|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM
|
Professional
|
Both
|
$1,179.00
|
|
|
Service Code
|
HCPCS 12047
|
| Min. Negotiated Rate |
$220.46 |
| Max. Negotiated Rate |
$884.25 |
| Rate for Payer: Aetna Commercial |
$454.22
|
| Rate for Payer: Aetna Medicare |
$338.97
|
| Rate for Payer: BCBS Complete |
$231.48
|
| Rate for Payer: BCBS MAPPO |
$338.97
|
| Rate for Payer: BCN Commercial |
$531.85
|
| Rate for Payer: BCN Medicare Advantage |
$338.97
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Cofinity Commercial |
$488.12
|
| Rate for Payer: Cofinity Commercial |
$454.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$338.97
|
| Rate for Payer: Healthscope Commercial |
$406.76
|
| Rate for Payer: Healthscope Whirlpool |
$406.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$355.92
|
| Rate for Payer: Meridian Medicaid |
$231.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$372.87
|
| Rate for Payer: Nomi Health Commercial |
$406.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$884.25
|
| Rate for Payer: PACE SWMI |
$338.97
|
| Rate for Payer: PHP Medicare Advantage |
$338.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$220.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$486.77
|
| Rate for Payer: Priority Health Medicare |
$338.97
|
| Rate for Payer: Priority Health Narrow Network |
$486.77
|
| Rate for Payer: Railroad Medicare Medicare |
$338.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$614.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$338.97
|
| Rate for Payer: UHC Exchange |
$614.86
|
| Rate for Payer: UHC Medicaid |
$220.46
|
| Rate for Payer: UHCCP DNSP |
$338.97
|
| Rate for Payer: UHCCP Medicaid |
$220.46
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM
|
Facility
|
OP
|
$582.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
12044
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$234.60 |
| Max. Negotiated Rate |
$920.51 |
| Rate for Payer: Aetna Commercial |
$523.80
|
| Rate for Payer: Aetna Medicare |
$736.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$920.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$920.51
|
| Rate for Payer: ASR ASR |
$564.54
|
| Rate for Payer: BCBS Complete |
$404.44
|
| Rate for Payer: BCBS MAPPO |
$736.41
|
| Rate for Payer: BCBS Trust/PPO |
$479.86
|
| Rate for Payer: BCN Commercial |
$479.86
|
| Rate for Payer: BCN Medicare Advantage |
$736.41
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cofinity Commercial |
$547.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.41
|
| Rate for Payer: Healthscope Commercial |
$564.54
|
| Rate for Payer: Healthscope Whirlpool |
$582.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$736.41
|
| Rate for Payer: Mclaren Commercial |
$523.80
|
| Rate for Payer: Mclaren Medicaid |
$736.41
|
| Rate for Payer: Mclaren Medicare |
$736.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.23
|
| Rate for Payer: Meridian Medicaid |
$404.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$846.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.70
|
| Rate for Payer: Nomi Health Commercial |
$477.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$436.50
|
| Rate for Payer: PACE Medicare |
$699.59
|
| Rate for Payer: PACE SWMI |
$736.41
|
| Rate for Payer: PHP Commercial |
$810.05
|
| Rate for Payer: PHP Medicaid |
$394.72
|
| Rate for Payer: PHP Medicare Advantage |
$736.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$293.24
|
| Rate for Payer: Priority Health Medicare |
$736.41
|
| Rate for Payer: Priority Health Narrow Network |
$234.60
|
| Rate for Payer: Railroad Medicare Medicare |
$736.41
|
| Rate for Payer: UHC Medicaid |
$385.14
|
| Rate for Payer: UHCCP DNSP |
$736.41
|
| Rate for Payer: UHCCP Medicaid |
$385.14
|
| Rate for Payer: VA VA |
$736.41
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM
|
Professional
|
Both
|
$582.00
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
12044
|
| Min. Negotiated Rate |
$121.62 |
| Max. Negotiated Rate |
$436.50 |
| Rate for Payer: Aetna Commercial |
$249.70
|
| Rate for Payer: Aetna Medicare |
$186.34
|
| Rate for Payer: BCBS Complete |
$127.70
|
| Rate for Payer: BCBS MAPPO |
$186.34
|
| Rate for Payer: BCN Commercial |
$323.19
|
| Rate for Payer: BCN Medicare Advantage |
$186.34
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cofinity Commercial |
$268.33
|
| Rate for Payer: Cofinity Commercial |
$249.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.34
|
| Rate for Payer: Healthscope Commercial |
$223.61
|
| Rate for Payer: Healthscope Whirlpool |
$223.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$195.66
|
| Rate for Payer: Meridian Medicaid |
$127.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$204.97
|
| Rate for Payer: Nomi Health Commercial |
$223.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$436.50
|
| Rate for Payer: PACE SWMI |
$186.34
|
| Rate for Payer: PHP Medicare Advantage |
$186.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$295.80
|
| Rate for Payer: Priority Health Medicare |
$186.34
|
| Rate for Payer: Priority Health Narrow Network |
$295.80
|
| Rate for Payer: Railroad Medicare Medicare |
$186.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$373.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$186.34
|
| Rate for Payer: UHC Exchange |
$373.40
|
| Rate for Payer: UHC Medicaid |
$121.62
|
| Rate for Payer: UHCCP DNSP |
$186.34
|
| Rate for Payer: UHCCP Medicaid |
$121.62
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM
|
Facility
|
IP
|
$582.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
12044
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$436.50 |
| Max. Negotiated Rate |
$582.00 |
| Rate for Payer: Aetna Commercial |
$523.80
|
| Rate for Payer: ASR ASR |
$564.54
|
| Rate for Payer: BCBS Trust/PPO |
$477.94
|
| Rate for Payer: BCN Commercial |
$477.94
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cofinity Commercial |
$547.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.60
|
| Rate for Payer: Healthscope Commercial |
$564.54
|
| Rate for Payer: Healthscope Whirlpool |
$582.00
|
| Rate for Payer: Mclaren Commercial |
$523.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.70
|
| Rate for Payer: Nomi Health Commercial |
$477.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$436.50
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM
|
Professional
|
Both
|
$582.00
|
|
|
Service Code
|
HCPCS 12044
|
| Min. Negotiated Rate |
$121.62 |
| Max. Negotiated Rate |
$436.50 |
| Rate for Payer: Aetna Commercial |
$249.70
|
| Rate for Payer: Aetna Medicare |
$186.34
|
| Rate for Payer: BCBS Complete |
$127.70
|
| Rate for Payer: BCBS MAPPO |
$186.34
|
| Rate for Payer: BCN Commercial |
$323.19
|
| Rate for Payer: BCN Medicare Advantage |
$186.34
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cofinity Commercial |
$268.33
|
| Rate for Payer: Cofinity Commercial |
$249.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.34
|
| Rate for Payer: Healthscope Commercial |
$223.61
|
| Rate for Payer: Healthscope Whirlpool |
$223.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$195.66
|
| Rate for Payer: Meridian Medicaid |
$127.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$204.97
|
| Rate for Payer: Nomi Health Commercial |
$223.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$436.50
|
| Rate for Payer: PACE SWMI |
$186.34
|
| Rate for Payer: PHP Medicare Advantage |
$186.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$295.80
|
| Rate for Payer: Priority Health Medicare |
$186.34
|
| Rate for Payer: Priority Health Narrow Network |
$295.80
|
| Rate for Payer: Railroad Medicare Medicare |
$186.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$373.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$186.34
|
| Rate for Payer: UHC Exchange |
$373.40
|
| Rate for Payer: UHC Medicaid |
$121.62
|
| Rate for Payer: UHCCP DNSP |
$186.34
|
| Rate for Payer: UHCCP Medicaid |
$121.62
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
12035
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$178.19 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: Aetna Commercial |
$643.50
|
| Rate for Payer: Aetna Medicare |
$405.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: ASR ASR |
$693.55
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$589.52
|
| Rate for Payer: BCN Commercial |
$589.52
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cofinity Commercial |
$672.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$693.55
|
| Rate for Payer: Healthscope Whirlpool |
$715.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$405.05
|
| Rate for Payer: Mclaren Commercial |
$643.50
|
| Rate for Payer: Mclaren Medicaid |
$405.05
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$222.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.75
|
| Rate for Payer: Nomi Health Commercial |
$586.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.25
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$445.56
|
| Rate for Payer: PHP Medicaid |
$217.11
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$222.74
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health Narrow Network |
$178.19
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP DNSP |
$405.05
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
12035
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$536.25 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: Aetna Commercial |
$643.50
|
| Rate for Payer: ASR ASR |
$693.55
|
| Rate for Payer: BCBS Trust/PPO |
$587.16
|
| Rate for Payer: BCN Commercial |
$587.16
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cofinity Commercial |
$672.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.00
|
| Rate for Payer: Healthscope Commercial |
$693.55
|
| Rate for Payer: Healthscope Whirlpool |
$715.00
|
| Rate for Payer: Mclaren Commercial |
$643.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.75
|
| Rate for Payer: Nomi Health Commercial |
$586.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.25
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
|
Professional
|
Both
|
$715.00
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
12035
|
| Min. Negotiated Rate |
$143.14 |
| Max. Negotiated Rate |
$536.25 |
| Rate for Payer: Aetna Commercial |
$293.88
|
| Rate for Payer: Aetna Medicare |
$219.31
|
| Rate for Payer: BCBS Complete |
$150.30
|
| Rate for Payer: BCBS MAPPO |
$219.31
|
| Rate for Payer: BCN Commercial |
$286.67
|
| Rate for Payer: BCN Medicare Advantage |
$219.31
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cofinity Commercial |
$315.81
|
| Rate for Payer: Cofinity Commercial |
$293.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.31
|
| Rate for Payer: Healthscope Commercial |
$263.17
|
| Rate for Payer: Healthscope Whirlpool |
$263.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.28
|
| Rate for Payer: Meridian Medicaid |
$150.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$241.24
|
| Rate for Payer: Nomi Health Commercial |
$263.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.25
|
| Rate for Payer: PACE SWMI |
$219.31
|
| Rate for Payer: PHP Medicare Advantage |
$219.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$332.72
|
| Rate for Payer: Priority Health Medicare |
$219.31
|
| Rate for Payer: Priority Health Narrow Network |
$332.72
|
| Rate for Payer: Railroad Medicare Medicare |
$219.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$420.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$219.31
|
| Rate for Payer: UHC Exchange |
$420.71
|
| Rate for Payer: UHC Medicaid |
$143.14
|
| Rate for Payer: UHCCP DNSP |
$219.31
|
| Rate for Payer: UHCCP Medicaid |
$143.14
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
|
Professional
|
Both
|
$715.00
|
|
|
Service Code
|
HCPCS 12035
|
| Min. Negotiated Rate |
$143.14 |
| Max. Negotiated Rate |
$536.25 |
| Rate for Payer: Aetna Commercial |
$293.88
|
| Rate for Payer: Aetna Medicare |
$219.31
|
| Rate for Payer: BCBS Complete |
$150.30
|
| Rate for Payer: BCBS MAPPO |
$219.31
|
| Rate for Payer: BCN Commercial |
$286.67
|
| Rate for Payer: BCN Medicare Advantage |
$219.31
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cofinity Commercial |
$315.81
|
| Rate for Payer: Cofinity Commercial |
$293.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.31
|
| Rate for Payer: Healthscope Commercial |
$263.17
|
| Rate for Payer: Healthscope Whirlpool |
$263.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.28
|
| Rate for Payer: Meridian Medicaid |
$150.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$241.24
|
| Rate for Payer: Nomi Health Commercial |
$263.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.25
|
| Rate for Payer: PACE SWMI |
$219.31
|
| Rate for Payer: PHP Medicare Advantage |
$219.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$332.72
|
| Rate for Payer: Priority Health Medicare |
$219.31
|
| Rate for Payer: Priority Health Narrow Network |
$332.72
|
| Rate for Payer: Railroad Medicare Medicare |
$219.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$420.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$219.31
|
| Rate for Payer: UHC Exchange |
$420.71
|
| Rate for Payer: UHC Medicaid |
$143.14
|
| Rate for Payer: UHCCP DNSP |
$219.31
|
| Rate for Payer: UHCCP Medicaid |
$143.14
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM
|
Professional
|
Both
|
$895.00
|
|
|
Service Code
|
HCPCS 12036
|
| Hospital Charge Code |
12036
|
| Min. Negotiated Rate |
$172.32 |
| Max. Negotiated Rate |
$671.25 |
| Rate for Payer: Aetna Commercial |
$355.33
|
| Rate for Payer: Aetna Medicare |
$265.17
|
| Rate for Payer: BCBS Complete |
$180.94
|
| Rate for Payer: BCBS MAPPO |
$265.17
|
| Rate for Payer: BCN Commercial |
$335.37
|
| Rate for Payer: BCN Medicare Advantage |
$265.17
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cofinity Commercial |
$381.84
|
| Rate for Payer: Cofinity Commercial |
$355.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$265.17
|
| Rate for Payer: Healthscope Commercial |
$318.20
|
| Rate for Payer: Healthscope Whirlpool |
$318.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$278.43
|
| Rate for Payer: Meridian Medicaid |
$180.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$291.69
|
| Rate for Payer: Nomi Health Commercial |
$318.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$671.25
|
| Rate for Payer: PACE SWMI |
$265.17
|
| Rate for Payer: PHP Medicare Advantage |
$265.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$389.24
|
| Rate for Payer: Priority Health Medicare |
$265.17
|
| Rate for Payer: Priority Health Narrow Network |
$389.24
|
| Rate for Payer: Railroad Medicare Medicare |
$265.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$495.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$265.17
|
| Rate for Payer: UHC Exchange |
$495.29
|
| Rate for Payer: UHC Medicaid |
$172.32
|
| Rate for Payer: UHCCP DNSP |
$265.17
|
| Rate for Payer: UHCCP Medicaid |
$172.32
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM
|
Professional
|
Both
|
$895.00
|
|
|
Service Code
|
HCPCS 12036
|
| Min. Negotiated Rate |
$172.32 |
| Max. Negotiated Rate |
$671.25 |
| Rate for Payer: Aetna Commercial |
$355.33
|
| Rate for Payer: Aetna Medicare |
$265.17
|
| Rate for Payer: BCBS Complete |
$180.94
|
| Rate for Payer: BCBS MAPPO |
$265.17
|
| Rate for Payer: BCN Commercial |
$335.37
|
| Rate for Payer: BCN Medicare Advantage |
$265.17
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cofinity Commercial |
$381.84
|
| Rate for Payer: Cofinity Commercial |
$355.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$265.17
|
| Rate for Payer: Healthscope Commercial |
$318.20
|
| Rate for Payer: Healthscope Whirlpool |
$318.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$278.43
|
| Rate for Payer: Meridian Medicaid |
$180.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$291.69
|
| Rate for Payer: Nomi Health Commercial |
$318.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$671.25
|
| Rate for Payer: PACE SWMI |
$265.17
|
| Rate for Payer: PHP Medicare Advantage |
$265.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$389.24
|
| Rate for Payer: Priority Health Medicare |
$265.17
|
| Rate for Payer: Priority Health Narrow Network |
$389.24
|
| Rate for Payer: Railroad Medicare Medicare |
$265.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$495.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$265.17
|
| Rate for Payer: UHC Exchange |
$495.29
|
| Rate for Payer: UHC Medicaid |
$172.32
|
| Rate for Payer: UHCCP DNSP |
$265.17
|
| Rate for Payer: UHCCP Medicaid |
$172.32
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
12036
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$385.14 |
| Max. Negotiated Rate |
$920.51 |
| Rate for Payer: Aetna Commercial |
$805.50
|
| Rate for Payer: Aetna Medicare |
$736.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$920.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$920.51
|
| Rate for Payer: ASR ASR |
$868.15
|
| Rate for Payer: BCBS Complete |
$404.44
|
| Rate for Payer: BCBS MAPPO |
$736.41
|
| Rate for Payer: BCBS Trust/PPO |
$737.93
|
| Rate for Payer: BCN Commercial |
$737.93
|
| Rate for Payer: BCN Medicare Advantage |
$736.41
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cofinity Commercial |
$841.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.41
|
| Rate for Payer: Healthscope Commercial |
$868.15
|
| Rate for Payer: Healthscope Whirlpool |
$895.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$736.41
|
| Rate for Payer: Mclaren Commercial |
$805.50
|
| Rate for Payer: Mclaren Medicaid |
$736.41
|
| Rate for Payer: Mclaren Medicare |
$736.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.23
|
| Rate for Payer: Meridian Medicaid |
$404.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$846.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.75
|
| Rate for Payer: Nomi Health Commercial |
$733.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$671.25
|
| Rate for Payer: PACE Medicare |
$699.59
|
| Rate for Payer: PACE SWMI |
$736.41
|
| Rate for Payer: PHP Commercial |
$810.05
|
| Rate for Payer: PHP Medicaid |
$394.72
|
| Rate for Payer: PHP Medicare Advantage |
$736.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$527.80
|
| Rate for Payer: Priority Health Medicare |
$736.41
|
| Rate for Payer: Priority Health Narrow Network |
$422.24
|
| Rate for Payer: Railroad Medicare Medicare |
$736.41
|
| Rate for Payer: UHC Medicaid |
$385.14
|
| Rate for Payer: UHCCP DNSP |
$736.41
|
| Rate for Payer: UHCCP Medicaid |
$385.14
|
| Rate for Payer: VA VA |
$736.41
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
12036
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$671.25 |
| Max. Negotiated Rate |
$895.00 |
| Rate for Payer: Aetna Commercial |
$805.50
|
| Rate for Payer: ASR ASR |
$868.15
|
| Rate for Payer: BCBS Trust/PPO |
$734.97
|
| Rate for Payer: BCN Commercial |
$734.97
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cofinity Commercial |
$841.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.00
|
| Rate for Payer: Healthscope Commercial |
$868.15
|
| Rate for Payer: Healthscope Whirlpool |
$895.00
|
| Rate for Payer: Mclaren Commercial |
$805.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.75
|
| Rate for Payer: Nomi Health Commercial |
$733.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$671.25
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
12031
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$506.31 |
| Rate for Payer: Aetna Commercial |
$365.40
|
| Rate for Payer: Aetna Medicare |
$405.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: ASR ASR |
$393.82
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$334.75
|
| Rate for Payer: BCN Commercial |
$334.75
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cofinity Commercial |
$381.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$393.82
|
| Rate for Payer: Healthscope Whirlpool |
$406.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$405.05
|
| Rate for Payer: Mclaren Commercial |
$365.40
|
| Rate for Payer: Mclaren Medicaid |
$405.05
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$222.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.10
|
| Rate for Payer: Nomi Health Commercial |
$332.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.50
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$445.56
|
| Rate for Payer: PHP Medicaid |
$217.11
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$293.24
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health Narrow Network |
$234.60
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP DNSP |
$405.05
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
HCPCS 12031
|
| Min. Negotiated Rate |
$84.99 |
| Max. Negotiated Rate |
$304.50 |
| Rate for Payer: Aetna Commercial |
$172.86
|
| Rate for Payer: Aetna Medicare |
$129.00
|
| Rate for Payer: BCBS Complete |
$89.24
|
| Rate for Payer: BCBS MAPPO |
$129.00
|
| Rate for Payer: BCN Commercial |
$179.46
|
| Rate for Payer: BCN Medicare Advantage |
$129.00
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cofinity Commercial |
$185.76
|
| Rate for Payer: Cofinity Commercial |
$172.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.00
|
| Rate for Payer: Healthscope Commercial |
$154.80
|
| Rate for Payer: Healthscope Whirlpool |
$154.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.45
|
| Rate for Payer: Meridian Medicaid |
$89.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.90
|
| Rate for Payer: Nomi Health Commercial |
$154.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.50
|
| Rate for Payer: PACE SWMI |
$129.00
|
| Rate for Payer: PHP Medicare Advantage |
$129.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$208.29
|
| Rate for Payer: Priority Health Medicare |
$129.00
|
| Rate for Payer: Priority Health Narrow Network |
$208.29
|
| Rate for Payer: Railroad Medicare Medicare |
$129.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$262.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$129.00
|
| Rate for Payer: UHC Exchange |
$262.57
|
| Rate for Payer: UHC Medicaid |
$84.99
|
| Rate for Payer: UHCCP DNSP |
$129.00
|
| Rate for Payer: UHCCP Medicaid |
$84.99
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
12031
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$304.50 |
| Max. Negotiated Rate |
$406.00 |
| Rate for Payer: Aetna Commercial |
$365.40
|
| Rate for Payer: ASR ASR |
$393.82
|
| Rate for Payer: BCBS Trust/PPO |
$333.41
|
| Rate for Payer: BCN Commercial |
$333.41
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cofinity Commercial |
$381.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.80
|
| Rate for Payer: Healthscope Commercial |
$393.82
|
| Rate for Payer: Healthscope Whirlpool |
$406.00
|
| Rate for Payer: Mclaren Commercial |
$365.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.10
|
| Rate for Payer: Nomi Health Commercial |
$332.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.50
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
HCPCS 12031
|
| Hospital Charge Code |
12031
|
| Min. Negotiated Rate |
$84.99 |
| Max. Negotiated Rate |
$304.50 |
| Rate for Payer: Aetna Commercial |
$172.86
|
| Rate for Payer: Aetna Medicare |
$129.00
|
| Rate for Payer: BCBS Complete |
$89.24
|
| Rate for Payer: BCBS MAPPO |
$129.00
|
| Rate for Payer: BCN Commercial |
$179.46
|
| Rate for Payer: BCN Medicare Advantage |
$129.00
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cofinity Commercial |
$185.76
|
| Rate for Payer: Cofinity Commercial |
$172.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.00
|
| Rate for Payer: Healthscope Commercial |
$154.80
|
| Rate for Payer: Healthscope Whirlpool |
$154.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.45
|
| Rate for Payer: Meridian Medicaid |
$89.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.90
|
| Rate for Payer: Nomi Health Commercial |
$154.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.50
|
| Rate for Payer: PACE SWMI |
$129.00
|
| Rate for Payer: PHP Medicare Advantage |
$129.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$208.29
|
| Rate for Payer: Priority Health Medicare |
$129.00
|
| Rate for Payer: Priority Health Narrow Network |
$208.29
|
| Rate for Payer: Railroad Medicare Medicare |
$129.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$262.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$129.00
|
| Rate for Payer: UHC Exchange |
$262.57
|
| Rate for Payer: UHC Medicaid |
$84.99
|
| Rate for Payer: UHCCP DNSP |
$129.00
|
| Rate for Payer: UHCCP Medicaid |
$84.99
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Professional
|
Both
|
$518.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
12032
|
| Min. Negotiated Rate |
$105.22 |
| Max. Negotiated Rate |
$388.50 |
| Rate for Payer: Aetna Commercial |
$213.96
|
| Rate for Payer: Aetna Medicare |
$159.67
|
| Rate for Payer: BCBS Complete |
$110.48
|
| Rate for Payer: BCBS MAPPO |
$159.67
|
| Rate for Payer: BCN Commercial |
$225.80
|
| Rate for Payer: BCN Medicare Advantage |
$159.67
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cofinity Commercial |
$229.92
|
| Rate for Payer: Cofinity Commercial |
$213.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.67
|
| Rate for Payer: Healthscope Commercial |
$191.60
|
| Rate for Payer: Healthscope Whirlpool |
$191.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.65
|
| Rate for Payer: Meridian Medicaid |
$110.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$175.64
|
| Rate for Payer: Nomi Health Commercial |
$191.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$388.50
|
| Rate for Payer: PACE SWMI |
$159.67
|
| Rate for Payer: PHP Medicare Advantage |
$159.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$262.07
|
| Rate for Payer: Priority Health Medicare |
$159.67
|
| Rate for Payer: Priority Health Narrow Network |
$262.07
|
| Rate for Payer: Railroad Medicare Medicare |
$159.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$328.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$159.67
|
| Rate for Payer: UHC Exchange |
$328.60
|
| Rate for Payer: UHC Medicaid |
$105.22
|
| Rate for Payer: UHCCP DNSP |
$159.67
|
| Rate for Payer: UHCCP Medicaid |
$105.22
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
12032
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$527.80 |
| Rate for Payer: Aetna Commercial |
$466.20
|
| Rate for Payer: Aetna Medicare |
$405.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: ASR ASR |
$502.46
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$427.09
|
| Rate for Payer: BCN Commercial |
$427.09
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cofinity Commercial |
$486.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$502.46
|
| Rate for Payer: Healthscope Whirlpool |
$518.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$405.05
|
| Rate for Payer: Mclaren Commercial |
$466.20
|
| Rate for Payer: Mclaren Medicaid |
$405.05
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$222.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.30
|
| Rate for Payer: Nomi Health Commercial |
$424.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$388.50
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$445.56
|
| Rate for Payer: PHP Medicaid |
$217.11
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$527.80
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health Narrow Network |
$422.24
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP DNSP |
$405.05
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
12032
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$388.50 |
| Max. Negotiated Rate |
$518.00 |
| Rate for Payer: Aetna Commercial |
$466.20
|
| Rate for Payer: ASR ASR |
$502.46
|
| Rate for Payer: BCBS Trust/PPO |
$425.38
|
| Rate for Payer: BCN Commercial |
$425.38
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cofinity Commercial |
$486.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.40
|
| Rate for Payer: Healthscope Commercial |
$502.46
|
| Rate for Payer: Healthscope Whirlpool |
$518.00
|
| Rate for Payer: Mclaren Commercial |
$466.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.30
|
| Rate for Payer: Nomi Health Commercial |
$424.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$388.50
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Professional
|
Both
|
$518.00
|
|
|
Service Code
|
HCPCS 12032
|
| Min. Negotiated Rate |
$105.22 |
| Max. Negotiated Rate |
$388.50 |
| Rate for Payer: Aetna Commercial |
$213.96
|
| Rate for Payer: Aetna Medicare |
$159.67
|
| Rate for Payer: BCBS Complete |
$110.48
|
| Rate for Payer: BCBS MAPPO |
$159.67
|
| Rate for Payer: BCN Commercial |
$225.80
|
| Rate for Payer: BCN Medicare Advantage |
$159.67
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cofinity Commercial |
$229.92
|
| Rate for Payer: Cofinity Commercial |
$213.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.67
|
| Rate for Payer: Healthscope Commercial |
$191.60
|
| Rate for Payer: Healthscope Whirlpool |
$191.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.65
|
| Rate for Payer: Meridian Medicaid |
$110.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$175.64
|
| Rate for Payer: Nomi Health Commercial |
$191.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$388.50
|
| Rate for Payer: PACE SWMI |
$159.67
|
| Rate for Payer: PHP Medicare Advantage |
$159.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$262.07
|
| Rate for Payer: Priority Health Medicare |
$159.67
|
| Rate for Payer: Priority Health Narrow Network |
$262.07
|
| Rate for Payer: Railroad Medicare Medicare |
$159.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$328.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$159.67
|
| Rate for Payer: UHC Exchange |
$328.60
|
| Rate for Payer: UHC Medicaid |
$105.22
|
| Rate for Payer: UHCCP DNSP |
$159.67
|
| Rate for Payer: UHCCP Medicaid |
$105.22
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E >30.0 CM
|
Professional
|
Both
|
$781.00
|
|
|
Service Code
|
HCPCS 12037
|
| Min. Negotiated Rate |
$196.17 |
| Max. Negotiated Rate |
$585.75 |
| Rate for Payer: Aetna Commercial |
$405.70
|
| Rate for Payer: Aetna Medicare |
$302.76
|
| Rate for Payer: BCBS Complete |
$205.98
|
| Rate for Payer: BCBS MAPPO |
$302.76
|
| Rate for Payer: BCN Commercial |
$388.38
|
| Rate for Payer: BCN Medicare Advantage |
$302.76
|
| Rate for Payer: Cash Price |
$624.80
|
| Rate for Payer: Cash Price |
$624.80
|
| Rate for Payer: Cofinity Commercial |
$435.97
|
| Rate for Payer: Cofinity Commercial |
$405.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$302.76
|
| Rate for Payer: Healthscope Commercial |
$363.31
|
| Rate for Payer: Healthscope Whirlpool |
$363.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$317.90
|
| Rate for Payer: Meridian Medicaid |
$205.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$333.04
|
| Rate for Payer: Nomi Health Commercial |
$363.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$585.75
|
| Rate for Payer: PACE SWMI |
$302.76
|
| Rate for Payer: PHP Medicare Advantage |
$302.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$196.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$450.77
|
| Rate for Payer: Priority Health Medicare |
$302.76
|
| Rate for Payer: Priority Health Narrow Network |
$450.77
|
| Rate for Payer: Railroad Medicare Medicare |
$302.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$579.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$302.76
|
| Rate for Payer: UHC Exchange |
$579.65
|
| Rate for Payer: UHC Medicaid |
$196.17
|
| Rate for Payer: UHCCP DNSP |
$302.76
|
| Rate for Payer: UHCCP Medicaid |
$196.17
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
12034
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Aetna Commercial |
$594.00
|
| Rate for Payer: Aetna Medicare |
$405.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: ASR ASR |
$640.20
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$544.17
|
| Rate for Payer: BCN Commercial |
$544.17
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cofinity Commercial |
$620.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$528.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$640.20
|
| Rate for Payer: Healthscope Whirlpool |
$660.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$405.05
|
| Rate for Payer: Mclaren Commercial |
$594.00
|
| Rate for Payer: Mclaren Medicaid |
$405.05
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$222.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$561.00
|
| Rate for Payer: Nomi Health Commercial |
$541.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$495.00
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$445.56
|
| Rate for Payer: PHP Medicaid |
$217.11
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$293.24
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health Narrow Network |
$234.60
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP DNSP |
$405.05
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
12034
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$495.00 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Aetna Commercial |
$594.00
|
| Rate for Payer: ASR ASR |
$640.20
|
| Rate for Payer: BCBS Trust/PPO |
$541.99
|
| Rate for Payer: BCN Commercial |
$541.99
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cofinity Commercial |
$620.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$528.00
|
| Rate for Payer: Healthscope Commercial |
$640.20
|
| Rate for Payer: Healthscope Whirlpool |
$660.00
|
| Rate for Payer: Mclaren Commercial |
$594.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$561.00
|
| Rate for Payer: Nomi Health Commercial |
$541.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$495.00
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 12034
|
| Min. Negotiated Rate |
$114.81 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna Commercial |
$235.32
|
| Rate for Payer: Aetna Medicare |
$175.61
|
| Rate for Payer: BCBS Complete |
$120.55
|
| Rate for Payer: BCBS MAPPO |
$175.61
|
| Rate for Payer: BCN Commercial |
$243.08
|
| Rate for Payer: BCN Medicare Advantage |
$175.61
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cofinity Commercial |
$252.88
|
| Rate for Payer: Cofinity Commercial |
$235.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.61
|
| Rate for Payer: Healthscope Commercial |
$210.73
|
| Rate for Payer: Healthscope Whirlpool |
$210.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$184.39
|
| Rate for Payer: Meridian Medicaid |
$120.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$193.17
|
| Rate for Payer: Nomi Health Commercial |
$210.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$495.00
|
| Rate for Payer: PACE SWMI |
$175.61
|
| Rate for Payer: PHP Medicare Advantage |
$175.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$282.12
|
| Rate for Payer: Priority Health Medicare |
$175.61
|
| Rate for Payer: Priority Health Narrow Network |
$282.12
|
| Rate for Payer: Railroad Medicare Medicare |
$175.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$357.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$175.61
|
| Rate for Payer: UHC Exchange |
$357.59
|
| Rate for Payer: UHC Medicaid |
$114.81
|
| Rate for Payer: UHCCP DNSP |
$175.61
|
| Rate for Payer: UHCCP Medicaid |
$114.81
|
|
