What is the top of the local market (P90) for CPT 12001 under Florida Blue for Grand Rapids-Wyoming-Kentwood, MI providers?

The P90, the top of the local market and Reddenda's target rate, is $207.50.

How does Florida Blue's rate for CPT 12001 compare to Medicare?

The Florida Blue local median of $196.70 is 173% of Medicare's national non-facility rate of $113.90 for CPT 12001.

Reddenda · Rate Intelligence · Grand Rapids-Wyoming-Kentwood, MI

12001 under Florida Blue, for Grand Rapids-Wyoming-Kentwood, MI providers

Name: Florida Blue rates for CPT 12001 among Grand Rapids-Wyoming-Kentwood, MI providers
Creator: Reddenda

Simple wound repair, ≤2.5cm · Local peer median $196.70 · Medium confidence

$196.70 local peer median. Florida Blue's published rate file lists a local peer median of $196.70 for CPT 12001 (Simple wound repair, ≤2.5cm) among 20 indexed providers in Grand Rapids-Wyoming-Kentwood, MI. Where a Blue Cross entity’s label carries a state, that state names the file we found the rate in, not the provider’s location. Blue Cross plans file separately per state and do not share rates, even for the same provider. The top of that filed distribution, the P90 target, is $207.50, 5% above the median. A provider billed below this median is being paid less than peers holding the identical Florida Blue contract for the identical code. Modeled from published rates, not guaranteed.

Local distribution · 20 providers · 20 rate records

P10

$39.39

P25

$171.72

Median

$196.70

P75

$201.15

P90 (target)

$207.50

P10$39.39

P25$171.72

Median (P50)$196.70

P75$201.15

P90 target$207.50

Peer basis: local peer distribution: same CPT, same payer file, same metro (CBSA) Benchmark: local peer median; never a national average Range: $39.39 – $207.50

The local peer median for CPT 12001 under Florida Blue for Grand Rapids-Wyoming-Kentwood, MI providers is $196.70, drawn from 20 distinct providers.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Florida Blue to publish this rate
The bottom of the local market (P10) is $39.39 and the top (P90) is $207.50; the median-to-P90 spread is $10.80.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Florida Blue to publish this rate
The lowest published rate in this market is $39.39; the highest is $207.50.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Florida Blue to publish this rate
This benchmark is drawn from 20 individual rate records that Florida Blue itself published for this code in this metro.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Florida Blue to publish this rate
Medicare's national non-facility rate for CPT 12001 is $113.90, making the Florida Blue local median 173% of Medicare.Source: Medicare Physician Fee Schedule; the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Florida Blue to publish this rate
25% of indexed providers cluster at the single most common rate; the remainder shows a real, scoreable spread across the local market.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Florida Blue to publish this rate
A federal No Surprises Act arbitrator may weigh up to four plan years of a provider's own contracted rate history and local market share when resolving a payment dispute over this exact code and payer.Source: 45 CFR §149.510(c)(4)(iii)(B)

20 providers bill this code to this payer in this metro.

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These are the rates Florida Blue publishes for CPT 12001 (Simple wound repair, ≤2.5cm) among Grand Rapids-Wyoming-Kentwood, MI providers. Enter your NPI to see your own contracted rate against this peer curve, per payer and per code. Free, about 15 seconds, no card and no PHI.

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Documented reimbursement opportunity, modeled from published rates and never a guaranteed outcome.

Modeled from Florida Blue's own published in-network rates, never guaranteed and never a national average. Peer basis: same CPT, same payer file, same metro (CBSA). Federal citation for the underlying obligation: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Florida Blue to publish this rate. Page generated 2026-08-23 23:42 UTC; the live index is queried in real time on every request.