|
PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
|
Professional
|
Both
|
$694.00
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
12035
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$459.81 |
| Rate for Payer: Aetna Commercial |
$308.91
|
| Rate for Payer: Aetna Medicare |
$239.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$308.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.96
|
| Rate for Payer: BCBS Complete |
$163.26
|
| Rate for Payer: BCBS MAPPO |
$230.53
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$459.81
|
| Rate for Payer: BCN Medicare Advantage |
$230.53
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Cofinity Commercial |
$331.96
|
| Rate for Payer: Cofinity Commercial |
$308.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$230.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$242.06
|
| Rate for Payer: Meridian Medicaid |
$163.26
|
| Rate for Payer: Nomi Health Commercial |
$276.64
|
| Rate for Payer: PACE SWMI |
$230.53
|
| Rate for Payer: PHP Commercial |
$322.74
|
| Rate for Payer: PHP Medicare Advantage |
$230.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$451.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.90
|
| Rate for Payer: Priority Health Medicare |
$230.53
|
| Rate for Payer: Priority Health Narrow Network |
$326.90
|
| Rate for Payer: Priority Health SBD |
$326.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$230.53
|
| Rate for Payer: UHC Medicare Advantage |
$230.53
|
| Rate for Payer: UHCCP Medicaid |
$155.49
|
| Rate for Payer: UMR Bronson Commercial |
$319.24
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
|
Facility
|
OP
|
$694.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
12035
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$209.82 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: Aetna American Axle |
$451.10
|
| Rate for Payer: Aetna Commercial |
$589.90
|
| Rate for Payer: Aetna Medicare |
$407.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$451.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$418.44
|
| Rate for Payer: BCN Commercial |
$418.44
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Cofinity Commercial |
$485.80
|
| Rate for Payer: Cofinity Commercial |
$596.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$485.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$555.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$624.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$485.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$520.50
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$589.90
|
| Rate for Payer: Nomi Health Commercial |
$822.04
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$589.90
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$451.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.33
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$984.26
|
| Rate for Payer: Priority Health SBD |
$437.22
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$254.73
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$231.57
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: UMR Bronson Commercial |
$256.78
|
| Rate for Payer: VA VA |
$391.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$520.50
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
|
Facility
|
IP
|
$694.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
12035
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$305.36 |
| Max. Negotiated Rate |
$624.60 |
| Rate for Payer: Aetna American Axle |
$451.10
|
| Rate for Payer: Aetna Commercial |
$589.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$451.10
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Cofinity Commercial |
$485.80
|
| Rate for Payer: Cofinity Commercial |
$596.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$485.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$555.20
|
| Rate for Payer: Healthscope Commercial |
$624.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$485.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$520.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$589.90
|
| Rate for Payer: PHP Commercial |
$589.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$451.10
|
| Rate for Payer: Priority Health SBD |
$437.22
|
| Rate for Payer: UMR Bronson Commercial |
$305.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$520.50
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
|
Professional
|
Both
|
$694.00
|
|
|
Service Code
|
HCPCS 12035
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$459.81 |
| Rate for Payer: Aetna Commercial |
$308.91
|
| Rate for Payer: Aetna Medicare |
$239.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$308.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.96
|
| Rate for Payer: BCBS Complete |
$163.26
|
| Rate for Payer: BCBS MAPPO |
$230.53
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$459.81
|
| Rate for Payer: BCN Medicare Advantage |
$230.53
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Cofinity Commercial |
$308.91
|
| Rate for Payer: Cofinity Commercial |
$331.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$230.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$242.06
|
| Rate for Payer: Meridian Medicaid |
$163.26
|
| Rate for Payer: Nomi Health Commercial |
$276.64
|
| Rate for Payer: PACE SWMI |
$230.53
|
| Rate for Payer: PHP Commercial |
$322.74
|
| Rate for Payer: PHP Medicare Advantage |
$230.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$451.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.90
|
| Rate for Payer: Priority Health Medicare |
$230.53
|
| Rate for Payer: Priority Health Narrow Network |
$326.90
|
| Rate for Payer: Priority Health SBD |
$326.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$230.53
|
| Rate for Payer: UHC Medicare Advantage |
$230.53
|
| Rate for Payer: UHCCP Medicaid |
$155.49
|
| Rate for Payer: UMR Bronson Commercial |
$319.24
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM
|
Professional
|
Both
|
$869.00
|
|
|
Service Code
|
HCPCS 12036
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$564.85 |
| Rate for Payer: Aetna Commercial |
$363.30
|
| Rate for Payer: Aetna Medicare |
$281.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$363.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$390.41
|
| Rate for Payer: BCBS Complete |
$191.00
|
| Rate for Payer: BCBS MAPPO |
$271.12
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$510.07
|
| Rate for Payer: BCN Medicare Advantage |
$271.12
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Cofinity Commercial |
$363.30
|
| Rate for Payer: Cofinity Commercial |
$390.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$271.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$284.68
|
| Rate for Payer: Meridian Medicaid |
$191.00
|
| Rate for Payer: Nomi Health Commercial |
$325.34
|
| Rate for Payer: PACE SWMI |
$271.12
|
| Rate for Payer: PHP Commercial |
$379.57
|
| Rate for Payer: PHP Medicare Advantage |
$271.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$564.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$382.44
|
| Rate for Payer: Priority Health Medicare |
$271.12
|
| Rate for Payer: Priority Health Narrow Network |
$382.44
|
| Rate for Payer: Priority Health SBD |
$382.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$271.12
|
| Rate for Payer: UHC Medicare Advantage |
$271.12
|
| Rate for Payer: UHCCP Medicaid |
$181.90
|
| Rate for Payer: UMR Bronson Commercial |
$399.74
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
12031
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$143.40 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: Aetna American Axle |
$256.10
|
| Rate for Payer: Aetna Commercial |
$334.90
|
| Rate for Payer: Aetna Medicare |
$407.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$418.44
|
| Rate for Payer: BCN Commercial |
$418.44
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cofinity Commercial |
$275.80
|
| Rate for Payer: Cofinity Commercial |
$338.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$275.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$354.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$275.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.50
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.90
|
| Rate for Payer: Nomi Health Commercial |
$822.04
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$334.90
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.33
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$984.26
|
| Rate for Payer: Priority Health SBD |
$248.22
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.74
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$143.40
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: UMR Bronson Commercial |
$145.78
|
| Rate for Payer: VA VA |
$391.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.50
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
12031
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$173.36 |
| Max. Negotiated Rate |
$354.60 |
| Rate for Payer: Aetna American Axle |
$256.10
|
| Rate for Payer: Aetna Commercial |
$334.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.10
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cofinity Commercial |
$275.80
|
| Rate for Payer: Cofinity Commercial |
$338.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$275.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.20
|
| Rate for Payer: Healthscope Commercial |
$354.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$275.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.90
|
| Rate for Payer: PHP Commercial |
$334.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.10
|
| Rate for Payer: Priority Health SBD |
$248.22
|
| Rate for Payer: UMR Bronson Commercial |
$173.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.50
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Professional
|
Both
|
$394.00
|
|
|
Service Code
|
HCPCS 12031
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$310.99 |
| Rate for Payer: Aetna Commercial |
$190.90
|
| Rate for Payer: Aetna Medicare |
$148.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.14
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$142.46
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$310.99
|
| Rate for Payer: BCN Medicare Advantage |
$142.46
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cofinity Commercial |
$190.90
|
| Rate for Payer: Cofinity Commercial |
$205.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.58
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Nomi Health Commercial |
$170.95
|
| Rate for Payer: PACE SWMI |
$142.46
|
| Rate for Payer: PHP Commercial |
$199.44
|
| Rate for Payer: PHP Medicare Advantage |
$142.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$205.00
|
| Rate for Payer: Priority Health Medicare |
$142.46
|
| Rate for Payer: Priority Health Narrow Network |
$205.00
|
| Rate for Payer: Priority Health SBD |
$205.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.46
|
| Rate for Payer: UHC Medicare Advantage |
$142.46
|
| Rate for Payer: UHCCP Medicaid |
$97.34
|
| Rate for Payer: UMR Bronson Commercial |
$181.24
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Professional
|
Both
|
$394.00
|
|
|
Service Code
|
HCPCS 12031
|
| Hospital Charge Code |
12031
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$310.99 |
| Rate for Payer: Aetna Commercial |
$190.90
|
| Rate for Payer: Aetna Medicare |
$148.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.14
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$142.46
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$310.99
|
| Rate for Payer: BCN Medicare Advantage |
$142.46
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cofinity Commercial |
$205.14
|
| Rate for Payer: Cofinity Commercial |
$190.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.58
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Nomi Health Commercial |
$170.95
|
| Rate for Payer: PACE SWMI |
$142.46
|
| Rate for Payer: PHP Commercial |
$199.44
|
| Rate for Payer: PHP Medicare Advantage |
$142.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$205.00
|
| Rate for Payer: Priority Health Medicare |
$142.46
|
| Rate for Payer: Priority Health Narrow Network |
$205.00
|
| Rate for Payer: Priority Health SBD |
$205.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.46
|
| Rate for Payer: UHC Medicare Advantage |
$142.46
|
| Rate for Payer: UHCCP Medicaid |
$97.34
|
| Rate for Payer: UMR Bronson Commercial |
$181.24
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
12032
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$221.32 |
| Max. Negotiated Rate |
$452.70 |
| Rate for Payer: Aetna American Axle |
$326.95
|
| Rate for Payer: Aetna Commercial |
$427.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$326.95
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Cofinity Commercial |
$352.10
|
| Rate for Payer: Cofinity Commercial |
$432.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$352.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$402.40
|
| Rate for Payer: Healthscope Commercial |
$452.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$352.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$377.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$427.55
|
| Rate for Payer: PHP Commercial |
$427.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.95
|
| Rate for Payer: Priority Health SBD |
$316.89
|
| Rate for Payer: UMR Bronson Commercial |
$221.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$377.25
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Professional
|
Both
|
$503.00
|
|
|
Service Code
|
HCPCS 12032
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$358.50 |
| Rate for Payer: Aetna Commercial |
$240.06
|
| Rate for Payer: Aetna Medicare |
$186.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.98
|
| Rate for Payer: BCBS Complete |
$128.60
|
| Rate for Payer: BCBS MAPPO |
$179.15
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$358.50
|
| Rate for Payer: BCN Medicare Advantage |
$179.15
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Cofinity Commercial |
$240.06
|
| Rate for Payer: Cofinity Commercial |
$257.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.11
|
| Rate for Payer: Meridian Medicaid |
$128.60
|
| Rate for Payer: Nomi Health Commercial |
$214.98
|
| Rate for Payer: PACE SWMI |
$179.15
|
| Rate for Payer: PHP Commercial |
$250.81
|
| Rate for Payer: PHP Medicare Advantage |
$179.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$257.37
|
| Rate for Payer: Priority Health Medicare |
$179.15
|
| Rate for Payer: Priority Health Narrow Network |
$257.37
|
| Rate for Payer: Priority Health SBD |
$257.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.15
|
| Rate for Payer: UHC Medicare Advantage |
$179.15
|
| Rate for Payer: UHCCP Medicaid |
$122.48
|
| Rate for Payer: UMR Bronson Commercial |
$231.38
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
12032
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$179.86 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: Aetna American Axle |
$326.95
|
| Rate for Payer: Aetna Commercial |
$427.55
|
| Rate for Payer: Aetna Medicare |
$407.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$326.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$560.72
|
| Rate for Payer: BCN Commercial |
$560.72
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Cofinity Commercial |
$352.10
|
| Rate for Payer: Cofinity Commercial |
$432.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$352.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$402.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$452.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$352.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$377.25
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$427.55
|
| Rate for Payer: Nomi Health Commercial |
$822.04
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$427.55
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.33
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$984.26
|
| Rate for Payer: Priority Health SBD |
$316.89
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.85
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$179.86
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: UMR Bronson Commercial |
$186.11
|
| Rate for Payer: VA VA |
$391.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$377.25
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Professional
|
Both
|
$503.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
12032
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$358.50 |
| Rate for Payer: Aetna Commercial |
$240.06
|
| Rate for Payer: Aetna Medicare |
$186.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.98
|
| Rate for Payer: BCBS Complete |
$128.60
|
| Rate for Payer: BCBS MAPPO |
$179.15
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$358.50
|
| Rate for Payer: BCN Medicare Advantage |
$179.15
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Cofinity Commercial |
$257.98
|
| Rate for Payer: Cofinity Commercial |
$240.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.11
|
| Rate for Payer: Meridian Medicaid |
$128.60
|
| Rate for Payer: Nomi Health Commercial |
$214.98
|
| Rate for Payer: PACE SWMI |
$179.15
|
| Rate for Payer: PHP Commercial |
$250.81
|
| Rate for Payer: PHP Medicare Advantage |
$179.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$257.37
|
| Rate for Payer: Priority Health Medicare |
$179.15
|
| Rate for Payer: Priority Health Narrow Network |
$257.37
|
| Rate for Payer: Priority Health SBD |
$257.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.15
|
| Rate for Payer: UHC Medicare Advantage |
$179.15
|
| Rate for Payer: UHCCP Medicaid |
$122.48
|
| Rate for Payer: UMR Bronson Commercial |
$231.38
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E >30.0 CM
|
Professional
|
Both
|
$758.00
|
|
|
Service Code
|
HCPCS 12037
|
| Min. Negotiated Rate |
$210.66 |
| Max. Negotiated Rate |
$1,594.65 |
| Rate for Payer: Aetna Commercial |
$421.62
|
| Rate for Payer: Aetna Medicare |
$327.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$421.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$453.08
|
| Rate for Payer: BCBS Complete |
$221.19
|
| Rate for Payer: BCBS MAPPO |
$314.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,594.65
|
| Rate for Payer: BCN Commercial |
$571.33
|
| Rate for Payer: BCN Medicare Advantage |
$314.64
|
| Rate for Payer: Cash Price |
$606.40
|
| Rate for Payer: Cash Price |
$606.40
|
| Rate for Payer: Cofinity Commercial |
$421.62
|
| Rate for Payer: Cofinity Commercial |
$453.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$314.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$330.37
|
| Rate for Payer: Meridian Medicaid |
$221.19
|
| Rate for Payer: Nomi Health Commercial |
$377.57
|
| Rate for Payer: PACE SWMI |
$314.64
|
| Rate for Payer: PHP Commercial |
$440.50
|
| Rate for Payer: PHP Medicare Advantage |
$314.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$444.29
|
| Rate for Payer: Priority Health Medicare |
$314.64
|
| Rate for Payer: Priority Health Narrow Network |
$444.29
|
| Rate for Payer: Priority Health SBD |
$444.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$314.64
|
| Rate for Payer: UHC Medicare Advantage |
$314.64
|
| Rate for Payer: UHCCP Medicaid |
$210.66
|
| Rate for Payer: UMR Bronson Commercial |
$348.68
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Professional
|
Both
|
$641.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
12034
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$416.65 |
| Rate for Payer: Aetna Commercial |
$260.31
|
| Rate for Payer: Aetna Medicare |
$202.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.73
|
| Rate for Payer: BCBS Complete |
$138.44
|
| Rate for Payer: BCBS MAPPO |
$194.26
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$394.62
|
| Rate for Payer: BCN Medicare Advantage |
$194.26
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cofinity Commercial |
$279.73
|
| Rate for Payer: Cofinity Commercial |
$260.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.97
|
| Rate for Payer: Meridian Medicaid |
$138.44
|
| Rate for Payer: Nomi Health Commercial |
$233.11
|
| Rate for Payer: PACE SWMI |
$194.26
|
| Rate for Payer: PHP Commercial |
$271.96
|
| Rate for Payer: PHP Medicare Advantage |
$194.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$277.69
|
| Rate for Payer: Priority Health Medicare |
$194.26
|
| Rate for Payer: Priority Health Narrow Network |
$277.69
|
| Rate for Payer: Priority Health SBD |
$277.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.26
|
| Rate for Payer: UHC Medicare Advantage |
$194.26
|
| Rate for Payer: UHCCP Medicaid |
$131.85
|
| Rate for Payer: UMR Bronson Commercial |
$294.86
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
12034
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$195.54 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: Aetna American Axle |
$416.65
|
| Rate for Payer: Aetna Commercial |
$544.85
|
| Rate for Payer: Aetna Medicare |
$407.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$416.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$561.10
|
| Rate for Payer: BCN Commercial |
$561.10
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cofinity Commercial |
$448.70
|
| Rate for Payer: Cofinity Commercial |
$551.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$448.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$512.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$576.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$448.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$480.75
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$544.85
|
| Rate for Payer: Nomi Health Commercial |
$822.04
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$544.85
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.33
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$984.26
|
| Rate for Payer: Priority Health SBD |
$403.83
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.09
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$195.54
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: UMR Bronson Commercial |
$237.17
|
| Rate for Payer: VA VA |
$391.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$480.75
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
12034
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$282.04 |
| Max. Negotiated Rate |
$576.90 |
| Rate for Payer: Aetna American Axle |
$416.65
|
| Rate for Payer: Aetna Commercial |
$544.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$416.65
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cofinity Commercial |
$448.70
|
| Rate for Payer: Cofinity Commercial |
$551.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$448.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$512.80
|
| Rate for Payer: Healthscope Commercial |
$576.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$448.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$480.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$544.85
|
| Rate for Payer: PHP Commercial |
$544.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.65
|
| Rate for Payer: Priority Health SBD |
$403.83
|
| Rate for Payer: UMR Bronson Commercial |
$282.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$480.75
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Professional
|
Both
|
$641.00
|
|
|
Service Code
|
HCPCS 12034
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$416.65 |
| Rate for Payer: Aetna Commercial |
$260.31
|
| Rate for Payer: Aetna Medicare |
$202.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.73
|
| Rate for Payer: BCBS Complete |
$138.44
|
| Rate for Payer: BCBS MAPPO |
$194.26
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$394.62
|
| Rate for Payer: BCN Medicare Advantage |
$194.26
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cofinity Commercial |
$260.31
|
| Rate for Payer: Cofinity Commercial |
$279.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.97
|
| Rate for Payer: Meridian Medicaid |
$138.44
|
| Rate for Payer: Nomi Health Commercial |
$233.11
|
| Rate for Payer: PACE SWMI |
$194.26
|
| Rate for Payer: PHP Commercial |
$271.96
|
| Rate for Payer: PHP Medicare Advantage |
$194.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$277.69
|
| Rate for Payer: Priority Health Medicare |
$194.26
|
| Rate for Payer: Priority Health Narrow Network |
$277.69
|
| Rate for Payer: Priority Health SBD |
$277.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.26
|
| Rate for Payer: UHC Medicare Advantage |
$194.26
|
| Rate for Payer: UHCCP Medicaid |
$131.85
|
| Rate for Payer: UMR Bronson Commercial |
$294.86
|
|
|
PR REPAIR INTRINSIC MUSCLES HAND EACH MUSCLE
|
Professional
|
Both
|
$762.00
|
|
|
Service Code
|
HCPCS 26591
|
| Min. Negotiated Rate |
$232.45 |
| Max. Negotiated Rate |
$758.72 |
| Rate for Payer: Aetna Commercial |
$605.39
|
| Rate for Payer: Aetna Medicare |
$469.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$605.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$650.56
|
| Rate for Payer: BCBS Complete |
$331.45
|
| Rate for Payer: BCBS MAPPO |
$451.78
|
| Rate for Payer: BCBS Trust/PPO |
$232.45
|
| Rate for Payer: BCN Commercial |
$727.64
|
| Rate for Payer: BCN Medicare Advantage |
$451.78
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cofinity Commercial |
$605.39
|
| Rate for Payer: Cofinity Commercial |
$650.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$451.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$474.37
|
| Rate for Payer: Meridian Medicaid |
$331.45
|
| Rate for Payer: Nomi Health Commercial |
$542.14
|
| Rate for Payer: PACE SWMI |
$451.78
|
| Rate for Payer: PHP Commercial |
$632.49
|
| Rate for Payer: PHP Medicare Advantage |
$451.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$315.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$495.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$758.72
|
| Rate for Payer: Priority Health Medicare |
$451.78
|
| Rate for Payer: Priority Health Narrow Network |
$758.72
|
| Rate for Payer: Priority Health SBD |
$758.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$451.78
|
| Rate for Payer: UHC Medicare Advantage |
$451.78
|
| Rate for Payer: UHCCP Medicaid |
$315.67
|
| Rate for Payer: UMR Bronson Commercial |
$350.52
|
|
|
PR REPAIR LACERATION DIAPHRAGM ANY APPROACH
|
Professional
|
Both
|
$4,732.00
|
|
|
Service Code
|
HCPCS 39501
|
| Min. Negotiated Rate |
$545.71 |
| Max. Negotiated Rate |
$3,075.80 |
| Rate for Payer: Aetna Commercial |
$1,102.94
|
| Rate for Payer: Aetna Medicare |
$856.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,102.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,185.25
|
| Rate for Payer: BCBS Complete |
$573.00
|
| Rate for Payer: BCBS MAPPO |
$823.09
|
| Rate for Payer: BCBS Trust/PPO |
$575.32
|
| Rate for Payer: BCN Commercial |
$1,234.88
|
| Rate for Payer: BCN Medicare Advantage |
$823.09
|
| Rate for Payer: Cash Price |
$3,785.60
|
| Rate for Payer: Cash Price |
$3,785.60
|
| Rate for Payer: Cofinity Commercial |
$1,102.94
|
| Rate for Payer: Cofinity Commercial |
$1,185.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$823.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$864.24
|
| Rate for Payer: Meridian Medicaid |
$573.00
|
| Rate for Payer: Nomi Health Commercial |
$987.71
|
| Rate for Payer: PACE SWMI |
$823.09
|
| Rate for Payer: PHP Commercial |
$1,152.33
|
| Rate for Payer: PHP Medicare Advantage |
$823.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$545.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,075.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,358.82
|
| Rate for Payer: Priority Health Medicare |
$823.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,358.82
|
| Rate for Payer: Priority Health SBD |
$1,358.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$823.09
|
| Rate for Payer: UHC Medicare Advantage |
$823.09
|
| Rate for Payer: UHCCP Medicaid |
$545.71
|
| Rate for Payer: UMR Bronson Commercial |
$2,176.72
|
|
|
PR REPAIR LACERATION PALATE <2 CM
|
Professional
|
Both
|
$348.00
|
|
|
Service Code
|
HCPCS 42180
|
| Min. Negotiated Rate |
$121.41 |
| Max. Negotiated Rate |
$377.75 |
| Rate for Payer: Aetna Commercial |
$239.23
|
| Rate for Payer: Aetna Medicare |
$185.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.08
|
| Rate for Payer: BCBS Complete |
$127.48
|
| Rate for Payer: BCBS MAPPO |
$178.53
|
| Rate for Payer: BCBS Trust/PPO |
$363.47
|
| Rate for Payer: BCN Commercial |
$377.75
|
| Rate for Payer: BCN Medicare Advantage |
$178.53
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cofinity Commercial |
$239.23
|
| Rate for Payer: Cofinity Commercial |
$257.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$187.46
|
| Rate for Payer: Meridian Medicaid |
$127.48
|
| Rate for Payer: Nomi Health Commercial |
$214.24
|
| Rate for Payer: PACE SWMI |
$178.53
|
| Rate for Payer: PHP Commercial |
$249.94
|
| Rate for Payer: PHP Medicare Advantage |
$178.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.27
|
| Rate for Payer: Priority Health Medicare |
$178.53
|
| Rate for Payer: Priority Health Narrow Network |
$338.27
|
| Rate for Payer: Priority Health SBD |
$338.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.53
|
| Rate for Payer: UHC Medicare Advantage |
$178.53
|
| Rate for Payer: UHCCP Medicaid |
$121.41
|
| Rate for Payer: UMR Bronson Commercial |
$160.08
|
|
|
PR REPAIR LACERATION PALATE >2 CM/COMPLEX
|
Professional
|
Both
|
$737.00
|
|
|
Service Code
|
HCPCS 42182
|
| Min. Negotiated Rate |
$166.57 |
| Max. Negotiated Rate |
$622.34 |
| Rate for Payer: Aetna Commercial |
$330.07
|
| Rate for Payer: Aetna Medicare |
$256.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.70
|
| Rate for Payer: BCBS Complete |
$174.90
|
| Rate for Payer: BCBS MAPPO |
$246.32
|
| Rate for Payer: BCBS Trust/PPO |
$622.34
|
| Rate for Payer: BCN Commercial |
$487.70
|
| Rate for Payer: BCN Medicare Advantage |
$246.32
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cofinity Commercial |
$330.07
|
| Rate for Payer: Cofinity Commercial |
$354.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$246.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.64
|
| Rate for Payer: Meridian Medicaid |
$174.90
|
| Rate for Payer: Nomi Health Commercial |
$295.58
|
| Rate for Payer: PACE SWMI |
$246.32
|
| Rate for Payer: PHP Commercial |
$344.85
|
| Rate for Payer: PHP Medicare Advantage |
$246.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$166.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$465.34
|
| Rate for Payer: Priority Health Medicare |
$246.32
|
| Rate for Payer: Priority Health Narrow Network |
$465.34
|
| Rate for Payer: Priority Health SBD |
$465.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$246.32
|
| Rate for Payer: UHC Medicare Advantage |
$246.32
|
| Rate for Payer: UHCCP Medicaid |
$166.57
|
| Rate for Payer: UMR Bronson Commercial |
$339.02
|
|
|
PR REPAIR LATERAL COLLATERAL LIGAMENT ELBOW
|
Professional
|
Both
|
$2,298.00
|
|
|
Service Code
|
HCPCS 24343
|
| Min. Negotiated Rate |
$147.92 |
| Max. Negotiated Rate |
$1,493.70 |
| Rate for Payer: Aetna Commercial |
$927.64
|
| Rate for Payer: Aetna Medicare |
$719.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$927.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$996.87
|
| Rate for Payer: BCBS Complete |
$493.82
|
| Rate for Payer: BCBS MAPPO |
$692.27
|
| Rate for Payer: BCBS Trust/PPO |
$147.92
|
| Rate for Payer: BCN Commercial |
$1,055.06
|
| Rate for Payer: BCN Medicare Advantage |
$692.27
|
| Rate for Payer: Cash Price |
$1,838.40
|
| Rate for Payer: Cash Price |
$1,838.40
|
| Rate for Payer: Cofinity Commercial |
$927.64
|
| Rate for Payer: Cofinity Commercial |
$996.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$692.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$726.88
|
| Rate for Payer: Meridian Medicaid |
$493.82
|
| Rate for Payer: Nomi Health Commercial |
$830.72
|
| Rate for Payer: PACE SWMI |
$692.27
|
| Rate for Payer: PHP Commercial |
$969.18
|
| Rate for Payer: PHP Medicare Advantage |
$692.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$470.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,493.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,109.82
|
| Rate for Payer: Priority Health Medicare |
$692.27
|
| Rate for Payer: Priority Health Narrow Network |
$1,109.82
|
| Rate for Payer: Priority Health SBD |
$1,109.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$692.27
|
| Rate for Payer: UHC Medicare Advantage |
$692.27
|
| Rate for Payer: UHCCP Medicaid |
$470.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,057.08
|
|
|
PR REPAIR LIP FULL THICKNESS <HALF VERTICAL HEIGHT
|
Professional
|
Both
|
$983.00
|
|
|
Service Code
|
HCPCS 40652
|
| Min. Negotiated Rate |
$236.22 |
| Max. Negotiated Rate |
$765.27 |
| Rate for Payer: Aetna Commercial |
$463.75
|
| Rate for Payer: Aetna Medicare |
$359.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$463.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$498.36
|
| Rate for Payer: BCBS Complete |
$248.03
|
| Rate for Payer: BCBS MAPPO |
$346.08
|
| Rate for Payer: BCBS Trust/PPO |
$649.28
|
| Rate for Payer: BCN Commercial |
$765.27
|
| Rate for Payer: BCN Medicare Advantage |
$346.08
|
| Rate for Payer: Cash Price |
$786.40
|
| Rate for Payer: Cash Price |
$786.40
|
| Rate for Payer: Cofinity Commercial |
$463.75
|
| Rate for Payer: Cofinity Commercial |
$498.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$346.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$363.38
|
| Rate for Payer: Meridian Medicaid |
$248.03
|
| Rate for Payer: Nomi Health Commercial |
$415.30
|
| Rate for Payer: PACE SWMI |
$346.08
|
| Rate for Payer: PHP Commercial |
$484.51
|
| Rate for Payer: PHP Medicare Advantage |
$346.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$236.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$653.87
|
| Rate for Payer: Priority Health Medicare |
$346.08
|
| Rate for Payer: Priority Health Narrow Network |
$653.87
|
| Rate for Payer: Priority Health SBD |
$653.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$346.08
|
| Rate for Payer: UHC Medicare Advantage |
$346.08
|
| Rate for Payer: UHCCP Medicaid |
$236.22
|
| Rate for Payer: UMR Bronson Commercial |
$452.18
|
|
|
PR REPAIR LIP FULL THICKNESS VERMILION ONLY
|
Professional
|
Both
|
$693.00
|
|
|
Service Code
|
HCPCS 40650
|
| Min. Negotiated Rate |
$207.25 |
| Max. Negotiated Rate |
$709.07 |
| Rate for Payer: Aetna Commercial |
$407.19
|
| Rate for Payer: Aetna Medicare |
$316.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$407.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$437.57
|
| Rate for Payer: BCBS Complete |
$217.61
|
| Rate for Payer: BCBS MAPPO |
$303.87
|
| Rate for Payer: BCBS Trust/PPO |
$462.26
|
| Rate for Payer: BCN Commercial |
$709.07
|
| Rate for Payer: BCN Medicare Advantage |
$303.87
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cofinity Commercial |
$407.19
|
| Rate for Payer: Cofinity Commercial |
$437.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$319.06
|
| Rate for Payer: Meridian Medicaid |
$217.61
|
| Rate for Payer: Nomi Health Commercial |
$364.64
|
| Rate for Payer: PACE SWMI |
$303.87
|
| Rate for Payer: PHP Commercial |
$425.42
|
| Rate for Payer: PHP Medicare Advantage |
$303.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$207.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$450.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$573.93
|
| Rate for Payer: Priority Health Medicare |
$303.87
|
| Rate for Payer: Priority Health Narrow Network |
$573.93
|
| Rate for Payer: Priority Health SBD |
$573.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.87
|
| Rate for Payer: UHC Medicare Advantage |
$303.87
|
| Rate for Payer: UHCCP Medicaid |
$207.25
|
| Rate for Payer: UMR Bronson Commercial |
$318.78
|
|
