|
PR REPAIR FIBULA NONUNION/MALUNION W/INT FIXATION
|
Professional
|
Both
|
$4,033.00
|
|
|
Service Code
|
HCPCS 27726
|
| Min. Negotiated Rate |
$621.32 |
| Max. Negotiated Rate |
$2,621.45 |
| Rate for Payer: Aetna Commercial |
$1,282.82
|
| Rate for Payer: Aetna Medicare |
$2,016.50
|
| Rate for Payer: BCBS Complete |
$652.39
|
| Rate for Payer: BCBS Trust/PPO |
$746.49
|
| Rate for Payer: BCN Commercial |
$1,403.48
|
| Rate for Payer: Cash Price |
$3,226.40
|
| Rate for Payer: Cash Price |
$3,226.40
|
| Rate for Payer: Meridian Medicaid |
$652.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$621.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,621.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,468.06
|
| Rate for Payer: Priority Health Narrow Network |
$1,468.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,096.20
|
| Rate for Payer: UHC Exchange |
$1,096.20
|
| Rate for Payer: UHCCP Medicaid |
$621.32
|
|
|
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 |
$299.48 |
| Max. Negotiated Rate |
$963.95 |
| Rate for Payer: Aetna Commercial |
$589.31
|
| Rate for Payer: Aetna Medicare |
$741.50
|
| Rate for Payer: BCBS Complete |
$314.45
|
| Rate for Payer: BCBS Trust/PPO |
$804.60
|
| Rate for Payer: BCN Commercial |
$894.28
|
| Rate for Payer: Cash Price |
$1,186.40
|
| Rate for Payer: Cash Price |
$1,186.40
|
| Rate for Payer: Meridian Medicaid |
$314.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$299.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$963.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$641.44
|
| Rate for Payer: Priority Health Narrow Network |
$641.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$544.26
|
| Rate for Payer: UHC Exchange |
$544.26
|
| Rate for Payer: UHCCP Medicaid |
$299.48
|
|
|
PR REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 27658
|
| Min. Negotiated Rate |
$212.38 |
| Max. Negotiated Rate |
$845.65 |
| Rate for Payer: Aetna Commercial |
$490.73
|
| Rate for Payer: Aetna Medicare |
$650.50
|
| Rate for Payer: BCBS Complete |
$254.51
|
| Rate for Payer: BCBS Trust/PPO |
$212.38
|
| Rate for Payer: BCN Commercial |
$542.92
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Meridian Medicaid |
$254.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$242.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$845.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$571.96
|
| Rate for Payer: Priority Health Narrow Network |
$571.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$433.92
|
| Rate for Payer: UHC Exchange |
$433.92
|
| Rate for Payer: UHCCP Medicaid |
$242.39
|
|
|
PR REPAIR INCOMPLETE CIRCUMCISION
|
Professional
|
Both
|
$409.00
|
|
|
Service Code
|
HCPCS 54163
|
| Min. Negotiated Rate |
$141.86 |
| Max. Negotiated Rate |
$452.22 |
| Rate for Payer: Aetna Commercial |
$277.43
|
| Rate for Payer: Aetna Medicare |
$204.50
|
| Rate for Payer: BCBS Complete |
$148.95
|
| Rate for Payer: BCBS Trust/PPO |
$452.22
|
| Rate for Payer: BCN Commercial |
$317.15
|
| Rate for Payer: Cash Price |
$327.20
|
| Rate for Payer: Cash Price |
$327.20
|
| Rate for Payer: Meridian Medicaid |
$148.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$141.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$352.05
|
| Rate for Payer: Priority Health Narrow Network |
$352.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$259.90
|
| Rate for Payer: UHC Exchange |
$259.90
|
| Rate for Payer: UHCCP Medicaid |
$141.86
|
|
|
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 |
$193.62 |
| Max. Negotiated Rate |
$747.19 |
| Rate for Payer: Aetna Commercial |
$322.34
|
| Rate for Payer: Aetna Medicare |
$508.50
|
| Rate for Payer: BCBS Complete |
$203.30
|
| Rate for Payer: BCBS Trust/PPO |
$364.91
|
| Rate for Payer: BCN Commercial |
$747.19
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Meridian Medicaid |
$203.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$661.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$408.62
|
| Rate for Payer: Priority Health Narrow Network |
$408.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$293.99
|
| Rate for Payer: UHC Exchange |
$293.99
|
| Rate for Payer: UHCCP Medicaid |
$193.62
|
|
|
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 |
$108.63 |
| Max. Negotiated Rate |
$417.33 |
| Rate for Payer: Aetna Commercial |
$180.03
|
| Rate for Payer: Aetna Medicare |
$222.50
|
| Rate for Payer: BCBS Complete |
$114.06
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$417.33
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Meridian Medicaid |
$114.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.37
|
| Rate for Payer: Priority Health Narrow Network |
$229.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.04
|
| Rate for Payer: UHC Exchange |
$191.04
|
| Rate for Payer: UHCCP Medicaid |
$108.63
|
|
|
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/<
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 12051
|
| Min. Negotiated Rate |
$108.63 |
| Max. Negotiated Rate |
$417.33 |
| Rate for Payer: Aetna Commercial |
$180.03
|
| Rate for Payer: Aetna Medicare |
$222.50
|
| Rate for Payer: BCBS Complete |
$114.06
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$417.33
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Meridian Medicaid |
$114.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.37
|
| Rate for Payer: Priority Health Narrow Network |
$229.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.04
|
| Rate for Payer: UHC Exchange |
$191.04
|
| Rate for Payer: UHCCP Medicaid |
$108.63
|
|
|
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 |
$209.82 |
| Max. Negotiated Rate |
$606.75 |
| Rate for Payer: Aetna Commercial |
$400.50
|
| Rate for Payer: Aetna Medicare |
$391.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: ASR ASR |
$431.65
|
| Rate for Payer: ASR Commercial |
$431.65
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$364.41
|
| Rate for Payer: BCN Commercial |
$345.01
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| 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 |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$445.00
|
| Rate for Payer: Healthscope Whirlpool |
$431.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.45
|
| Rate for Payer: Mclaren Commercial |
$400.50
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.25
|
| Rate for Payer: Nomi Health Commercial |
$364.90
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$430.60
|
| Rate for Payer: PHP Medicaid |
$209.82
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$478.73
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$382.98
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$391.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$606.75
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP DNSP |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
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 |
$209.82 |
| Max. Negotiated Rate |
$606.75 |
| Rate for Payer: Aetna Commercial |
$504.00
|
| Rate for Payer: Aetna Medicare |
$391.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: ASR ASR |
$543.20
|
| Rate for Payer: ASR Commercial |
$543.20
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$458.58
|
| Rate for Payer: BCN Commercial |
$434.17
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| 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 |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$560.00
|
| Rate for Payer: Healthscope Whirlpool |
$543.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.45
|
| Rate for Payer: Mclaren Commercial |
$504.00
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$476.00
|
| Rate for Payer: Nomi Health Commercial |
$459.20
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$430.60
|
| Rate for Payer: PHP Medicaid |
$209.82
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$265.98
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$212.78
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$492.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$606.75
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP DNSP |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
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 |
$128.23 |
| Max. Negotiated Rate |
$464.25 |
| Rate for Payer: Aetna Commercial |
$213.15
|
| Rate for Payer: Aetna Medicare |
$280.00
|
| Rate for Payer: BCBS Complete |
$134.64
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$464.25
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Meridian Medicaid |
$134.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$269.56
|
| Rate for Payer: Priority Health Narrow Network |
$269.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.02
|
| Rate for Payer: UHC Exchange |
$226.02
|
| Rate for Payer: UHCCP Medicaid |
$128.23
|
|
|
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 |
$128.23 |
| Max. Negotiated Rate |
$464.25 |
| Rate for Payer: Aetna Commercial |
$213.15
|
| Rate for Payer: Aetna Medicare |
$280.00
|
| Rate for Payer: BCBS Complete |
$134.64
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$464.25
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Meridian Medicaid |
$134.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$269.56
|
| Rate for Payer: Priority Health Narrow Network |
$269.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.02
|
| Rate for Payer: UHC Exchange |
$226.02
|
| Rate for Payer: UHCCP Medicaid |
$128.23
|
|
|
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 5.1-7.5 CM
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
12053
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$209.82 |
| Max. Negotiated Rate |
$634.00 |
| Rate for Payer: Aetna Commercial |
$570.60
|
| Rate for Payer: Aetna Medicare |
$391.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: ASR ASR |
$614.98
|
| Rate for Payer: ASR Commercial |
$614.98
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$519.18
|
| Rate for Payer: BCN Commercial |
$491.54
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| 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 |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$634.00
|
| Rate for Payer: Healthscope Whirlpool |
$614.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.45
|
| Rate for Payer: Mclaren Commercial |
$570.60
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$538.90
|
| Rate for Payer: Nomi Health Commercial |
$519.88
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$430.60
|
| Rate for Payer: PHP Medicaid |
$209.82
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$265.98
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$212.78
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$557.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$606.75
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP DNSP |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Professional
|
Both
|
$634.00
|
|
|
Service Code
|
HCPCS 12053
|
| Min. Negotiated Rate |
$138.24 |
| Max. Negotiated Rate |
$535.59 |
| Rate for Payer: Aetna Commercial |
$230.84
|
| Rate for Payer: Aetna Medicare |
$317.00
|
| Rate for Payer: BCBS Complete |
$145.15
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$535.59
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Meridian Medicaid |
$145.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$290.77
|
| Rate for Payer: Priority Health Narrow Network |
$290.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.33
|
| Rate for Payer: UHC Exchange |
$228.33
|
| Rate for Payer: UHCCP Medicaid |
$138.24
|
|
|
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 |
$138.24 |
| Max. Negotiated Rate |
$535.59 |
| Rate for Payer: Aetna Commercial |
$230.84
|
| Rate for Payer: Aetna Medicare |
$317.00
|
| Rate for Payer: BCBS Complete |
$145.15
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$535.59
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Meridian Medicaid |
$145.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$290.77
|
| Rate for Payer: Priority Health Narrow Network |
$290.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.33
|
| Rate for Payer: UHC Exchange |
$228.33
|
| Rate for Payer: UHCCP Medicaid |
$138.24
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
12054
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$209.82 |
| Max. Negotiated Rate |
$796.00 |
| Rate for Payer: Aetna Commercial |
$716.40
|
| Rate for Payer: Aetna Medicare |
$391.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: ASR ASR |
$772.12
|
| Rate for Payer: ASR Commercial |
$772.12
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$651.84
|
| Rate for Payer: BCN Commercial |
$617.14
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cofinity Commercial |
$748.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$796.00
|
| Rate for Payer: Healthscope Whirlpool |
$772.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.45
|
| Rate for Payer: Mclaren Commercial |
$716.40
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$676.60
|
| Rate for Payer: Nomi Health Commercial |
$652.72
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$430.60
|
| Rate for Payer: PHP Medicaid |
$209.82
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$265.98
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$212.78
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$700.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$606.75
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP DNSP |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Professional
|
Both
|
$796.00
|
|
|
Service Code
|
HCPCS 12054
|
| Hospital Charge Code |
12054
|
| Min. Negotiated Rate |
$141.22 |
| Max. Negotiated Rate |
$566.38 |
| Rate for Payer: Aetna Commercial |
$235.75
|
| Rate for Payer: Aetna Medicare |
$398.00
|
| Rate for Payer: BCBS Complete |
$148.28
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$566.38
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Meridian Medicaid |
$148.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$141.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$297.54
|
| Rate for Payer: Priority Health Narrow Network |
$297.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.40
|
| Rate for Payer: UHC Exchange |
$242.40
|
| Rate for Payer: UHCCP Medicaid |
$141.22
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Professional
|
Both
|
$796.00
|
|
|
Service Code
|
HCPCS 12054
|
| Min. Negotiated Rate |
$141.22 |
| Max. Negotiated Rate |
$566.38 |
| Rate for Payer: Aetna Commercial |
$235.75
|
| Rate for Payer: Aetna Medicare |
$398.00
|
| Rate for Payer: BCBS Complete |
$148.28
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$566.38
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Meridian Medicaid |
$148.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$141.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$297.54
|
| Rate for Payer: Priority Health Narrow Network |
$297.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.40
|
| Rate for Payer: UHC Exchange |
$242.40
|
| Rate for Payer: UHCCP Medicaid |
$141.22
|
|
|
PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
12054
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$517.40 |
| Max. Negotiated Rate |
$796.00 |
| Rate for Payer: Aetna Commercial |
$716.40
|
| Rate for Payer: ASR ASR |
$772.12
|
| Rate for Payer: ASR Commercial |
$772.12
|
| Rate for Payer: BCBS Trust/PPO |
$648.66
|
| Rate for Payer: BCN Commercial |
$617.14
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cofinity Commercial |
$748.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.80
|
| Rate for Payer: Healthscope Commercial |
$796.00
|
| Rate for Payer: Healthscope Whirlpool |
$772.12
|
| Rate for Payer: Mclaren Commercial |
$716.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$676.60
|
| Rate for Payer: Nomi Health Commercial |
$652.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$700.48
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM
|
Professional
|
Both
|
$628.00
|
|
|
Service Code
|
HCPCS 12045
|
| Min. Negotiated Rate |
$175.30 |
| Max. Negotiated Rate |
$609.87 |
| Rate for Payer: Aetna Commercial |
$289.67
|
| Rate for Payer: Aetna Medicare |
$314.00
|
| Rate for Payer: BCBS Complete |
$184.06
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$609.87
|
| Rate for Payer: Cash Price |
$502.40
|
| Rate for Payer: Cash Price |
$502.40
|
| Rate for Payer: Meridian Medicaid |
$184.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$408.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$371.14
|
| Rate for Payer: Priority Health Narrow Network |
$371.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$258.43
|
| Rate for Payer: UHC Exchange |
$258.43
|
| Rate for Payer: UHCCP Medicaid |
$175.30
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Professional
|
Both
|
$418.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
12041
|
| Min. Negotiated Rate |
$93.72 |
| Max. Negotiated Rate |
$2,369.57 |
| Rate for Payer: Aetna Commercial |
$155.41
|
| Rate for Payer: Aetna Medicare |
$209.00
|
| Rate for Payer: BCBS Complete |
$98.41
|
| Rate for Payer: BCBS Trust/PPO |
$2,369.57
|
| Rate for Payer: BCN Commercial |
$388.50
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Meridian Medicaid |
$98.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.41
|
| Rate for Payer: Priority Health Narrow Network |
$196.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.08
|
| Rate for Payer: UHC Exchange |
$179.08
|
| Rate for Payer: UHCCP Medicaid |
$93.72
|
|
|
PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Professional
|
Both
|
$418.00
|
|
|
Service Code
|
HCPCS 12041
|
| Min. Negotiated Rate |
$93.72 |
| Max. Negotiated Rate |
$2,369.57 |
| Rate for Payer: Aetna Commercial |
$155.41
|
| Rate for Payer: Aetna Medicare |
$209.00
|
| Rate for Payer: BCBS Complete |
$98.41
|
| Rate for Payer: BCBS Trust/PPO |
$2,369.57
|
| Rate for Payer: BCN Commercial |
$388.50
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Meridian Medicaid |
$98.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.41
|
| Rate for Payer: Priority Health Narrow Network |
$196.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.08
|
| Rate for Payer: UHC Exchange |
$179.08
|
| Rate for Payer: UHCCP Medicaid |
$93.72
|
|
