|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM
|
Professional
|
Both
|
$997.00
|
|
|
Service Code
|
HCPCS 12055
|
| Min. Negotiated Rate |
$192.77 |
| Max. Negotiated Rate |
$747.19 |
| Rate for Payer: Aetna Commercial |
$394.16
|
| Rate for Payer: Aetna Medicare |
$294.15
|
| Rate for Payer: BCBS Complete |
$202.41
|
| Rate for Payer: BCBS MAPPO |
$294.15
|
| Rate for Payer: BCBS Trust/PPO |
$364.91
|
| Rate for Payer: BCN Commercial |
$747.19
|
| Rate for Payer: BCN Medicare Advantage |
$294.15
|
| Rate for Payer: Cash Price |
$797.60
|
| Rate for Payer: Cash Price |
$797.60
|
| Rate for Payer: Cofinity Commercial |
$394.16
|
| Rate for Payer: Cofinity Commercial |
$423.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$294.15
|
| Rate for Payer: Healthscope Commercial |
$352.98
|
| Rate for Payer: Healthscope Whirlpool |
$352.98
|
| Rate for Payer: Meridian Medicaid |
$202.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$308.86
|
| Rate for Payer: PACE SWMI |
$294.15
|
| Rate for Payer: PHP Medicare Advantage |
$294.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$697.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$367.47
|
| Rate for Payer: Priority Health Medicare |
$294.15
|
| Rate for Payer: Priority Health Narrow Network |
$367.47
|
| Rate for Payer: UHC Medicare Advantage |
$302.97
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Facility
|
OP
|
$436.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
12051
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$193.87 |
| Max. Negotiated Rate |
$447.41 |
| Rate for Payer: Aetna Commercial |
$392.40
|
| Rate for Payer: Aetna Medicare |
$354.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: ASR ASR |
$422.92
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$338.03
|
| Rate for Payer: BCN Commercial |
$338.03
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cofinity Commercial |
$409.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$348.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$436.00
|
| Rate for Payer: Healthscope Whirlpool |
$422.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.43
|
| Rate for Payer: Mclaren Commercial |
$392.40
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$370.60
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$389.87
|
| Rate for Payer: PHP Medicaid |
$193.87
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$447.41
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$357.93
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$383.68
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Professional
|
Both
|
$436.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
12051
|
| Min. Negotiated Rate |
$108.20 |
| Max. Negotiated Rate |
$417.33 |
| Rate for Payer: Aetna Commercial |
$220.16
|
| Rate for Payer: Aetna Medicare |
$164.30
|
| Rate for Payer: BCBS Complete |
$113.61
|
| Rate for Payer: BCBS MAPPO |
$164.30
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$417.33
|
| Rate for Payer: BCN Medicare Advantage |
$164.30
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cofinity Commercial |
$220.16
|
| Rate for Payer: Cofinity Commercial |
$236.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.30
|
| Rate for Payer: Healthscope Commercial |
$197.16
|
| Rate for Payer: Healthscope Whirlpool |
$197.16
|
| Rate for Payer: Meridian Medicaid |
$113.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$172.52
|
| Rate for Payer: PACE SWMI |
$164.30
|
| Rate for Payer: PHP Medicare Advantage |
$164.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$207.16
|
| Rate for Payer: Priority Health Medicare |
$164.30
|
| Rate for Payer: Priority Health Narrow Network |
$207.16
|
| Rate for Payer: UHC Medicare Advantage |
$169.23
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Facility
|
IP
|
$436.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
12051
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$305.20 |
| Max. Negotiated Rate |
$436.00 |
| Rate for Payer: Aetna Commercial |
$392.40
|
| Rate for Payer: ASR ASR |
$422.92
|
| Rate for Payer: BCBS Trust/PPO |
$338.03
|
| Rate for Payer: BCN Commercial |
$338.03
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cofinity Commercial |
$409.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$348.80
|
| Rate for Payer: Healthscope Commercial |
$436.00
|
| Rate for Payer: Healthscope Whirlpool |
$422.92
|
| Rate for Payer: Mclaren Commercial |
$392.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$370.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$383.68
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Professional
|
Both
|
$436.00
|
|
|
Service Code
|
HCPCS 12051
|
| Min. Negotiated Rate |
$108.20 |
| Max. Negotiated Rate |
$417.33 |
| Rate for Payer: Aetna Commercial |
$220.16
|
| Rate for Payer: Aetna Medicare |
$164.30
|
| Rate for Payer: BCBS Complete |
$113.61
|
| Rate for Payer: BCBS MAPPO |
$164.30
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$417.33
|
| Rate for Payer: BCN Medicare Advantage |
$164.30
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cofinity Commercial |
$236.59
|
| Rate for Payer: Cofinity Commercial |
$220.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.30
|
| Rate for Payer: Healthscope Commercial |
$197.16
|
| Rate for Payer: Healthscope Whirlpool |
$197.16
|
| Rate for Payer: Meridian Medicaid |
$113.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$172.52
|
| Rate for Payer: PACE SWMI |
$164.30
|
| Rate for Payer: PHP Medicare Advantage |
$164.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$207.16
|
| Rate for Payer: Priority Health Medicare |
$164.30
|
| Rate for Payer: Priority Health Narrow Network |
$207.16
|
| Rate for Payer: UHC Medicare Advantage |
$169.23
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Facility
|
IP
|
$549.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
12052
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$384.30 |
| Max. Negotiated Rate |
$549.00 |
| Rate for Payer: Aetna Commercial |
$494.10
|
| Rate for Payer: ASR ASR |
$532.53
|
| Rate for Payer: BCBS Trust/PPO |
$425.64
|
| Rate for Payer: BCN Commercial |
$425.64
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cofinity Commercial |
$516.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.20
|
| Rate for Payer: Healthscope Commercial |
$549.00
|
| Rate for Payer: Healthscope Whirlpool |
$532.53
|
| Rate for Payer: Mclaren Commercial |
$494.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$466.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$483.12
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Facility
|
OP
|
$549.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
12052
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$193.87 |
| Max. Negotiated Rate |
$549.00 |
| Rate for Payer: Aetna Commercial |
$494.10
|
| Rate for Payer: Aetna Medicare |
$354.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: ASR ASR |
$532.53
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$425.64
|
| Rate for Payer: BCN Commercial |
$425.64
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cofinity Commercial |
$516.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$549.00
|
| Rate for Payer: Healthscope Whirlpool |
$532.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.43
|
| Rate for Payer: Mclaren Commercial |
$494.10
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$466.65
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$389.87
|
| Rate for Payer: PHP Medicaid |
$193.87
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.58
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$198.86
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$483.12
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Professional
|
Both
|
$549.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
12052
|
| Min. Negotiated Rate |
$127.16 |
| Max. Negotiated Rate |
$464.25 |
| Rate for Payer: Aetna Commercial |
$259.53
|
| Rate for Payer: Aetna Medicare |
$193.68
|
| Rate for Payer: BCBS Complete |
$133.52
|
| Rate for Payer: BCBS MAPPO |
$193.68
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$464.25
|
| Rate for Payer: BCN Medicare Advantage |
$193.68
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cofinity Commercial |
$278.90
|
| Rate for Payer: Cofinity Commercial |
$259.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.68
|
| Rate for Payer: Healthscope Commercial |
$232.42
|
| Rate for Payer: Healthscope Whirlpool |
$232.42
|
| Rate for Payer: Meridian Medicaid |
$133.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$203.36
|
| Rate for Payer: PACE SWMI |
$193.68
|
| Rate for Payer: PHP Medicare Advantage |
$193.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$243.74
|
| Rate for Payer: Priority Health Medicare |
$193.68
|
| Rate for Payer: Priority Health Narrow Network |
$243.74
|
| Rate for Payer: UHC Medicare Advantage |
$199.49
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Professional
|
Both
|
$549.00
|
|
|
Service Code
|
HCPCS 12052
|
| Min. Negotiated Rate |
$127.16 |
| Max. Negotiated Rate |
$464.25 |
| Rate for Payer: Aetna Commercial |
$259.53
|
| Rate for Payer: Aetna Medicare |
$193.68
|
| Rate for Payer: BCBS Complete |
$133.52
|
| Rate for Payer: BCBS MAPPO |
$193.68
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$464.25
|
| Rate for Payer: BCN Medicare Advantage |
$193.68
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cofinity Commercial |
$278.90
|
| Rate for Payer: Cofinity Commercial |
$259.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.68
|
| Rate for Payer: Healthscope Commercial |
$232.42
|
| Rate for Payer: Healthscope Whirlpool |
$232.42
|
| Rate for Payer: Meridian Medicaid |
$133.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$203.36
|
| Rate for Payer: PACE SWMI |
$193.68
|
| Rate for Payer: PHP Medicare Advantage |
$193.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$243.74
|
| Rate for Payer: Priority Health Medicare |
$193.68
|
| Rate for Payer: Priority Health Narrow Network |
$243.74
|
| Rate for Payer: UHC Medicare Advantage |
$199.49
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Professional
|
Both
|
$622.00
|
|
|
Service Code
|
HCPCS 12053
|
| Hospital Charge Code |
12053
|
| Min. Negotiated Rate |
$137.17 |
| Max. Negotiated Rate |
$535.59 |
| Rate for Payer: Aetna Commercial |
$280.64
|
| Rate for Payer: Aetna Medicare |
$209.43
|
| Rate for Payer: BCBS Complete |
$144.03
|
| Rate for Payer: BCBS MAPPO |
$209.43
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$535.59
|
| Rate for Payer: BCN Medicare Advantage |
$209.43
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$280.64
|
| Rate for Payer: Cofinity Commercial |
$301.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.43
|
| Rate for Payer: Healthscope Commercial |
$251.32
|
| Rate for Payer: Healthscope Whirlpool |
$251.32
|
| Rate for Payer: Meridian Medicaid |
$144.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$219.90
|
| Rate for Payer: PACE SWMI |
$209.43
|
| Rate for Payer: PHP Medicare Advantage |
$209.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.07
|
| Rate for Payer: Priority Health Medicare |
$209.43
|
| Rate for Payer: Priority Health Narrow Network |
$263.07
|
| Rate for Payer: UHC Medicare Advantage |
$215.71
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
12053
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$193.87 |
| Max. Negotiated Rate |
$622.00 |
| Rate for Payer: Aetna Commercial |
$559.80
|
| Rate for Payer: Aetna Medicare |
$354.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: ASR ASR |
$603.34
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$482.24
|
| Rate for Payer: BCN Commercial |
$482.24
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$584.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$622.00
|
| Rate for Payer: Healthscope Whirlpool |
$603.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.43
|
| Rate for Payer: Mclaren Commercial |
$559.80
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$528.70
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$389.87
|
| Rate for Payer: PHP Medicaid |
$193.87
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.58
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$198.86
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$547.36
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Professional
|
Both
|
$622.00
|
|
|
Service Code
|
HCPCS 12053
|
| Min. Negotiated Rate |
$137.17 |
| Max. Negotiated Rate |
$535.59 |
| Rate for Payer: Aetna Commercial |
$280.64
|
| Rate for Payer: Aetna Medicare |
$209.43
|
| Rate for Payer: BCBS Complete |
$144.03
|
| Rate for Payer: BCBS MAPPO |
$209.43
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$535.59
|
| Rate for Payer: BCN Medicare Advantage |
$209.43
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$280.64
|
| Rate for Payer: Cofinity Commercial |
$301.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.43
|
| Rate for Payer: Healthscope Commercial |
$251.32
|
| Rate for Payer: Healthscope Whirlpool |
$251.32
|
| Rate for Payer: Meridian Medicaid |
$144.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$219.90
|
| Rate for Payer: PACE SWMI |
$209.43
|
| Rate for Payer: PHP Medicare Advantage |
$209.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.07
|
| Rate for Payer: Priority Health Medicare |
$209.43
|
| Rate for Payer: Priority Health Narrow Network |
$263.07
|
| Rate for Payer: UHC Medicare Advantage |
$215.71
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
12053
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$435.40 |
| Max. Negotiated Rate |
$622.00 |
| Rate for Payer: Aetna Commercial |
$559.80
|
| Rate for Payer: ASR ASR |
$603.34
|
| Rate for Payer: BCBS Trust/PPO |
$482.24
|
| Rate for Payer: BCN Commercial |
$482.24
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$584.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.60
|
| Rate for Payer: Healthscope Commercial |
$622.00
|
| Rate for Payer: Healthscope Whirlpool |
$603.34
|
| Rate for Payer: Mclaren Commercial |
$559.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$528.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$547.36
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
12054
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Aetna Commercial |
$702.00
|
| Rate for Payer: ASR ASR |
$756.60
|
| Rate for Payer: BCBS Trust/PPO |
$604.73
|
| Rate for Payer: BCN Commercial |
$604.73
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cofinity Commercial |
$733.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.00
|
| Rate for Payer: Healthscope Commercial |
$780.00
|
| Rate for Payer: Healthscope Whirlpool |
$756.60
|
| Rate for Payer: Mclaren Commercial |
$702.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$663.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$686.40
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
12054
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$193.87 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Aetna Commercial |
$702.00
|
| Rate for Payer: Aetna Medicare |
$354.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: ASR ASR |
$756.60
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$604.73
|
| Rate for Payer: BCN Commercial |
$604.73
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cofinity Commercial |
$733.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$780.00
|
| Rate for Payer: Healthscope Whirlpool |
$756.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.43
|
| Rate for Payer: Mclaren Commercial |
$702.00
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$663.00
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$389.87
|
| Rate for Payer: PHP Medicaid |
$193.87
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.58
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$198.86
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$686.40
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
HCPCS 12054
|
| Hospital Charge Code |
12054
|
| Min. Negotiated Rate |
$140.37 |
| Max. Negotiated Rate |
$566.38 |
| Rate for Payer: Aetna Commercial |
$288.73
|
| Rate for Payer: Aetna Medicare |
$215.47
|
| Rate for Payer: BCBS Complete |
$147.39
|
| Rate for Payer: BCBS MAPPO |
$215.47
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$566.38
|
| Rate for Payer: BCN Medicare Advantage |
$215.47
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cofinity Commercial |
$310.28
|
| Rate for Payer: Cofinity Commercial |
$288.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.47
|
| Rate for Payer: Healthscope Commercial |
$258.56
|
| Rate for Payer: Healthscope Whirlpool |
$258.56
|
| Rate for Payer: Meridian Medicaid |
$147.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$226.24
|
| Rate for Payer: PACE SWMI |
$215.47
|
| Rate for Payer: PHP Medicare Advantage |
$215.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$268.82
|
| Rate for Payer: Priority Health Medicare |
$215.47
|
| Rate for Payer: Priority Health Narrow Network |
$268.82
|
| Rate for Payer: UHC Medicare Advantage |
$221.93
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
HCPCS 12054
|
| Min. Negotiated Rate |
$140.37 |
| Max. Negotiated Rate |
$566.38 |
| Rate for Payer: Aetna Commercial |
$288.73
|
| Rate for Payer: Aetna Medicare |
$215.47
|
| Rate for Payer: BCBS Complete |
$147.39
|
| Rate for Payer: BCBS MAPPO |
$215.47
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$566.38
|
| Rate for Payer: BCN Medicare Advantage |
$215.47
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cofinity Commercial |
$288.73
|
| Rate for Payer: Cofinity Commercial |
$310.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.47
|
| Rate for Payer: Healthscope Commercial |
$258.56
|
| Rate for Payer: Healthscope Whirlpool |
$258.56
|
| Rate for Payer: Meridian Medicaid |
$147.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$226.24
|
| Rate for Payer: PACE SWMI |
$215.47
|
| Rate for Payer: PHP Medicare Advantage |
$215.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$268.82
|
| Rate for Payer: Priority Health Medicare |
$215.47
|
| Rate for Payer: Priority Health Narrow Network |
$268.82
|
| Rate for Payer: UHC Medicare Advantage |
$221.93
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM
|
Professional
|
Both
|
$616.00
|
|
|
Service Code
|
HCPCS 12045
|
| Min. Negotiated Rate |
$175.09 |
| Max. Negotiated Rate |
$609.87 |
| Rate for Payer: Aetna Commercial |
$358.97
|
| Rate for Payer: Aetna Medicare |
$267.89
|
| Rate for Payer: BCBS Complete |
$183.84
|
| Rate for Payer: BCBS MAPPO |
$267.89
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$609.87
|
| Rate for Payer: BCN Medicare Advantage |
$267.89
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cofinity Commercial |
$385.76
|
| Rate for Payer: Cofinity Commercial |
$358.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$267.89
|
| Rate for Payer: Healthscope Commercial |
$321.47
|
| Rate for Payer: Healthscope Whirlpool |
$321.47
|
| Rate for Payer: Meridian Medicaid |
$183.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$281.28
|
| Rate for Payer: PACE SWMI |
$267.89
|
| Rate for Payer: PHP Medicare Advantage |
$267.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$431.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$336.65
|
| Rate for Payer: Priority Health Medicare |
$267.89
|
| Rate for Payer: Priority Health Narrow Network |
$336.65
|
| Rate for Payer: UHC Medicare Advantage |
$275.93
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
12041
|
| Min. Negotiated Rate |
$92.66 |
| Max. Negotiated Rate |
$2,369.57 |
| Rate for Payer: Aetna Commercial |
$188.73
|
| Rate for Payer: Aetna Medicare |
$140.84
|
| Rate for Payer: BCBS Complete |
$97.29
|
| Rate for Payer: BCBS MAPPO |
$140.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,369.57
|
| Rate for Payer: BCN Commercial |
$388.50
|
| Rate for Payer: BCN Medicare Advantage |
$140.84
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$188.73
|
| Rate for Payer: Cofinity Commercial |
$202.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.84
|
| Rate for Payer: Healthscope Commercial |
$169.01
|
| Rate for Payer: Healthscope Whirlpool |
$169.01
|
| Rate for Payer: Meridian Medicaid |
$97.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$147.88
|
| Rate for Payer: PACE SWMI |
$140.84
|
| Rate for Payer: PHP Medicare Advantage |
$140.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$177.15
|
| Rate for Payer: Priority Health Medicare |
$140.84
|
| Rate for Payer: Priority Health Narrow Network |
$177.15
|
| Rate for Payer: UHC Medicare Advantage |
$145.07
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
12041
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$193.87 |
| Max. Negotiated Rate |
$443.04 |
| Rate for Payer: Aetna Commercial |
$369.00
|
| Rate for Payer: Aetna Medicare |
$354.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: ASR ASR |
$397.70
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$317.87
|
| Rate for Payer: BCN Commercial |
$317.87
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$385.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$410.00
|
| Rate for Payer: Healthscope Whirlpool |
$397.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.43
|
| Rate for Payer: Mclaren Commercial |
$369.00
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$348.50
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$389.87
|
| Rate for Payer: PHP Medicaid |
$193.87
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.58
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$198.86
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$360.80
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
HCPCS 12041
|
| Min. Negotiated Rate |
$92.66 |
| Max. Negotiated Rate |
$2,369.57 |
| Rate for Payer: Aetna Commercial |
$188.73
|
| Rate for Payer: Aetna Medicare |
$140.84
|
| Rate for Payer: BCBS Complete |
$97.29
|
| Rate for Payer: BCBS MAPPO |
$140.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,369.57
|
| Rate for Payer: BCN Commercial |
$388.50
|
| Rate for Payer: BCN Medicare Advantage |
$140.84
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$202.81
|
| Rate for Payer: Cofinity Commercial |
$188.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.84
|
| Rate for Payer: Healthscope Commercial |
$169.01
|
| Rate for Payer: Healthscope Whirlpool |
$169.01
|
| Rate for Payer: Meridian Medicaid |
$97.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$147.88
|
| Rate for Payer: PACE SWMI |
$140.84
|
| Rate for Payer: PHP Medicare Advantage |
$140.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$177.15
|
| Rate for Payer: Priority Health Medicare |
$140.84
|
| Rate for Payer: Priority Health Narrow Network |
$177.15
|
| Rate for Payer: UHC Medicare Advantage |
$145.07
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
12041
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$287.00 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: Aetna Commercial |
$369.00
|
| Rate for Payer: ASR ASR |
$397.70
|
| Rate for Payer: BCBS Trust/PPO |
$317.87
|
| Rate for Payer: BCN Commercial |
$317.87
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$385.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.00
|
| Rate for Payer: Healthscope Commercial |
$410.00
|
| Rate for Payer: Healthscope Whirlpool |
$397.70
|
| Rate for Payer: Mclaren Commercial |
$369.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$348.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$360.80
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Facility
|
OP
|
$516.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
12042
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$193.87 |
| Max. Negotiated Rate |
$516.00 |
| Rate for Payer: Aetna Commercial |
$464.40
|
| Rate for Payer: Aetna Medicare |
$354.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: ASR ASR |
$500.52
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$400.05
|
| Rate for Payer: BCN Commercial |
$400.05
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cofinity Commercial |
$485.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$412.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$516.00
|
| Rate for Payer: Healthscope Whirlpool |
$500.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.43
|
| Rate for Payer: Mclaren Commercial |
$464.40
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$438.60
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$389.87
|
| Rate for Payer: PHP Medicaid |
$193.87
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.58
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$198.86
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$454.08
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Facility
|
IP
|
$516.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
12042
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$361.20 |
| Max. Negotiated Rate |
$516.00 |
| Rate for Payer: Aetna Commercial |
$464.40
|
| Rate for Payer: ASR ASR |
$500.52
|
| Rate for Payer: BCBS Trust/PPO |
$400.05
|
| Rate for Payer: BCN Commercial |
$400.05
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cofinity Commercial |
$485.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$412.80
|
| Rate for Payer: Healthscope Commercial |
$516.00
|
| Rate for Payer: Healthscope Whirlpool |
$500.52
|
| Rate for Payer: Mclaren Commercial |
$464.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$438.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$454.08
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Professional
|
Both
|
$516.00
|
|
|
Service Code
|
HCPCS 12042
|
| Hospital Charge Code |
12042
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$454.96 |
| Rate for Payer: Aetna Commercial |
$253.53
|
| Rate for Payer: Aetna Medicare |
$189.20
|
| Rate for Payer: BCBS Complete |
$131.06
|
| Rate for Payer: BCBS MAPPO |
$189.20
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$454.96
|
| Rate for Payer: BCN Medicare Advantage |
$189.20
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cofinity Commercial |
$253.53
|
| Rate for Payer: Cofinity Commercial |
$272.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.20
|
| Rate for Payer: Healthscope Commercial |
$227.04
|
| Rate for Payer: Healthscope Whirlpool |
$227.04
|
| Rate for Payer: Meridian Medicaid |
$131.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$198.66
|
| Rate for Payer: PACE SWMI |
$189.20
|
| Rate for Payer: PHP Medicare Advantage |
$189.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.41
|
| Rate for Payer: Priority Health Medicare |
$189.20
|
| Rate for Payer: Priority Health Narrow Network |
$238.41
|
| Rate for Payer: UHC Medicare Advantage |
$194.88
|
|
