|
PR REPAIR ENTEROCELE VAGINAL APPROACH SPX
|
Professional
|
Both
|
$1,530.00
|
|
|
Service Code
|
HCPCS 57268
|
| Min. Negotiated Rate |
$482.90 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Aetna Commercial |
$647.09
|
| Rate for Payer: Aetna Medicare |
$482.90
|
| Rate for Payer: BCBS Complete |
$612.00
|
| Rate for Payer: BCBS MAPPO |
$482.90
|
| Rate for Payer: BCN Medicare Advantage |
$482.90
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cofinity Commercial |
$695.38
|
| Rate for Payer: Cofinity Commercial |
$647.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$482.90
|
| Rate for Payer: Healthscope Commercial |
$579.48
|
| Rate for Payer: Healthscope Whirlpool |
$579.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$507.05
|
| Rate for Payer: Nomi Health Commercial |
$579.48
|
| Rate for Payer: PACE SWMI |
$482.90
|
| Rate for Payer: PHP Medicare Advantage |
$482.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.50
|
| Rate for Payer: Priority Health Medicare |
$482.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$482.90
|
| Rate for Payer: UHC Medicare Advantage |
$482.90
|
| Rate for Payer: UHCCP DNSP |
$482.90
|
|
|
PR REPAIR ENTROPION SUTURE
|
Professional
|
Both
|
$674.00
|
|
|
Service Code
|
HCPCS 67921
|
| Min. Negotiated Rate |
$269.60 |
| Max. Negotiated Rate |
$438.10 |
| Rate for Payer: Aetna Commercial |
$385.37
|
| Rate for Payer: Aetna Medicare |
$287.59
|
| Rate for Payer: BCBS Complete |
$269.60
|
| Rate for Payer: BCBS MAPPO |
$287.59
|
| Rate for Payer: BCN Medicare Advantage |
$287.59
|
| Rate for Payer: Cash Price |
$539.20
|
| Rate for Payer: Cash Price |
$539.20
|
| Rate for Payer: Cofinity Commercial |
$414.13
|
| Rate for Payer: Cofinity Commercial |
$385.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.59
|
| Rate for Payer: Healthscope Commercial |
$345.11
|
| Rate for Payer: Healthscope Whirlpool |
$345.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$301.97
|
| Rate for Payer: Nomi Health Commercial |
$345.11
|
| Rate for Payer: PACE SWMI |
$287.59
|
| Rate for Payer: PHP Medicare Advantage |
$287.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.10
|
| Rate for Payer: Priority Health Medicare |
$287.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.59
|
| Rate for Payer: UHC Medicare Advantage |
$287.59
|
| Rate for Payer: UHCCP DNSP |
$287.59
|
|
|
PR REPAIR EXTENSOR TENDON DISTAL INSERTION W/O GRF
|
Professional
|
Both
|
$1,388.00
|
|
|
Service Code
|
HCPCS 26433
|
| Min. Negotiated Rate |
$530.19 |
| Max. Negotiated Rate |
$902.20 |
| Rate for Payer: Aetna Commercial |
$710.45
|
| Rate for Payer: Aetna Medicare |
$530.19
|
| Rate for Payer: BCBS Complete |
$555.20
|
| Rate for Payer: BCBS MAPPO |
$530.19
|
| Rate for Payer: BCN Medicare Advantage |
$530.19
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cofinity Commercial |
$763.47
|
| Rate for Payer: Cofinity Commercial |
$710.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$530.19
|
| Rate for Payer: Healthscope Commercial |
$636.23
|
| Rate for Payer: Healthscope Whirlpool |
$636.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$556.70
|
| Rate for Payer: Nomi Health Commercial |
$636.23
|
| Rate for Payer: PACE SWMI |
$530.19
|
| Rate for Payer: PHP Medicare Advantage |
$530.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.20
|
| Rate for Payer: Priority Health Medicare |
$530.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$530.19
|
| Rate for Payer: UHC Medicare Advantage |
$530.19
|
| Rate for Payer: UHCCP DNSP |
$530.19
|
|
|
PR REPAIR EXTENSOR TENDON FINGER W/GRAFT EACH
|
Professional
|
Both
|
$1,788.00
|
|
|
Service Code
|
HCPCS 26420
|
| Min. Negotiated Rate |
$690.78 |
| Max. Negotiated Rate |
$1,162.20 |
| Rate for Payer: Aetna Commercial |
$925.65
|
| Rate for Payer: Aetna Medicare |
$690.78
|
| Rate for Payer: BCBS Complete |
$715.20
|
| Rate for Payer: BCBS MAPPO |
$690.78
|
| Rate for Payer: BCN Medicare Advantage |
$690.78
|
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Cofinity Commercial |
$994.72
|
| Rate for Payer: Cofinity Commercial |
$925.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$690.78
|
| Rate for Payer: Healthscope Commercial |
$828.94
|
| Rate for Payer: Healthscope Whirlpool |
$828.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$725.32
|
| Rate for Payer: Nomi Health Commercial |
$828.94
|
| Rate for Payer: PACE SWMI |
$690.78
|
| Rate for Payer: PHP Medicare Advantage |
$690.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,162.20
|
| Rate for Payer: Priority Health Medicare |
$690.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$690.78
|
| Rate for Payer: UHC Medicare Advantage |
$690.78
|
| Rate for Payer: UHCCP DNSP |
$690.78
|
|
|
PR REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH
|
Professional
|
Both
|
$1,309.00
|
|
|
Service Code
|
HCPCS 26418
|
| Min. Negotiated Rate |
$523.60 |
| Max. Negotiated Rate |
$850.85 |
| Rate for Payer: Aetna Commercial |
$772.68
|
| Rate for Payer: Aetna Medicare |
$576.63
|
| Rate for Payer: BCBS Complete |
$523.60
|
| Rate for Payer: BCBS MAPPO |
$576.63
|
| Rate for Payer: BCN Medicare Advantage |
$576.63
|
| Rate for Payer: Cash Price |
$1,047.20
|
| Rate for Payer: Cash Price |
$1,047.20
|
| Rate for Payer: Cofinity Commercial |
$830.35
|
| Rate for Payer: Cofinity Commercial |
$772.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$576.63
|
| Rate for Payer: Healthscope Commercial |
$691.96
|
| Rate for Payer: Healthscope Whirlpool |
$691.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$605.46
|
| Rate for Payer: Nomi Health Commercial |
$691.96
|
| Rate for Payer: PACE SWMI |
$576.63
|
| Rate for Payer: PHP Medicare Advantage |
$576.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.85
|
| Rate for Payer: Priority Health Medicare |
$576.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$576.63
|
| Rate for Payer: UHC Medicare Advantage |
$576.63
|
| Rate for Payer: UHCCP DNSP |
$576.63
|
|
|
PR REPAIR EXTENSOR TENDON HAND W/GRAFT EACH
|
Professional
|
Both
|
$1,933.00
|
|
|
Service Code
|
HCPCS 26412
|
| Min. Negotiated Rate |
$665.88 |
| Max. Negotiated Rate |
$1,256.45 |
| Rate for Payer: Aetna Commercial |
$892.28
|
| Rate for Payer: Aetna Medicare |
$665.88
|
| Rate for Payer: BCBS Complete |
$773.20
|
| Rate for Payer: BCBS MAPPO |
$665.88
|
| Rate for Payer: BCN Medicare Advantage |
$665.88
|
| Rate for Payer: Cash Price |
$1,546.40
|
| Rate for Payer: Cash Price |
$1,546.40
|
| Rate for Payer: Cofinity Commercial |
$958.87
|
| Rate for Payer: Cofinity Commercial |
$892.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$665.88
|
| Rate for Payer: Healthscope Commercial |
$799.06
|
| Rate for Payer: Healthscope Whirlpool |
$799.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$699.17
|
| Rate for Payer: Nomi Health Commercial |
$799.06
|
| Rate for Payer: PACE SWMI |
$665.88
|
| Rate for Payer: PHP Medicare Advantage |
$665.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,256.45
|
| Rate for Payer: Priority Health Medicare |
$665.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$665.88
|
| Rate for Payer: UHC Medicare Advantage |
$665.88
|
| Rate for Payer: UHCCP DNSP |
$665.88
|
|
|
PR REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH
|
Professional
|
Both
|
$1,257.00
|
|
|
Service Code
|
HCPCS 26410
|
| Min. Negotiated Rate |
$502.80 |
| Max. Negotiated Rate |
$817.05 |
| Rate for Payer: Aetna Commercial |
$745.98
|
| Rate for Payer: Aetna Medicare |
$556.70
|
| Rate for Payer: BCBS Complete |
$502.80
|
| Rate for Payer: BCBS MAPPO |
$556.70
|
| Rate for Payer: BCN Medicare Advantage |
$556.70
|
| Rate for Payer: Cash Price |
$1,005.60
|
| Rate for Payer: Cash Price |
$1,005.60
|
| Rate for Payer: Cofinity Commercial |
$801.65
|
| Rate for Payer: Cofinity Commercial |
$745.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$556.70
|
| Rate for Payer: Healthscope Commercial |
$668.04
|
| Rate for Payer: Healthscope Whirlpool |
$668.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$584.53
|
| Rate for Payer: Nomi Health Commercial |
$668.04
|
| Rate for Payer: PACE SWMI |
$556.70
|
| Rate for Payer: PHP Medicare Advantage |
$556.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$817.05
|
| Rate for Payer: Priority Health Medicare |
$556.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$556.70
|
| Rate for Payer: UHC Medicare Advantage |
$556.70
|
| Rate for Payer: UHCCP DNSP |
$556.70
|
|
|
PR REPAIR FASCIAL DEFECT LEG
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 27656
|
| Min. Negotiated Rate |
$324.14 |
| Max. Negotiated Rate |
$601.25 |
| Rate for Payer: Aetna Commercial |
$434.35
|
| Rate for Payer: Aetna Medicare |
$324.14
|
| Rate for Payer: BCBS Complete |
$370.00
|
| Rate for Payer: BCBS MAPPO |
$324.14
|
| Rate for Payer: BCN Medicare Advantage |
$324.14
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cofinity Commercial |
$466.76
|
| Rate for Payer: Cofinity Commercial |
$434.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.14
|
| Rate for Payer: Healthscope Commercial |
$388.97
|
| Rate for Payer: Healthscope Whirlpool |
$388.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$340.35
|
| Rate for Payer: Nomi Health Commercial |
$388.97
|
| Rate for Payer: PACE SWMI |
$324.14
|
| Rate for Payer: PHP Medicare Advantage |
$324.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.25
|
| Rate for Payer: Priority Health Medicare |
$324.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.14
|
| Rate for Payer: UHC Medicare Advantage |
$324.14
|
| Rate for Payer: UHCCP DNSP |
$324.14
|
|
|
PR REPAIR FIBULA NONUNION/MALUNION W/INT FIXATION
|
Professional
|
Both
|
$4,033.00
|
|
|
Service Code
|
HCPCS 27726
|
| Min. Negotiated Rate |
$924.08 |
| Max. Negotiated Rate |
$2,621.45 |
| Rate for Payer: Aetna Commercial |
$1,238.27
|
| Rate for Payer: Aetna Medicare |
$924.08
|
| Rate for Payer: BCBS Complete |
$1,613.20
|
| Rate for Payer: BCBS MAPPO |
$924.08
|
| Rate for Payer: BCN Medicare Advantage |
$924.08
|
| Rate for Payer: Cash Price |
$3,226.40
|
| Rate for Payer: Cash Price |
$3,226.40
|
| Rate for Payer: Cofinity Commercial |
$1,330.68
|
| Rate for Payer: Cofinity Commercial |
$1,238.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$924.08
|
| Rate for Payer: Healthscope Commercial |
$1,108.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,108.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$970.28
|
| Rate for Payer: Nomi Health Commercial |
$1,108.90
|
| Rate for Payer: PACE SWMI |
$924.08
|
| Rate for Payer: PHP Medicare Advantage |
$924.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,621.45
|
| Rate for Payer: Priority Health Medicare |
$924.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$924.08
|
| Rate for Payer: UHC Medicare Advantage |
$924.08
|
| Rate for Payer: UHCCP DNSP |
$924.08
|
|
|
PR REPAIR FIRST ABDOMINAL WALL HERNIA
|
Professional
|
Both
|
$2,106.00
|
|
|
Service Code
|
HCPCS 49560
|
| Min. Negotiated Rate |
$842.40 |
| Max. Negotiated Rate |
$1,368.90 |
| Rate for Payer: Aetna Medicare |
$1,053.00
|
| Rate for Payer: BCBS Complete |
$842.40
|
| Rate for Payer: Cash Price |
$1,684.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,368.90
|
|
|
PR REPAIR FISTULA OROMAXILLARY
|
Professional
|
Both
|
$1,483.00
|
|
|
Service Code
|
HCPCS 30580
|
| Min. Negotiated Rate |
$440.14 |
| Max. Negotiated Rate |
$963.95 |
| Rate for Payer: Aetna Commercial |
$589.79
|
| Rate for Payer: Aetna Medicare |
$440.14
|
| Rate for Payer: BCBS Complete |
$593.20
|
| Rate for Payer: BCBS MAPPO |
$440.14
|
| Rate for Payer: BCN Medicare Advantage |
$440.14
|
| Rate for Payer: Cash Price |
$1,186.40
|
| Rate for Payer: Cash Price |
$1,186.40
|
| Rate for Payer: Cofinity Commercial |
$633.80
|
| Rate for Payer: Cofinity Commercial |
$589.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$440.14
|
| Rate for Payer: Healthscope Commercial |
$528.17
|
| Rate for Payer: Healthscope Whirlpool |
$528.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$462.15
|
| Rate for Payer: Nomi Health Commercial |
$528.17
|
| Rate for Payer: PACE SWMI |
$440.14
|
| Rate for Payer: PHP Medicare Advantage |
$440.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$963.95
|
| Rate for Payer: Priority Health Medicare |
$440.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$440.14
|
| Rate for Payer: UHC Medicare Advantage |
$440.14
|
| Rate for Payer: UHCCP DNSP |
$440.14
|
|
|
PR REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 27658
|
| Min. Negotiated Rate |
$356.27 |
| Max. Negotiated Rate |
$845.65 |
| Rate for Payer: Aetna Commercial |
$477.40
|
| Rate for Payer: Aetna Medicare |
$356.27
|
| Rate for Payer: BCBS Complete |
$520.40
|
| Rate for Payer: BCBS MAPPO |
$356.27
|
| Rate for Payer: BCN Medicare Advantage |
$356.27
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cofinity Commercial |
$513.03
|
| Rate for Payer: Cofinity Commercial |
$477.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$356.27
|
| Rate for Payer: Healthscope Commercial |
$427.52
|
| Rate for Payer: Healthscope Whirlpool |
$427.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$374.08
|
| Rate for Payer: Nomi Health Commercial |
$427.52
|
| Rate for Payer: PACE SWMI |
$356.27
|
| Rate for Payer: PHP Medicare Advantage |
$356.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$845.65
|
| Rate for Payer: Priority Health Medicare |
$356.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$356.27
|
| Rate for Payer: UHC Medicare Advantage |
$356.27
|
| Rate for Payer: UHCCP DNSP |
$356.27
|
|
|
PR REPAIR INCOMPLETE CIRCUMCISION
|
Professional
|
Both
|
$409.00
|
|
|
Service Code
|
HCPCS 54163
|
| Min. Negotiated Rate |
$163.60 |
| Max. Negotiated Rate |
$301.25 |
| Rate for Payer: Aetna Commercial |
$280.33
|
| Rate for Payer: Aetna Medicare |
$209.20
|
| Rate for Payer: BCBS Complete |
$163.60
|
| Rate for Payer: BCBS MAPPO |
$209.20
|
| Rate for Payer: BCN Medicare Advantage |
$209.20
|
| Rate for Payer: Cash Price |
$327.20
|
| Rate for Payer: Cash Price |
$327.20
|
| Rate for Payer: Cofinity Commercial |
$301.25
|
| Rate for Payer: Cofinity Commercial |
$280.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.20
|
| Rate for Payer: Healthscope Commercial |
$251.04
|
| Rate for Payer: Healthscope Whirlpool |
$251.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$219.66
|
| Rate for Payer: Nomi Health Commercial |
$251.04
|
| Rate for Payer: PACE SWMI |
$209.20
|
| Rate for Payer: PHP Medicare Advantage |
$209.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.85
|
| Rate for Payer: Priority Health Medicare |
$209.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.20
|
| Rate for Payer: UHC Medicare Advantage |
$209.20
|
| Rate for Payer: UHCCP DNSP |
$209.20
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM
|
Professional
|
Both
|
$1,017.00
|
|
|
Service Code
|
HCPCS 12055
|
| Min. Negotiated Rate |
$287.77 |
| Max. Negotiated Rate |
$661.05 |
| Rate for Payer: Aetna Commercial |
$385.61
|
| Rate for Payer: Aetna Medicare |
$287.77
|
| Rate for Payer: BCBS Complete |
$406.80
|
| Rate for Payer: BCBS MAPPO |
$287.77
|
| Rate for Payer: BCN Medicare Advantage |
$287.77
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cofinity Commercial |
$414.39
|
| Rate for Payer: Cofinity Commercial |
$385.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.77
|
| Rate for Payer: Healthscope Commercial |
$345.32
|
| Rate for Payer: Healthscope Whirlpool |
$345.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.16
|
| Rate for Payer: Nomi Health Commercial |
$345.32
|
| Rate for Payer: PACE SWMI |
$287.77
|
| Rate for Payer: PHP Medicare Advantage |
$287.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$661.05
|
| Rate for Payer: Priority Health Medicare |
$287.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.77
|
| Rate for Payer: UHC Medicare Advantage |
$287.77
|
| Rate for Payer: UHCCP DNSP |
$287.77
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 12051
|
| Min. Negotiated Rate |
$159.45 |
| Max. Negotiated Rate |
$289.25 |
| Rate for Payer: Aetna Commercial |
$213.66
|
| Rate for Payer: Aetna Medicare |
$159.45
|
| Rate for Payer: BCBS Complete |
$178.00
|
| Rate for Payer: BCBS MAPPO |
$159.45
|
| Rate for Payer: BCN Medicare Advantage |
$159.45
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cofinity Commercial |
$229.61
|
| Rate for Payer: Cofinity Commercial |
$213.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.45
|
| Rate for Payer: Healthscope Commercial |
$191.34
|
| Rate for Payer: Healthscope Whirlpool |
$191.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.42
|
| Rate for Payer: Nomi Health Commercial |
$191.34
|
| Rate for Payer: PACE SWMI |
$159.45
|
| Rate for Payer: PHP Medicare Advantage |
$159.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.25
|
| Rate for Payer: Priority Health Medicare |
$159.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$159.45
|
| Rate for Payer: UHC Medicare Advantage |
$159.45
|
| Rate for Payer: UHCCP DNSP |
$159.45
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
12051
|
| Min. Negotiated Rate |
$159.45 |
| Max. Negotiated Rate |
$289.25 |
| Rate for Payer: Aetna Commercial |
$213.66
|
| Rate for Payer: Aetna Medicare |
$159.45
|
| Rate for Payer: BCBS Complete |
$178.00
|
| Rate for Payer: BCBS MAPPO |
$159.45
|
| Rate for Payer: BCN Medicare Advantage |
$159.45
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cofinity Commercial |
$229.61
|
| Rate for Payer: Cofinity Commercial |
$213.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.45
|
| Rate for Payer: Healthscope Commercial |
$191.34
|
| Rate for Payer: Healthscope Whirlpool |
$191.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.42
|
| Rate for Payer: Nomi Health Commercial |
$191.34
|
| Rate for Payer: PACE SWMI |
$159.45
|
| Rate for Payer: PHP Medicare Advantage |
$159.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.25
|
| Rate for Payer: Priority Health Medicare |
$159.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$159.45
|
| Rate for Payer: UHC Medicare Advantage |
$159.45
|
| Rate for Payer: UHCCP DNSP |
$159.45
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
12051
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$289.25 |
| Max. Negotiated Rate |
$445.00 |
| Rate for Payer: Aetna Commercial |
$400.50
|
| Rate for Payer: ASR ASR |
$431.65
|
| Rate for Payer: ASR Commercial |
$431.65
|
| Rate for Payer: BCBS Trust/PPO |
$362.63
|
| Rate for Payer: BCN Commercial |
$345.01
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cofinity Commercial |
$418.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.00
|
| Rate for Payer: Healthscope Commercial |
$445.00
|
| Rate for Payer: Healthscope Whirlpool |
$431.65
|
| Rate for Payer: Mclaren Commercial |
$400.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.25
|
| Rate for Payer: Nomi Health Commercial |
$364.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$391.60
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
12051
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$603.96 |
| Rate for Payer: Aetna Commercial |
$400.50
|
| Rate for Payer: Aetna Medicare |
$389.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: ASR ASR |
$431.65
|
| Rate for Payer: ASR Commercial |
$431.65
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCBS Trust/PPO |
$364.41
|
| Rate for Payer: BCN Commercial |
$345.01
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cofinity Commercial |
$418.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$445.00
|
| Rate for Payer: Healthscope Whirlpool |
$431.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$389.65
|
| Rate for Payer: Mclaren Commercial |
$400.50
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.25
|
| Rate for Payer: Nomi Health Commercial |
$364.90
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$428.62
|
| Rate for Payer: PHP Medicaid |
$208.85
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$389.91
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health Narrow Network |
$311.94
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$391.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$603.96
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP DNSP |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: VA VA |
$389.65
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
12052
|
| Min. Negotiated Rate |
$188.62 |
| Max. Negotiated Rate |
$364.00 |
| Rate for Payer: Aetna Commercial |
$252.75
|
| Rate for Payer: Aetna Medicare |
$188.62
|
| Rate for Payer: BCBS Complete |
$224.00
|
| Rate for Payer: BCBS MAPPO |
$188.62
|
| Rate for Payer: BCN Medicare Advantage |
$188.62
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cofinity Commercial |
$271.61
|
| Rate for Payer: Cofinity Commercial |
$252.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.62
|
| Rate for Payer: Healthscope Commercial |
$226.34
|
| Rate for Payer: Healthscope Whirlpool |
$226.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.05
|
| Rate for Payer: Nomi Health Commercial |
$226.34
|
| Rate for Payer: PACE SWMI |
$188.62
|
| Rate for Payer: PHP Medicare Advantage |
$188.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.00
|
| Rate for Payer: Priority Health Medicare |
$188.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$188.62
|
| Rate for Payer: UHC Medicare Advantage |
$188.62
|
| Rate for Payer: UHCCP DNSP |
$188.62
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
HCPCS 12052
|
| Min. Negotiated Rate |
$188.62 |
| Max. Negotiated Rate |
$364.00 |
| Rate for Payer: Aetna Commercial |
$252.75
|
| Rate for Payer: Aetna Medicare |
$188.62
|
| Rate for Payer: BCBS Complete |
$224.00
|
| Rate for Payer: BCBS MAPPO |
$188.62
|
| Rate for Payer: BCN Medicare Advantage |
$188.62
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cofinity Commercial |
$271.61
|
| Rate for Payer: Cofinity Commercial |
$252.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.62
|
| Rate for Payer: Healthscope Commercial |
$226.34
|
| Rate for Payer: Healthscope Whirlpool |
$226.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.05
|
| Rate for Payer: Nomi Health Commercial |
$226.34
|
| Rate for Payer: PACE SWMI |
$188.62
|
| Rate for Payer: PHP Medicare Advantage |
$188.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.00
|
| Rate for Payer: Priority Health Medicare |
$188.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$188.62
|
| Rate for Payer: UHC Medicare Advantage |
$188.62
|
| Rate for Payer: UHCCP DNSP |
$188.62
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
12052
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$504.00
|
| Rate for Payer: ASR ASR |
$543.20
|
| Rate for Payer: ASR Commercial |
$543.20
|
| Rate for Payer: BCBS Trust/PPO |
$456.34
|
| Rate for Payer: BCN Commercial |
$434.17
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cofinity Commercial |
$526.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$448.00
|
| Rate for Payer: Healthscope Commercial |
$560.00
|
| Rate for Payer: Healthscope Whirlpool |
$543.20
|
| Rate for Payer: Mclaren Commercial |
$504.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$476.00
|
| Rate for Payer: Nomi Health Commercial |
$459.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$492.80
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
12052
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$603.96 |
| Rate for Payer: Aetna Commercial |
$504.00
|
| Rate for Payer: Aetna Medicare |
$389.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: ASR ASR |
$543.20
|
| Rate for Payer: ASR Commercial |
$543.20
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCBS Trust/PPO |
$458.58
|
| Rate for Payer: BCN Commercial |
$434.17
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cofinity Commercial |
$526.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$448.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$560.00
|
| Rate for Payer: Healthscope Whirlpool |
$543.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$389.65
|
| Rate for Payer: Mclaren Commercial |
$504.00
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$476.00
|
| Rate for Payer: Nomi Health Commercial |
$459.20
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$428.62
|
| Rate for Payer: PHP Medicaid |
$208.85
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$490.67
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health Narrow Network |
$392.56
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$492.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$603.96
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP DNSP |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: VA VA |
$389.65
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
12053
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$634.00 |
| Rate for Payer: Aetna Commercial |
$570.60
|
| Rate for Payer: Aetna Medicare |
$389.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: ASR ASR |
$614.98
|
| Rate for Payer: ASR Commercial |
$614.98
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCBS Trust/PPO |
$519.18
|
| Rate for Payer: BCN Commercial |
$491.54
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cofinity Commercial |
$595.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$507.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$634.00
|
| Rate for Payer: Healthscope Whirlpool |
$614.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$389.65
|
| Rate for Payer: Mclaren Commercial |
$570.60
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$538.90
|
| Rate for Payer: Nomi Health Commercial |
$519.88
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$428.62
|
| Rate for Payer: PHP Medicaid |
$208.85
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$555.51
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health Narrow Network |
$444.43
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$557.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$603.96
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP DNSP |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: VA VA |
$389.65
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
12053
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$412.10 |
| Max. Negotiated Rate |
$634.00 |
| Rate for Payer: Aetna Commercial |
$570.60
|
| Rate for Payer: ASR ASR |
$614.98
|
| Rate for Payer: ASR Commercial |
$614.98
|
| Rate for Payer: BCBS Trust/PPO |
$516.65
|
| Rate for Payer: BCN Commercial |
$491.54
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cofinity Commercial |
$595.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$507.20
|
| Rate for Payer: Healthscope Commercial |
$634.00
|
| Rate for Payer: Healthscope Whirlpool |
$614.98
|
| Rate for Payer: Mclaren Commercial |
$570.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$538.90
|
| Rate for Payer: Nomi Health Commercial |
$519.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$557.92
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Professional
|
Both
|
$634.00
|
|
|
Service Code
|
HCPCS 12053
|
| Hospital Charge Code |
12053
|
| Min. Negotiated Rate |
$203.68 |
| Max. Negotiated Rate |
$412.10 |
| Rate for Payer: Aetna Commercial |
$272.93
|
| Rate for Payer: Aetna Medicare |
$203.68
|
| Rate for Payer: BCBS Complete |
$253.60
|
| Rate for Payer: BCBS MAPPO |
$203.68
|
| Rate for Payer: BCN Medicare Advantage |
$203.68
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cofinity Commercial |
$293.30
|
| Rate for Payer: Cofinity Commercial |
$272.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$203.68
|
| Rate for Payer: Healthscope Commercial |
$244.42
|
| Rate for Payer: Healthscope Whirlpool |
$244.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$213.86
|
| Rate for Payer: Nomi Health Commercial |
$244.42
|
| Rate for Payer: PACE SWMI |
$203.68
|
| Rate for Payer: PHP Medicare Advantage |
$203.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.10
|
| Rate for Payer: Priority Health Medicare |
$203.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$203.68
|
| Rate for Payer: UHC Medicare Advantage |
$203.68
|
| Rate for Payer: UHCCP DNSP |
$203.68
|
|
