|
PR APNEALINK
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS 00020
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
|
|
PR APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX
|
Professional
|
Both
|
$848.00
|
|
|
Service Code
|
HCPCS 44955
|
| Min. Negotiated Rate |
$52.82 |
| Max. Negotiated Rate |
$593.60 |
| Rate for Payer: Aetna Commercial |
$111.33
|
| Rate for Payer: Aetna Medicare |
$86.40
|
| Rate for Payer: BCBS Complete |
$55.46
|
| Rate for Payer: BCBS MAPPO |
$83.08
|
| Rate for Payer: BCBS Trust/PPO |
$566.34
|
| Rate for Payer: BCN Commercial |
$121.19
|
| Rate for Payer: BCN Medicare Advantage |
$83.08
|
| Rate for Payer: Cash Price |
$678.40
|
| Rate for Payer: Cash Price |
$678.40
|
| Rate for Payer: Cofinity Commercial |
$119.64
|
| Rate for Payer: Cofinity Commercial |
$111.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.08
|
| Rate for Payer: Mclaren Medicaid |
$52.82
|
| Rate for Payer: Meridian Medicaid |
$55.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$87.23
|
| Rate for Payer: PACE SWMI |
$83.08
|
| Rate for Payer: PHP Medicare Advantage |
$83.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$145.82
|
| Rate for Payer: Priority Health Medicare |
$83.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.08
|
| Rate for Payer: UHC Medicare Advantage |
$85.57
|
|
|
PR APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX
|
Facility
|
IP
|
$848.00
|
|
|
Service Code
|
CPT 44955
|
| Hospital Charge Code |
44955
|
| Min. Negotiated Rate |
$517.20 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$720.80
|
| Rate for Payer: BCBS Trust/PPO |
$655.33
|
| Rate for Payer: BCN Commercial |
$655.33
|
| Rate for Payer: Cash Price |
$678.40
|
| Rate for Payer: Cofinity Commercial |
$729.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$678.40
|
| Rate for Payer: Healthscope Commercial |
$763.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$636.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$720.80
|
| Rate for Payer: PHP Commercial |
$720.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$737.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$517.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$746.24
|
| Rate for Payer: UHC Core |
$708.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$636.00
|
|
|
PR APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX
|
Facility
|
OP
|
$848.00
|
|
|
Service Code
|
CPT 44955
|
| Hospital Charge Code |
44955
|
| Min. Negotiated Rate |
$201.40 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$720.80
|
| Rate for Payer: Aetna Medicare |
$220.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$265.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$265.00
|
| Rate for Payer: BCBS Complete |
$339.20
|
| Rate for Payer: BCBS MAPPO |
$212.00
|
| Rate for Payer: BCBS Trust/PPO |
$659.32
|
| Rate for Payer: BCN Commercial |
$659.32
|
| Rate for Payer: BCN Medicare Advantage |
$212.00
|
| Rate for Payer: Cash Price |
$678.40
|
| Rate for Payer: Cofinity Commercial |
$729.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$678.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.00
|
| Rate for Payer: Healthscope Commercial |
$763.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$636.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$222.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$720.80
|
| Rate for Payer: PACE Senior Care Partners |
$201.40
|
| Rate for Payer: PACE SWMI |
$212.00
|
| Rate for Payer: PHP Commercial |
$720.80
|
| Rate for Payer: PHP Medicare Advantage |
$212.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$737.76
|
| Rate for Payer: Priority Health Medicare |
$212.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$212.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$746.24
|
| Rate for Payer: UHC Core |
$708.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$212.00
|
| Rate for Payer: UHC Medicare Advantage |
$218.36
|
| Rate for Payer: VA VA |
$212.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$636.00
|
|
|
PR APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX
|
Professional
|
Both
|
$848.00
|
|
|
Service Code
|
HCPCS 44955
|
| Hospital Charge Code |
44955
|
| Min. Negotiated Rate |
$52.82 |
| Max. Negotiated Rate |
$593.60 |
| Rate for Payer: Aetna Commercial |
$111.33
|
| Rate for Payer: Aetna Medicare |
$86.40
|
| Rate for Payer: BCBS Complete |
$55.46
|
| Rate for Payer: BCBS MAPPO |
$83.08
|
| Rate for Payer: BCBS Trust/PPO |
$566.34
|
| Rate for Payer: BCN Commercial |
$121.19
|
| Rate for Payer: BCN Medicare Advantage |
$83.08
|
| Rate for Payer: Cash Price |
$678.40
|
| Rate for Payer: Cash Price |
$678.40
|
| Rate for Payer: Cofinity Commercial |
$119.64
|
| Rate for Payer: Cofinity Commercial |
$111.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.08
|
| Rate for Payer: Mclaren Medicaid |
$52.82
|
| Rate for Payer: Meridian Medicaid |
$55.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$87.23
|
| Rate for Payer: PACE SWMI |
$83.08
|
| Rate for Payer: PHP Medicare Advantage |
$83.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$145.82
|
| Rate for Payer: Priority Health Medicare |
$83.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.08
|
| Rate for Payer: UHC Medicare Advantage |
$85.57
|
|
|
PR APPENDEC RPTD APPENDIX ABSC/PRITONITIS
|
Professional
|
Both
|
$2,095.00
|
|
|
Service Code
|
HCPCS 44960
|
| Min. Negotiated Rate |
$561.26 |
| Max. Negotiated Rate |
$1,541.66 |
| Rate for Payer: Aetna Commercial |
$1,169.70
|
| Rate for Payer: Aetna Medicare |
$907.83
|
| Rate for Payer: BCBS Complete |
$589.32
|
| Rate for Payer: BCBS MAPPO |
$872.91
|
| Rate for Payer: BCBS Trust/PPO |
$857.96
|
| Rate for Payer: BCN Commercial |
$1,281.31
|
| Rate for Payer: BCN Medicare Advantage |
$872.91
|
| Rate for Payer: Cash Price |
$1,676.00
|
| Rate for Payer: Cash Price |
$1,676.00
|
| Rate for Payer: Cofinity Commercial |
$1,169.70
|
| Rate for Payer: Cofinity Commercial |
$1,256.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.91
|
| Rate for Payer: Mclaren Medicaid |
$561.26
|
| Rate for Payer: Meridian Medicaid |
$589.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$916.56
|
| Rate for Payer: PACE SWMI |
$872.91
|
| Rate for Payer: PHP Medicare Advantage |
$872.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$561.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,466.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,541.66
|
| Rate for Payer: Priority Health Medicare |
$872.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,541.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$872.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.91
|
| Rate for Payer: UHC Medicare Advantage |
$899.10
|
|
|
PR APPENDECTOMY
|
Professional
|
Both
|
$1,704.00
|
|
|
Service Code
|
HCPCS 44950
|
| Min. Negotiated Rate |
$411.52 |
| Max. Negotiated Rate |
$1,192.80 |
| Rate for Payer: Aetna Commercial |
$856.61
|
| Rate for Payer: Aetna Medicare |
$664.83
|
| Rate for Payer: BCBS Complete |
$432.10
|
| Rate for Payer: BCBS MAPPO |
$639.26
|
| Rate for Payer: BCBS Trust/PPO |
$413.13
|
| Rate for Payer: BCN Commercial |
$938.75
|
| Rate for Payer: BCN Medicare Advantage |
$639.26
|
| Rate for Payer: Cash Price |
$1,363.20
|
| Rate for Payer: Cash Price |
$1,363.20
|
| Rate for Payer: Cofinity Commercial |
$920.53
|
| Rate for Payer: Cofinity Commercial |
$856.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$639.26
|
| Rate for Payer: Mclaren Medicaid |
$411.52
|
| Rate for Payer: Meridian Medicaid |
$432.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$671.22
|
| Rate for Payer: PACE SWMI |
$639.26
|
| Rate for Payer: PHP Medicare Advantage |
$639.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$411.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,192.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,129.49
|
| Rate for Payer: Priority Health Medicare |
$639.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,129.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$639.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$639.26
|
| Rate for Payer: UHC Medicare Advantage |
$658.44
|
|
|
PR APPENDECTOMY
|
Facility
|
OP
|
$1,704.00
|
|
|
Service Code
|
CPT 44950
|
| Hospital Charge Code |
44950
|
| Min. Negotiated Rate |
$404.70 |
| Max. Negotiated Rate |
$5,211.10 |
| Rate for Payer: Aetna Commercial |
$1,448.40
|
| Rate for Payer: Aetna Medicare |
$443.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$532.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$532.50
|
| Rate for Payer: BCBS Complete |
$5,211.10
|
| Rate for Payer: BCBS MAPPO |
$426.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,324.86
|
| Rate for Payer: BCN Commercial |
$1,324.86
|
| Rate for Payer: BCN Medicare Advantage |
$426.00
|
| Rate for Payer: Cash Price |
$1,363.20
|
| Rate for Payer: Cash Price |
$1,363.20
|
| Rate for Payer: Cofinity Commercial |
$1,465.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,363.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$426.00
|
| Rate for Payer: Healthscope Commercial |
$1,533.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,278.00
|
| Rate for Payer: Mclaren Medicaid |
$4,962.95
|
| Rate for Payer: Meridian Medicaid |
$5,211.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$447.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$489.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,448.40
|
| Rate for Payer: PACE Senior Care Partners |
$404.70
|
| Rate for Payer: PACE SWMI |
$426.00
|
| Rate for Payer: PHP Commercial |
$1,448.40
|
| Rate for Payer: PHP Medicare Advantage |
$426.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,962.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,192.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,482.48
|
| Rate for Payer: Priority Health Medicare |
$426.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,039.27
|
| Rate for Payer: Railroad Medicare Medicare |
$426.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,499.52
|
| Rate for Payer: UHC Core |
$1,422.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$426.00
|
| Rate for Payer: UHC Medicare Advantage |
$438.78
|
| Rate for Payer: VA VA |
$426.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,278.00
|
|
|
PR APPENDECTOMY
|
Professional
|
Both
|
$1,704.00
|
|
|
Service Code
|
HCPCS 44950
|
| Hospital Charge Code |
44950
|
| Min. Negotiated Rate |
$411.52 |
| Max. Negotiated Rate |
$1,192.80 |
| Rate for Payer: Aetna Commercial |
$856.61
|
| Rate for Payer: Aetna Medicare |
$664.83
|
| Rate for Payer: BCBS Complete |
$432.10
|
| Rate for Payer: BCBS MAPPO |
$639.26
|
| Rate for Payer: BCBS Trust/PPO |
$413.13
|
| Rate for Payer: BCN Commercial |
$938.75
|
| Rate for Payer: BCN Medicare Advantage |
$639.26
|
| Rate for Payer: Cash Price |
$1,363.20
|
| Rate for Payer: Cash Price |
$1,363.20
|
| Rate for Payer: Cofinity Commercial |
$920.53
|
| Rate for Payer: Cofinity Commercial |
$856.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$639.26
|
| Rate for Payer: Mclaren Medicaid |
$411.52
|
| Rate for Payer: Meridian Medicaid |
$432.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$671.22
|
| Rate for Payer: PACE SWMI |
$639.26
|
| Rate for Payer: PHP Medicare Advantage |
$639.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$411.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,192.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,129.49
|
| Rate for Payer: Priority Health Medicare |
$639.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,129.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$639.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$639.26
|
| Rate for Payer: UHC Medicare Advantage |
$658.44
|
|
|
PR APPENDECTOMY
|
Facility
|
IP
|
$1,704.00
|
|
|
Service Code
|
CPT 44950
|
| Hospital Charge Code |
44950
|
| Min. Negotiated Rate |
$1,039.27 |
| Max. Negotiated Rate |
$1,533.60 |
| Rate for Payer: Aetna Commercial |
$1,448.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,316.85
|
| Rate for Payer: BCN Commercial |
$1,316.85
|
| Rate for Payer: Cash Price |
$1,363.20
|
| Rate for Payer: Cofinity Commercial |
$1,465.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,363.20
|
| Rate for Payer: Healthscope Commercial |
$1,533.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,278.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,448.40
|
| Rate for Payer: PHP Commercial |
$1,448.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,192.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,482.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,039.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,499.52
|
| Rate for Payer: UHC Core |
$1,422.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,278.00
|
|
|
PR APPL CRANIAL TONG/STRTCTC FRAME W/REMOVAL SPX
|
Professional
|
Both
|
$847.00
|
|
|
Service Code
|
HCPCS 20660
|
| Min. Negotiated Rate |
$153.36 |
| Max. Negotiated Rate |
$6,925.56 |
| Rate for Payer: Aetna Commercial |
$324.51
|
| Rate for Payer: Aetna Medicare |
$251.86
|
| Rate for Payer: BCBS Complete |
$161.03
|
| Rate for Payer: BCBS MAPPO |
$242.17
|
| Rate for Payer: BCBS Trust/PPO |
$6,925.56
|
| Rate for Payer: BCN Commercial |
$352.82
|
| Rate for Payer: BCN Medicare Advantage |
$242.17
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: Cofinity Commercial |
$348.72
|
| Rate for Payer: Cofinity Commercial |
$324.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$242.17
|
| Rate for Payer: Mclaren Medicaid |
$153.36
|
| Rate for Payer: Meridian Medicaid |
$161.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$254.28
|
| Rate for Payer: PACE SWMI |
$242.17
|
| Rate for Payer: PHP Medicare Advantage |
$242.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$153.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$592.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$368.70
|
| Rate for Payer: Priority Health Medicare |
$242.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$368.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$242.17
|
| Rate for Payer: UHC Medicare Advantage |
$249.44
|
|
|
PR APPL HIP SPICA CAST ONE&ONE-HALF SPICA/BOTH LEGS
|
Professional
|
Both
|
$647.00
|
|
|
Service Code
|
HCPCS 29325
|
| Min. Negotiated Rate |
$113.96 |
| Max. Negotiated Rate |
$1,154.34 |
| Rate for Payer: Aetna Commercial |
$231.24
|
| Rate for Payer: Aetna Medicare |
$179.47
|
| Rate for Payer: BCBS Complete |
$119.66
|
| Rate for Payer: BCBS MAPPO |
$172.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,154.34
|
| Rate for Payer: BCN Commercial |
$402.67
|
| Rate for Payer: BCN Medicare Advantage |
$172.57
|
| Rate for Payer: Cash Price |
$517.60
|
| Rate for Payer: Cash Price |
$517.60
|
| Rate for Payer: Cofinity Commercial |
$231.24
|
| Rate for Payer: Cofinity Commercial |
$248.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.57
|
| Rate for Payer: Mclaren Medicaid |
$113.96
|
| Rate for Payer: Meridian Medicaid |
$119.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$181.20
|
| Rate for Payer: PACE SWMI |
$172.57
|
| Rate for Payer: PHP Medicare Advantage |
$172.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$269.62
|
| Rate for Payer: Priority Health Medicare |
$172.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$269.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.57
|
| Rate for Payer: UHC Medicare Advantage |
$177.75
|
|
|
PR APPLICATION CAST ELBOW FINGER SHORT ARM
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 29075
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$1,010.64 |
| Rate for Payer: Aetna Commercial |
$82.16
|
| Rate for Payer: Aetna Medicare |
$63.76
|
| Rate for Payer: BCBS Complete |
$42.27
|
| Rate for Payer: BCBS MAPPO |
$61.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,010.64
|
| Rate for Payer: BCN Commercial |
$104.05
|
| Rate for Payer: BCN Medicare Advantage |
$61.31
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$88.29
|
| Rate for Payer: Cofinity Commercial |
$82.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.31
|
| Rate for Payer: Mclaren Medicaid |
$40.26
|
| Rate for Payer: Meridian Medicaid |
$42.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$64.38
|
| Rate for Payer: PACE SWMI |
$61.31
|
| Rate for Payer: PHP Medicare Advantage |
$61.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.01
|
| Rate for Payer: Priority Health Medicare |
$61.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.31
|
| Rate for Payer: UHC Medicare Advantage |
$63.15
|
|
|
PR APPLICATION CAST FIGURE-OF-8
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS 29049
|
| Min. Negotiated Rate |
$44.94 |
| Max. Negotiated Rate |
$822.03 |
| Rate for Payer: Aetna Commercial |
$90.57
|
| Rate for Payer: Aetna Medicare |
$70.29
|
| Rate for Payer: BCBS Complete |
$47.19
|
| Rate for Payer: BCBS MAPPO |
$67.59
|
| Rate for Payer: BCBS Trust/PPO |
$822.03
|
| Rate for Payer: BCN Commercial |
$146.60
|
| Rate for Payer: BCN Medicare Advantage |
$67.59
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cofinity Commercial |
$97.33
|
| Rate for Payer: Cofinity Commercial |
$90.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.59
|
| Rate for Payer: Mclaren Medicaid |
$44.94
|
| Rate for Payer: Meridian Medicaid |
$47.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$70.97
|
| Rate for Payer: PACE SWMI |
$67.59
|
| Rate for Payer: PHP Medicare Advantage |
$67.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.71
|
| Rate for Payer: Priority Health Medicare |
$67.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.59
|
| Rate for Payer: UHC Medicare Advantage |
$69.62
|
|
|
PR APPLICATION CAST FINGER
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 29086
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$1,122.64 |
| Rate for Payer: Aetna Commercial |
$63.84
|
| Rate for Payer: Aetna Medicare |
$49.55
|
| Rate for Payer: BCBS Complete |
$33.33
|
| Rate for Payer: BCBS MAPPO |
$47.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,122.64
|
| Rate for Payer: BCN Commercial |
$112.40
|
| Rate for Payer: BCN Medicare Advantage |
$47.64
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cofinity Commercial |
$68.60
|
| Rate for Payer: Cofinity Commercial |
$63.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.64
|
| Rate for Payer: Mclaren Medicaid |
$31.74
|
| Rate for Payer: Meridian Medicaid |
$33.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50.02
|
| Rate for Payer: PACE SWMI |
$47.64
|
| Rate for Payer: PHP Medicare Advantage |
$47.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.06
|
| Rate for Payer: Priority Health Medicare |
$47.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.64
|
| Rate for Payer: UHC Medicare Advantage |
$49.07
|
|
|
PR APPLICATION CAST HAND & LOWER FOREARM GAUNTLET
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 29085
|
| Min. Negotiated Rate |
$43.45 |
| Max. Negotiated Rate |
$1,099.39 |
| Rate for Payer: Aetna Commercial |
$87.94
|
| Rate for Payer: Aetna Medicare |
$68.26
|
| Rate for Payer: BCBS Complete |
$45.62
|
| Rate for Payer: BCBS MAPPO |
$65.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,099.39
|
| Rate for Payer: BCN Commercial |
$113.88
|
| Rate for Payer: BCN Medicare Advantage |
$65.63
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cofinity Commercial |
$94.51
|
| Rate for Payer: Cofinity Commercial |
$87.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.63
|
| Rate for Payer: Mclaren Medicaid |
$43.45
|
| Rate for Payer: Meridian Medicaid |
$45.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$68.91
|
| Rate for Payer: PACE SWMI |
$65.63
|
| Rate for Payer: PHP Medicare Advantage |
$65.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.64
|
| Rate for Payer: Priority Health Medicare |
$65.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.63
|
| Rate for Payer: UHC Medicare Advantage |
$67.60
|
|
|
PR APPLICATION CAST SHOULDER HAND LONG ARM
|
Professional
|
Both
|
$254.00
|
|
|
Service Code
|
HCPCS 29065
|
| Min. Negotiated Rate |
$43.88 |
| Max. Negotiated Rate |
$1,191.32 |
| Rate for Payer: Aetna Commercial |
$89.26
|
| Rate for Payer: Aetna Medicare |
$69.27
|
| Rate for Payer: BCBS Complete |
$46.07
|
| Rate for Payer: BCBS MAPPO |
$66.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,191.32
|
| Rate for Payer: BCN Commercial |
$114.65
|
| Rate for Payer: BCN Medicare Advantage |
$66.61
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cofinity Commercial |
$89.26
|
| Rate for Payer: Cofinity Commercial |
$95.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.61
|
| Rate for Payer: Mclaren Medicaid |
$43.88
|
| Rate for Payer: Meridian Medicaid |
$46.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$69.94
|
| Rate for Payer: PACE SWMI |
$66.61
|
| Rate for Payer: PHP Medicare Advantage |
$66.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.17
|
| Rate for Payer: Priority Health Medicare |
$66.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.61
|
| Rate for Payer: UHC Medicare Advantage |
$68.61
|
|
|
PR APPLICATION CYLINDER CAST THIGH ANKLE
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 29365
|
| Min. Negotiated Rate |
$56.45 |
| Max. Negotiated Rate |
$701.58 |
| Rate for Payer: Aetna Commercial |
$114.05
|
| Rate for Payer: Aetna Medicare |
$88.51
|
| Rate for Payer: BCBS Complete |
$59.27
|
| Rate for Payer: BCBS MAPPO |
$85.11
|
| Rate for Payer: BCBS Trust/PPO |
$701.58
|
| Rate for Payer: BCN Commercial |
$182.28
|
| Rate for Payer: BCN Medicare Advantage |
$85.11
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$114.05
|
| Rate for Payer: Cofinity Commercial |
$122.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.11
|
| Rate for Payer: Mclaren Medicaid |
$56.45
|
| Rate for Payer: Meridian Medicaid |
$59.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$89.37
|
| Rate for Payer: PACE SWMI |
$85.11
|
| Rate for Payer: PHP Medicare Advantage |
$85.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.77
|
| Rate for Payer: Priority Health Medicare |
$85.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$132.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.11
|
| Rate for Payer: UHC Medicare Advantage |
$87.66
|
|
|
PR APPLICATION FINGER SPLINT DYNAMIC
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 29131
|
| Min. Negotiated Rate |
$22.15 |
| Max. Negotiated Rate |
$2,121.65 |
| Rate for Payer: Aetna Commercial |
$45.99
|
| Rate for Payer: Aetna Medicare |
$35.69
|
| Rate for Payer: BCBS Complete |
$23.26
|
| Rate for Payer: BCBS MAPPO |
$34.32
|
| Rate for Payer: BCBS Trust/PPO |
$2,121.65
|
| Rate for Payer: BCN Commercial |
$78.68
|
| Rate for Payer: BCN Medicare Advantage |
$34.32
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$45.99
|
| Rate for Payer: Cofinity Commercial |
$49.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.32
|
| Rate for Payer: Mclaren Medicaid |
$22.15
|
| Rate for Payer: Meridian Medicaid |
$23.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.04
|
| Rate for Payer: PACE SWMI |
$34.32
|
| Rate for Payer: PHP Medicare Advantage |
$34.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.10
|
| Rate for Payer: Priority Health Medicare |
$34.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.32
|
| Rate for Payer: UHC Medicare Advantage |
$35.35
|
|
|
PR APPLICATION FINGER SPLINT STATIC
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS 29130
|
| Min. Negotiated Rate |
$18.53 |
| Max. Negotiated Rate |
$2,436.52 |
| Rate for Payer: Aetna Commercial |
$39.17
|
| Rate for Payer: Aetna Medicare |
$30.40
|
| Rate for Payer: BCBS Complete |
$19.46
|
| Rate for Payer: BCBS MAPPO |
$29.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,436.52
|
| Rate for Payer: BCN Commercial |
$61.58
|
| Rate for Payer: BCN Medicare Advantage |
$29.23
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cofinity Commercial |
$42.09
|
| Rate for Payer: Cofinity Commercial |
$39.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.23
|
| Rate for Payer: Mclaren Medicaid |
$18.53
|
| Rate for Payer: Meridian Medicaid |
$19.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.69
|
| Rate for Payer: PACE SWMI |
$29.23
|
| Rate for Payer: PHP Medicare Advantage |
$29.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.94
|
| Rate for Payer: Priority Health Medicare |
$29.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.23
|
| Rate for Payer: UHC Medicare Advantage |
$30.11
|
|
|
PR APPLICATION HALO CRANIAL INCLUDING REMOVAL
|
Professional
|
Both
|
$1,077.00
|
|
|
Service Code
|
HCPCS 20661
|
| Min. Negotiated Rate |
$342.08 |
| Max. Negotiated Rate |
$32,076.33 |
| Rate for Payer: Aetna Commercial |
$681.72
|
| Rate for Payer: Aetna Medicare |
$529.10
|
| Rate for Payer: BCBS Complete |
$359.18
|
| Rate for Payer: BCBS MAPPO |
$508.75
|
| Rate for Payer: BCBS Trust/PPO |
$32,076.33
|
| Rate for Payer: BCN Commercial |
$841.55
|
| Rate for Payer: BCN Medicare Advantage |
$508.75
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Cofinity Commercial |
$732.60
|
| Rate for Payer: Cofinity Commercial |
$681.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$508.75
|
| Rate for Payer: Mclaren Medicaid |
$342.08
|
| Rate for Payer: Meridian Medicaid |
$359.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$534.19
|
| Rate for Payer: PACE SWMI |
$508.75
|
| Rate for Payer: PHP Medicare Advantage |
$508.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$753.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$798.66
|
| Rate for Payer: Priority Health Medicare |
$508.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$798.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$508.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$508.75
|
| Rate for Payer: UHC Medicare Advantage |
$524.01
|
|
|
PR APPLICATION HIP SPICA CAST 1 LEG
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
HCPCS 29305
|
| Min. Negotiated Rate |
$101.81 |
| Max. Negotiated Rate |
$1,986.41 |
| Rate for Payer: Aetna Commercial |
$206.53
|
| Rate for Payer: Aetna Medicare |
$160.30
|
| Rate for Payer: BCBS Complete |
$106.90
|
| Rate for Payer: BCBS MAPPO |
$154.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,986.41
|
| Rate for Payer: BCN Commercial |
$365.04
|
| Rate for Payer: BCN Medicare Advantage |
$154.13
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cofinity Commercial |
$206.53
|
| Rate for Payer: Cofinity Commercial |
$221.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.13
|
| Rate for Payer: Mclaren Medicaid |
$101.81
|
| Rate for Payer: Meridian Medicaid |
$106.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$161.84
|
| Rate for Payer: PACE SWMI |
$154.13
|
| Rate for Payer: PHP Medicare Advantage |
$154.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.03
|
| Rate for Payer: Priority Health Medicare |
$154.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.13
|
| Rate for Payer: UHC Medicare Advantage |
$158.75
|
|
|
PR APPLICATION INTERVERTEBRAL BIOMECHANICAL DEVICE
|
Professional
|
Both
|
$2,042.00
|
|
|
Service Code
|
HCPCS 22851
|
| Min. Negotiated Rate |
$816.80 |
| Max. Negotiated Rate |
$1,429.40 |
| Rate for Payer: BCBS Complete |
$816.80
|
| Rate for Payer: Cash Price |
$1,633.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,429.40
|
|
|
PR APPLICATION LONG ARM SPLINT SHOULDER HAND
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
HCPCS 29105
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$950.41 |
| Rate for Payer: Aetna Commercial |
$56.63
|
| Rate for Payer: Aetna Medicare |
$43.95
|
| Rate for Payer: BCBS Complete |
$27.96
|
| Rate for Payer: BCBS MAPPO |
$42.26
|
| Rate for Payer: BCBS Trust/PPO |
$950.41
|
| Rate for Payer: BCN Commercial |
$122.17
|
| Rate for Payer: BCN Medicare Advantage |
$42.26
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cofinity Commercial |
$60.85
|
| Rate for Payer: Cofinity Commercial |
$56.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.26
|
| Rate for Payer: Mclaren Medicaid |
$26.63
|
| Rate for Payer: Meridian Medicaid |
$27.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.37
|
| Rate for Payer: PACE SWMI |
$42.26
|
| Rate for Payer: PHP Medicare Advantage |
$42.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.35
|
| Rate for Payer: Priority Health Medicare |
$42.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.26
|
| Rate for Payer: UHC Medicare Advantage |
$43.53
|
|
|
PR APPLICATION LONG LEG CAST BRACE
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS 29358
|
| Min. Negotiated Rate |
$66.24 |
| Max. Negotiated Rate |
$236.52 |
| Rate for Payer: Aetna Commercial |
$134.95
|
| Rate for Payer: Aetna Medicare |
$104.74
|
| Rate for Payer: BCBS Complete |
$69.55
|
| Rate for Payer: BCBS MAPPO |
$100.71
|
| Rate for Payer: BCBS Trust/PPO |
$104.08
|
| Rate for Payer: BCN Commercial |
$236.52
|
| Rate for Payer: BCN Medicare Advantage |
$100.71
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cofinity Commercial |
$145.02
|
| Rate for Payer: Cofinity Commercial |
$134.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.71
|
| Rate for Payer: Mclaren Medicaid |
$66.24
|
| Rate for Payer: Meridian Medicaid |
$69.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$105.75
|
| Rate for Payer: PACE SWMI |
$100.71
|
| Rate for Payer: PHP Medicare Advantage |
$100.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$156.76
|
| Rate for Payer: Priority Health Medicare |
$100.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.71
|
| Rate for Payer: UHC Medicare Advantage |
$103.73
|
|
