04
|
| Rate for Payer: UHC Medicare Advantage |
$244.04
|
| Rate for Payer: UHCCP Medicaid |
$165.08
|
| Rate for Payer: UMR Bronson Commercial |
$413.08
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
13121
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$395.12 |
| Max. Negotiated Rate |
$808.20 |
| Rate for Payer: Aetna American Axle |
$583.70
|
| Rate for Payer: Aetna Commercial |
$763.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$583.70
|
| 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: 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: Multiplan/Beech St/PHCS Commercial |
$763.30
|
| Rate for Payer: PHP Commercial |
$763.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.70
|
| Rate for Payer: Priority Health SBD |
$565.74
|
| Rate for Payer: UMR Bronson Commercial |
$395.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$673.50
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Professional
|
Both
|
$898.00
|
|
|
Service Code
|
HCPCS 13121
|
| Min. Negotiated Rate |
$165.08 |
| Max. Negotiated Rate |
$624.53 |
| Rate for Payer: Aetna Commercial |
$327.01
|
| Rate for Payer: Aetna Medicare |
$253.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$351.42
|
| Rate for Payer: BCBS Complete |
$173.33
|
| Rate for Payer: BCBS MAPPO |
$244.04
|
| Rate for Payer: BCBS Trust/PPO |
$347.82
|
| Rate for Payer: BCN Commercial |
$624.53
|
| 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: Meridian Medicaid |
$173.33
|
| 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 Choice Medicaid |
$165.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$346.77
|
| Rate for Payer: Priority Health Medicare |
$244.04
|
| Rate for Payer: Priority Health Narrow Network |
$346.77
|
| Rate for Payer: Priority Health SBD |
$346.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$244.04
|
| Rate for Payer: UHC Medicare Advantage |
$244.04
|
| Rate for Payer: UHCCP Medicaid |
$165.08
|
| 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 |
$244.78 |
| Max. Negotiated Rate |
$1,885.01 |
| Rate for Payer: Aetna American Axle |
$583.70
|
| Rate for Payer: Aetna Commercial |
$763.30
|
| Rate for Payer: Aetna Medicare |
$623.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$583.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$749.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$749.69
|
| Rate for Payer: BCBS Complete |
$337.54
|
| Rate for Payer: BCBS MAPPO |
$599.75
|
| Rate for Payer: BCBS Trust/PPO |
$651.59
|
| Rate for Payer: BCN Commercial |
$651.59
|
| Rate for Payer: BCN Medicare Advantage |
$599.75
|
| Rate for Payer: Cash Price |
$718.40
|
| 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 |
$599.75
|
| 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 |
$321.47
|
| Rate for Payer: Mclaren Medicare |
$599.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$629.74
|
| Rate for Payer: Meridian Medicaid |
$337.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$689.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$763.30
|
| Rate for Payer: Nomi Health Commercial |
$1,259.48
|
| Rate for Payer: PACE Medicare |
$569.76
|
| Rate for Payer: PACE SWMI |
$599.75
|
| Rate for Payer: PHP Commercial |
$763.30
|
| Rate for Payer: PHP Medicare Advantage |
$599.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,885.01
|
| Rate for Payer: Priority Health Medicare |
$599.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,508.01
|
| Rate for Payer: Priority Health SBD |
$565.74
|
| Rate for Payer: Railroad Medicare Medicare |
$599.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.26
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$599.75
|
| Rate for Payer: UHC Exchange |
$244.78
|
| Rate for Payer: UHC Medicare Advantage |
$599.75
|
| Rate for Payer: UHCCP Medicaid |
$321.47
|
| Rate for Payer: UMR Bronson Commercial |
$332.26
|
| Rate for Payer: VA VA |
$599.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$673.50
|
|
|
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 |
$79.17 |
| Max. Negotiated Rate |
$1,394.71 |
| 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: BCBS Trust/PPO |
$1,394.71
|
| Rate for Payer: BCN Commercial |
$1,394.71
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| 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: UHC All Payor (Choice/PPO) |
$87.09
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$79.17
|
| 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/<
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 13122
|
| Hospital Charge Code |
13122
|
| Min. Negotiated Rate |
$52.19 |
| Max. Negotiated Rate |
$377.55 |
| Rate for Payer: Aetna Commercial |
$104.68
|
| Rate for Payer: Aetna Medicare |
$81.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.49
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS MAPPO |
$78.12
|
| Rate for Payer: BCBS Trust/PPO |
$377.55
|
| Rate for Payer: BCN Commercial |
$186.67
|
| 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: Meridian Medicaid |
$54.80
|
| 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 Choice Medicaid |
$52.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.62
|
| Rate for Payer: Priority Health Medicare |
$78.12
|
| Rate for Payer: Priority Health Narrow Network |
$110.62
|
| Rate for Payer: Priority Health SBD |
$110.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.12
|
| Rate for Payer: UHC Medicare Advantage |
$78.12
|
| Rate for Payer: UHCCP Medicaid |
$52.19
|
| Rate for Payer: UMR Bronson Commercial |
$129.26
|
|
|
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
|
| Min. Negotiated Rate |
$52.19 |
| Max. Negotiated Rate |
$377.55 |
| Rate for Payer: Aetna Commercial |
$104.68
|
| Rate for Payer: Aetna Medicare |
$81.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.49
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS MAPPO |
$78.12
|
| Rate for Payer: BCBS Trust/PPO |
$377.55
|
| Rate for Payer: BCN Commercial |
$186.67
|
| 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: Meridian Medicaid |
$54.80
|
| 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 Choice Medicaid |
$52.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.62
|
| Rate for Payer: Priority Health Medicare |
$78.12
|
| Rate for Payer: Priority Health Narrow Network |
$110.62
|
| Rate for Payer: Priority Health SBD |
$110.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.12
|
| Rate for Payer: UHC Medicare Advantage |
$78.12
|
| Rate for Payer: UHCCP Medicaid |
$52.19
|
| 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 |
$128.65 |
| Max. Negotiated Rate |
$501.39 |
| Rate for Payer: Aetna Commercial |
$254.51
|
| Rate for Payer: Aetna Medicare |
$197.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.50
|
| Rate for Payer: BCBS Complete |
$135.08
|
| Rate for Payer: BCBS MAPPO |
$189.93
|
| Rate for Payer: BCBS Trust/PPO |
$293.06
|
| Rate for Payer: BCN Commercial |
$501.39
|
| 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 |
$254.51
|
| Rate for Payer: Cofinity Commercial |
$273.50
|
| 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: Meridian Medicaid |
$135.08
|
| 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 Choice Medicaid |
$128.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$358.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$270.01
|
| Rate for Payer: Priority Health Medicare |
$189.93
|
| Rate for Payer: Priority Health Narrow Network |
$270.01
|
| Rate for Payer: Priority Health SBD |
$270.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.93
|
| Rate for Payer: UHC Medicare Advantage |
$189.93
|
| Rate for Payer: UHCCP Medicaid |
$128.65
|
| Rate for Payer: UMR Bronson Commercial |
$253.92
|
|
|
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 2.6-7.5 CM
|
Professional
|
Both
|
$666.00
|
|
|
Service Code
|
HCPCS 13101
|
| Hospital Charge Code |
13101
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$583.97 |
| Rate for Payer: Aetna Commercial |
$310.59
|
| Rate for Payer: Aetna Medicare |
$241.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.76
|
| Rate for Payer: BCBS Complete |
$165.50
|
| Rate for Payer: BCBS MAPPO |
$231.78
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$583.97
|
| 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: Meridian Medicaid |
$165.50
|
| 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 Choice Medicaid |
$157.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$332.32
|
| Rate for Payer: Priority Health Medicare |
$231.78
|
| Rate for Payer: Priority Health Narrow Network |
$332.32
|
| Rate for Payer: Priority Health SBD |
$332.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.78
|
| Rate for Payer: UHC Medicare Advantage |
$231.78
|
| Rate for Payer: UHCCP Medicaid |
$157.62
|
| 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 |
$233.35 |
| Max. Negotiated Rate |
$1,885.01 |
| Rate for Payer: Aetna American Axle |
$432.90
|
| Rate for Payer: Aetna Commercial |
$566.10
|
| Rate for Payer: Aetna Medicare |
$623.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$432.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$749.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$749.69
|
| Rate for Payer: BCBS Complete |
$337.54
|
| Rate for Payer: BCBS MAPPO |
$599.75
|
| Rate for Payer: BCBS Trust/PPO |
$651.59
|
| Rate for Payer: BCN Commercial |
$651.59
|
| Rate for Payer: BCN Medicare Advantage |
$599.75
|
| Rate for Payer: Cash Price |
$532.80
|
| 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 |
$599.75
|
| 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 |
$321.47
|
| Rate for Payer: Mclaren Medicare |
$599.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$629.74
|
| Rate for Payer: Meridian Medicaid |
$337.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$689.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.10
|
| Rate for Payer: Nomi Health Commercial |
$1,259.48
|
| Rate for Payer: PACE Medicare |
$569.76
|
| Rate for Payer: PACE SWMI |
$599.75
|
| Rate for Payer: PHP Commercial |
$566.10
|
| Rate for Payer: PHP Medicare Advantage |
$599.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,885.01
|
| Rate for Payer: Priority Health Medicare |
$599.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,508.01
|
| Rate for Payer: Priority Health SBD |
$419.58
|
| Rate for Payer: Railroad Medicare Medicare |
$599.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.68
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$599.75
|
| Rate for Payer: UHC Exchange |
$233.35
|
| Rate for Payer: UHC Medicare Advantage |
$599.75
|
| Rate for Payer: UHCCP Medicaid |
$321.47
|
| Rate for Payer: UMR Bronson Commercial |
$246.42
|
| Rate for Payer: VA VA |
$599.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$499.50
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Professional
|
Both
|
$666.00
|
|
|
Service Code
|
HCPCS 13101
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$583.97 |
| Rate for Payer: Aetna Commercial |
$310.59
|
| Rate for Payer: Aetna Medicare |
$241.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.76
|
| Rate for Payer: BCBS Complete |
$165.50
|
| Rate for Payer: BCBS MAPPO |
$231.78
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$583.97
|
| 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: Meridian Medicaid |
$165.50
|
| 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 Choice Medicaid |
$157.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$332.32
|
| Rate for Payer: Priority Health Medicare |
$231.78
|
| Rate for Payer: Priority Health Narrow Network |
$332.32
|
| Rate for Payer: Priority Health SBD |
$332.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.78
|
| Rate for Payer: UHC Medicare Advantage |
$231.78
|
| Rate for Payer: UHCCP Medicaid |
$157.62
|
| Rate for Payer: UMR Bronson Commercial |
$306.36
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 13102
|
| Hospital Charge Code |
13102
|
| Min. Negotiated Rate |
$45.58 |
| Max. Negotiated Rate |
$483.39 |
| 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 |
$47.86
|
| Rate for Payer: BCBS MAPPO |
$68.33
|
| Rate for Payer: BCBS Trust/PPO |
$483.39
|
| Rate for Payer: BCN Commercial |
$171.04
|
| 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 |
$91.56
|
| Rate for Payer: Cofinity Commercial |
$98.40
|
| 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: Meridian Medicaid |
$47.86
|
| 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 Choice Medicaid |
$45.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.17
|
| Rate for Payer: Priority Health Medicare |
$68.33
|
| Rate for Payer: Priority Health Narrow Network |
$96.17
|
| Rate for Payer: Priority Health SBD |
$96.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.33
|
| Rate for Payer: UHC Medicare Advantage |
$68.33
|
| Rate for Payer: UHCCP Medicaid |
$45.58
|
| Rate for Payer: UMR Bronson Commercial |
$96.14
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 13102
|
| Min. Negotiated Rate |
$45.58 |
| Max. Negotiated Rate |
$483.39 |
| 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 |
$47.86
|
| Rate for Payer: BCBS MAPPO |
$68.33
|
| Rate for Payer: BCBS Trust/PPO |
$483.39
|
| Rate for Payer: BCN Commercial |
$171.04
|
| 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 |
$91.56
|
| Rate for Payer: Cofinity Commercial |
$98.40
|
| 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: Meridian Medicaid |
$47.86
|
| 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 Choice Medicaid |
$45.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.17
|
| Rate for Payer: Priority Health Medicare |
$68.33
|
| Rate for Payer: Priority Health Narrow Network |
$96.17
|
| Rate for Payer: Priority Health SBD |
$96.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.33
|
| Rate for Payer: UHC Medicare Advantage |
$68.33
|
| Rate for Payer: UHCCP Medicaid |
$45.58
|
| 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 |
$68.87 |
| Max. Negotiated Rate |
$700.00 |
| 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: BCBS Trust/PPO |
$435.91
|
| Rate for Payer: BCN Commercial |
$435.91
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$179.74
|
| Rate for Payer: Cofinity Commercial |
$146.30
|
| 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: UHC All Payor (Choice/PPO) |
$75.76
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$68.87
|
| Rate for Payer: UMR Bronson Commercial |
$77.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.75
|
|
|
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
|
|
