|
PR APPENDECTOMY
|
Facility
|
IP
|
$1,738.00
|
|
|
Service Code
|
CPT 44950
|
| Hospital Charge Code |
44950
|
| Min. Negotiated Rate |
$1,129.70 |
| Max. Negotiated Rate |
$1,564.20 |
| Rate for Payer: Aetna Commercial |
$1,477.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,418.73
|
| Rate for Payer: BCN Commercial |
$1,343.13
|
| Rate for Payer: Cash Price |
$1,390.40
|
| Rate for Payer: Cofinity Commercial |
$1,494.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,390.40
|
| Rate for Payer: Healthscope Commercial |
$1,564.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,303.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,477.30
|
| Rate for Payer: Nomi Health Commercial |
$1,425.16
|
| Rate for Payer: PHP Commercial |
$1,477.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.70
|
| Rate for Payer: Priority Health HMO/PPO |
$1,512.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,164.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,529.44
|
| Rate for Payer: UHC Core |
$1,451.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,303.50
|
|
|
PR APPENDECTOMY
|
Facility
|
OP
|
$1,738.00
|
|
|
Service Code
|
CPT 44950
|
| Hospital Charge Code |
44950
|
| Min. Negotiated Rate |
$412.77 |
| Max. Negotiated Rate |
$4,737.22 |
| Rate for Payer: Aetna Commercial |
$1,477.30
|
| Rate for Payer: Aetna Medicare |
$451.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$543.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$543.12
|
| Rate for Payer: BCBS Complete |
$4,737.22
|
| Rate for Payer: BCBS MAPPO |
$434.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,428.81
|
| Rate for Payer: BCN Commercial |
$1,351.30
|
| Rate for Payer: BCN Medicare Advantage |
$434.50
|
| Rate for Payer: Cash Price |
$1,390.40
|
| Rate for Payer: Cash Price |
$1,390.40
|
| Rate for Payer: Cofinity Commercial |
$1,494.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,390.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$434.50
|
| Rate for Payer: Healthscope Commercial |
$1,564.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,303.50
|
| Rate for Payer: Mclaren Medicaid |
$4,511.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$456.23
|
| Rate for Payer: Meridian Medicaid |
$4,737.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$499.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,477.30
|
| Rate for Payer: Nomi Health Commercial |
$1,425.16
|
| Rate for Payer: PACE Senior Care Partners |
$412.77
|
| Rate for Payer: PACE SWMI |
$434.50
|
| Rate for Payer: PHP Commercial |
$1,477.30
|
| Rate for Payer: PHP Medicare Advantage |
$434.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,511.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.70
|
| Rate for Payer: Priority Health HMO/PPO |
$1,512.06
|
| Rate for Payer: Priority Health Medicare |
$438.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,164.46
|
| Rate for Payer: Railroad Medicare Medicare |
$434.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,529.44
|
| Rate for Payer: UHC Core |
$1,451.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$434.50
|
| Rate for Payer: UHC Exchange |
$434.50
|
| Rate for Payer: UHC Medicare Advantage |
$434.50
|
| Rate for Payer: UHCCP Medicaid |
$4,511.34
|
| Rate for Payer: VA VA |
$434.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,303.50
|
|
|
PR APPENDECTOMY
|
Professional
|
Both
|
$1,738.00
|
|
|
Service Code
|
HCPCS 44950
|
| Hospital Charge Code |
44950
|
| Min. Negotiated Rate |
$624.56 |
| Max. Negotiated Rate |
$1,129.70 |
| Rate for Payer: Aetna Commercial |
$836.91
|
| Rate for Payer: Aetna Medicare |
$649.54
|
| Rate for Payer: BCBS Complete |
$695.20
|
| Rate for Payer: BCBS MAPPO |
$624.56
|
| Rate for Payer: BCN Medicare Advantage |
$624.56
|
| Rate for Payer: Cash Price |
$1,390.40
|
| Rate for Payer: Cash Price |
$1,390.40
|
| Rate for Payer: Cofinity Commercial |
$899.37
|
| Rate for Payer: Cofinity Commercial |
$836.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$624.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$655.79
|
| Rate for Payer: Nomi Health Commercial |
$749.47
|
| Rate for Payer: PACE SWMI |
$624.56
|
| Rate for Payer: PHP Medicare Advantage |
$624.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.70
|
| Rate for Payer: Priority Health Medicare |
$630.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$624.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$624.56
|
| Rate for Payer: UHC Exchange |
$624.56
|
| Rate for Payer: UHC Medicare Advantage |
$624.56
|
|
|
PR APPL CRANIAL TONG/STRTCTC FRAME W/REMOVAL SPX
|
Professional
|
Both
|
$864.00
|
|
|
Service Code
|
HCPCS 20660
|
| Min. Negotiated Rate |
$236.76 |
| Max. Negotiated Rate |
$561.60 |
| Rate for Payer: Aetna Commercial |
$317.26
|
| Rate for Payer: Aetna Medicare |
$246.23
|
| Rate for Payer: BCBS Complete |
$345.60
|
| Rate for Payer: BCBS MAPPO |
$236.76
|
| Rate for Payer: BCN Medicare Advantage |
$236.76
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cofinity Commercial |
$340.93
|
| Rate for Payer: Cofinity Commercial |
$317.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.60
|
| Rate for Payer: Nomi Health Commercial |
$284.11
|
| Rate for Payer: PACE SWMI |
$236.76
|
| Rate for Payer: PHP Medicare Advantage |
$236.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.60
|
| Rate for Payer: Priority Health Medicare |
$239.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.76
|
| Rate for Payer: UHC Exchange |
$236.76
|
| Rate for Payer: UHC Medicare Advantage |
$236.76
|
|
|
PR APPL HIP SPICA CAST ONE&ONE-HALF SPICA/BOTH LEGS
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 29325
|
| Min. Negotiated Rate |
$171.43 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Aetna Commercial |
$229.72
|
| Rate for Payer: Aetna Medicare |
$178.29
|
| Rate for Payer: BCBS Complete |
$264.00
|
| Rate for Payer: BCBS MAPPO |
$171.43
|
| Rate for Payer: BCN Medicare Advantage |
$171.43
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cofinity Commercial |
$246.86
|
| Rate for Payer: Cofinity Commercial |
$229.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$171.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.00
|
| Rate for Payer: Nomi Health Commercial |
$205.72
|
| Rate for Payer: PACE SWMI |
$171.43
|
| Rate for Payer: PHP Medicare Advantage |
$171.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$429.00
|
| Rate for Payer: Priority Health Medicare |
$173.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$171.43
|
| Rate for Payer: UHC Exchange |
$171.43
|
| Rate for Payer: UHC Medicare Advantage |
$171.43
|
|
|
PR APPLICATION CAST ELBOW FINGER SHORT ARM
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
HCPCS 29075
|
| Min. Negotiated Rate |
$60.45 |
| Max. Negotiated Rate |
$130.65 |
| Rate for Payer: Aetna Commercial |
$81.00
|
| Rate for Payer: Aetna Medicare |
$62.87
|
| Rate for Payer: BCBS Complete |
$80.40
|
| Rate for Payer: BCBS MAPPO |
$60.45
|
| Rate for Payer: BCN Medicare Advantage |
$60.45
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cofinity Commercial |
$87.05
|
| Rate for Payer: Cofinity Commercial |
$81.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.47
|
| Rate for Payer: Nomi Health Commercial |
$72.54
|
| Rate for Payer: PACE SWMI |
$60.45
|
| Rate for Payer: PHP Medicare Advantage |
$60.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.65
|
| Rate for Payer: Priority Health Medicare |
$61.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.45
|
| Rate for Payer: UHC Exchange |
$60.45
|
| Rate for Payer: UHC Medicare Advantage |
$60.45
|
|
|
PR APPLICATION CAST FIGURE-OF-8
|
Professional
|
Both
|
$239.00
|
|
|
Service Code
|
HCPCS 29049
|
| Min. Negotiated Rate |
$67.15 |
| Max. Negotiated Rate |
$155.35 |
| Rate for Payer: Aetna Commercial |
$89.98
|
| Rate for Payer: Aetna Medicare |
$69.84
|
| Rate for Payer: BCBS Complete |
$95.60
|
| Rate for Payer: BCBS MAPPO |
$67.15
|
| Rate for Payer: BCN Medicare Advantage |
$67.15
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Cofinity Commercial |
$96.70
|
| Rate for Payer: Cofinity Commercial |
$89.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.51
|
| Rate for Payer: Nomi Health Commercial |
$80.58
|
| Rate for Payer: PACE SWMI |
$67.15
|
| Rate for Payer: PHP Medicare Advantage |
$67.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.35
|
| Rate for Payer: Priority Health Medicare |
$67.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.15
|
| Rate for Payer: UHC Exchange |
$67.15
|
| Rate for Payer: UHC Medicare Advantage |
$67.15
|
|
|
PR APPLICATION CAST FINGER
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 29086
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$85.15 |
| Rate for Payer: Aetna Commercial |
$62.19
|
| Rate for Payer: Aetna Medicare |
$48.27
|
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: BCBS MAPPO |
$46.41
|
| Rate for Payer: BCN Medicare Advantage |
$46.41
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cofinity Commercial |
$66.83
|
| Rate for Payer: Cofinity Commercial |
$62.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.73
|
| Rate for Payer: Nomi Health Commercial |
$55.69
|
| Rate for Payer: PACE SWMI |
$46.41
|
| Rate for Payer: PHP Medicare Advantage |
$46.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health Medicare |
$46.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.41
|
| Rate for Payer: UHC Exchange |
$46.41
|
| Rate for Payer: UHC Medicare Advantage |
$46.41
|
|
|
PR APPLICATION CAST HAND & LOWER FOREARM GAUNTLET
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
HCPCS 29085
|
| Min. Negotiated Rate |
$64.86 |
| Max. Negotiated Rate |
$122.85 |
| Rate for Payer: Aetna Commercial |
$86.91
|
| Rate for Payer: Aetna Medicare |
$67.45
|
| Rate for Payer: BCBS Complete |
$75.60
|
| Rate for Payer: BCBS MAPPO |
$64.86
|
| Rate for Payer: BCN Medicare Advantage |
$64.86
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$93.40
|
| Rate for Payer: Cofinity Commercial |
$86.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.10
|
| Rate for Payer: Nomi Health Commercial |
$77.83
|
| Rate for Payer: PACE SWMI |
$64.86
|
| Rate for Payer: PHP Medicare Advantage |
$64.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.85
|
| Rate for Payer: Priority Health Medicare |
$65.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.86
|
| Rate for Payer: UHC Exchange |
$64.86
|
| Rate for Payer: UHC Medicare Advantage |
$64.86
|
|
|
PR APPLICATION CAST SHOULDER HAND LONG ARM
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS 29065
|
| Min. Negotiated Rate |
$65.15 |
| Max. Negotiated Rate |
$168.35 |
| Rate for Payer: Aetna Commercial |
$87.30
|
| Rate for Payer: Aetna Medicare |
$67.76
|
| Rate for Payer: BCBS Complete |
$103.60
|
| Rate for Payer: BCBS MAPPO |
$65.15
|
| Rate for Payer: BCN Medicare Advantage |
$65.15
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cofinity Commercial |
$93.82
|
| Rate for Payer: Cofinity Commercial |
$87.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.41
|
| Rate for Payer: Nomi Health Commercial |
$78.18
|
| Rate for Payer: PACE SWMI |
$65.15
|
| Rate for Payer: PHP Medicare Advantage |
$65.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.35
|
| Rate for Payer: Priority Health Medicare |
$65.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.15
|
| Rate for Payer: UHC Exchange |
$65.15
|
| Rate for Payer: UHC Medicare Advantage |
$65.15
|
|
|
PR APPLICATION CYLINDER CAST THIGH ANKLE
|
Professional
|
Both
|
$252.00
|
|
|
Service Code
|
HCPCS 29365
|
| Min. Negotiated Rate |
$83.73 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Aetna Commercial |
$112.20
|
| Rate for Payer: Aetna Medicare |
$87.08
|
| Rate for Payer: BCBS Complete |
$100.80
|
| Rate for Payer: BCBS MAPPO |
$83.73
|
| Rate for Payer: BCN Medicare Advantage |
$83.73
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$120.57
|
| Rate for Payer: Cofinity Commercial |
$112.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.92
|
| Rate for Payer: Nomi Health Commercial |
$100.48
|
| Rate for Payer: PACE SWMI |
$83.73
|
| Rate for Payer: PHP Medicare Advantage |
$83.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health Medicare |
$84.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.73
|
| Rate for Payer: UHC Exchange |
$83.73
|
| Rate for Payer: UHC Medicare Advantage |
$83.73
|
|
|
PR APPLICATION FINGER SPLINT DYNAMIC
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 29131
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Aetna Commercial |
$44.49
|
| Rate for Payer: Aetna Medicare |
$34.53
|
| Rate for Payer: BCBS Complete |
$42.00
|
| Rate for Payer: BCBS MAPPO |
$33.20
|
| Rate for Payer: BCN Medicare Advantage |
$33.20
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$47.81
|
| Rate for Payer: Cofinity Commercial |
$44.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.86
|
| Rate for Payer: Nomi Health Commercial |
$39.84
|
| Rate for Payer: PACE SWMI |
$33.20
|
| Rate for Payer: PHP Medicare Advantage |
$33.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.25
|
| Rate for Payer: Priority Health Medicare |
$33.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.20
|
| Rate for Payer: UHC Exchange |
$33.20
|
| Rate for Payer: UHC Medicare Advantage |
$33.20
|
|
|
PR APPLICATION FINGER SPLINT STATIC
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 29130
|
| Min. Negotiated Rate |
$27.75 |
| Max. Negotiated Rate |
$61.10 |
| Rate for Payer: Aetna Commercial |
$37.19
|
| Rate for Payer: Aetna Medicare |
$28.86
|
| Rate for Payer: BCBS Complete |
$37.60
|
| Rate for Payer: BCBS MAPPO |
$27.75
|
| Rate for Payer: BCN Medicare Advantage |
$27.75
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cofinity Commercial |
$39.96
|
| Rate for Payer: Cofinity Commercial |
$37.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.14
|
| Rate for Payer: Nomi Health Commercial |
$33.30
|
| Rate for Payer: PACE SWMI |
$27.75
|
| Rate for Payer: PHP Medicare Advantage |
$27.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.10
|
| Rate for Payer: Priority Health Medicare |
$28.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.75
|
| Rate for Payer: UHC Exchange |
$27.75
|
| Rate for Payer: UHC Medicare Advantage |
$27.75
|
|
|
PR APPLICATION HALO CRANIAL INCLUDING REMOVAL
|
Professional
|
Both
|
$1,099.00
|
|
|
Service Code
|
HCPCS 20661
|
| Min. Negotiated Rate |
$439.60 |
| Max. Negotiated Rate |
$719.31 |
| Rate for Payer: Aetna Commercial |
$669.36
|
| Rate for Payer: Aetna Medicare |
$519.50
|
| Rate for Payer: BCBS Complete |
$439.60
|
| Rate for Payer: BCBS MAPPO |
$499.52
|
| Rate for Payer: BCN Medicare Advantage |
$499.52
|
| Rate for Payer: Cash Price |
$879.20
|
| Rate for Payer: Cash Price |
$879.20
|
| Rate for Payer: Cofinity Commercial |
$719.31
|
| Rate for Payer: Cofinity Commercial |
$669.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$499.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$524.50
|
| Rate for Payer: Nomi Health Commercial |
$599.42
|
| Rate for Payer: PACE SWMI |
$499.52
|
| Rate for Payer: PHP Medicare Advantage |
$499.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$714.35
|
| Rate for Payer: Priority Health Medicare |
$504.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$499.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$499.52
|
| Rate for Payer: UHC Exchange |
$499.52
|
| Rate for Payer: UHC Medicare Advantage |
$499.52
|
|
|
PR APPLICATION HIP SPICA CAST 1 LEG
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 29305
|
| Min. Negotiated Rate |
$152.62 |
| Max. Negotiated Rate |
$318.50 |
| Rate for Payer: Aetna Commercial |
$204.51
|
| Rate for Payer: Aetna Medicare |
$158.72
|
| Rate for Payer: BCBS Complete |
$196.00
|
| Rate for Payer: BCBS MAPPO |
$152.62
|
| Rate for Payer: BCN Medicare Advantage |
$152.62
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cofinity Commercial |
$219.77
|
| Rate for Payer: Cofinity Commercial |
$204.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.25
|
| Rate for Payer: Nomi Health Commercial |
$183.14
|
| Rate for Payer: PACE SWMI |
$152.62
|
| Rate for Payer: PHP Medicare Advantage |
$152.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.50
|
| Rate for Payer: Priority Health Medicare |
$154.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.62
|
| Rate for Payer: UHC Exchange |
$152.62
|
| Rate for Payer: UHC Medicare Advantage |
$152.62
|
|
|
PR APPLICATION INTERVERTEBRAL BIOMECHANICAL DEVICE
|
Professional
|
Both
|
$2,083.00
|
|
|
Service Code
|
HCPCS 22851
|
| Min. Negotiated Rate |
$833.20 |
| Max. Negotiated Rate |
$1,353.95 |
| Rate for Payer: Aetna Medicare |
$1,041.50
|
| Rate for Payer: BCBS Complete |
$833.20
|
| Rate for Payer: Cash Price |
$1,666.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,353.95
|
|
|
PR APPLICATION LONG ARM SPLINT SHOULDER HAND
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 29105
|
| Min. Negotiated Rate |
$40.49 |
| Max. Negotiated Rate |
$107.25 |
| Rate for Payer: Aetna Commercial |
$54.26
|
| Rate for Payer: Aetna Medicare |
$42.11
|
| Rate for Payer: BCBS Complete |
$66.00
|
| Rate for Payer: BCBS MAPPO |
$40.49
|
| Rate for Payer: BCN Medicare Advantage |
$40.49
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Commercial |
$58.31
|
| Rate for Payer: Cofinity Commercial |
$54.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.51
|
| Rate for Payer: Nomi Health Commercial |
$48.59
|
| Rate for Payer: PACE SWMI |
$40.49
|
| Rate for Payer: PHP Medicare Advantage |
$40.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.25
|
| Rate for Payer: Priority Health Medicare |
$40.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.49
|
| Rate for Payer: UHC Exchange |
$40.49
|
| Rate for Payer: UHC Medicare Advantage |
$40.49
|
|
|
PR APPLICATION LONG LEG CAST BRACE
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
HCPCS 29358
|
| Min. Negotiated Rate |
$99.10 |
| Max. Negotiated Rate |
$180.05 |
| Rate for Payer: Aetna Commercial |
$132.79
|
| Rate for Payer: Aetna Medicare |
$103.06
|
| Rate for Payer: BCBS Complete |
$110.80
|
| Rate for Payer: BCBS MAPPO |
$99.10
|
| Rate for Payer: BCN Medicare Advantage |
$99.10
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cofinity Commercial |
$142.70
|
| Rate for Payer: Cofinity Commercial |
$132.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.06
|
| Rate for Payer: Nomi Health Commercial |
$118.92
|
| Rate for Payer: PACE SWMI |
$99.10
|
| Rate for Payer: PHP Medicare Advantage |
$99.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.05
|
| Rate for Payer: Priority Health Medicare |
$100.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.10
|
| Rate for Payer: UHC Exchange |
$99.10
|
| Rate for Payer: UHC Medicare Advantage |
$99.10
|
|
|
PR APPLICATION LONG LEG CAST THIGH-TOE
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
HCPCS 29345
|
| Min. Negotiated Rate |
$95.31 |
| Max. Negotiated Rate |
$183.30 |
| Rate for Payer: Aetna Commercial |
$127.72
|
| Rate for Payer: Aetna Medicare |
$99.12
|
| Rate for Payer: BCBS Complete |
$112.80
|
| Rate for Payer: BCBS MAPPO |
$95.31
|
| Rate for Payer: BCN Medicare Advantage |
$95.31
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$137.25
|
| Rate for Payer: Cofinity Commercial |
$127.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.08
|
| Rate for Payer: Nomi Health Commercial |
$114.37
|
| Rate for Payer: PACE SWMI |
$95.31
|
| Rate for Payer: PHP Medicare Advantage |
$95.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.30
|
| Rate for Payer: Priority Health Medicare |
$96.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.31
|
| Rate for Payer: UHC Exchange |
$95.31
|
| Rate for Payer: UHC Medicare Advantage |
$95.31
|
|
|
PR APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE
|
Professional
|
Both
|
$252.00
|
|
|
Service Code
|
HCPCS 29355
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Aetna Commercial |
$135.84
|
| Rate for Payer: Aetna Medicare |
$105.42
|
| Rate for Payer: BCBS Complete |
$100.80
|
| Rate for Payer: BCBS MAPPO |
$101.37
|
| Rate for Payer: BCN Medicare Advantage |
$101.37
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$145.97
|
| Rate for Payer: Cofinity Commercial |
$135.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.44
|
| Rate for Payer: Nomi Health Commercial |
$121.64
|
| Rate for Payer: PACE SWMI |
$101.37
|
| Rate for Payer: PHP Medicare Advantage |
$101.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health Medicare |
$102.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.37
|
| Rate for Payer: UHC Exchange |
$101.37
|
| Rate for Payer: UHC Medicare Advantage |
$101.37
|
|
|
PR APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 29505
|
| Min. Negotiated Rate |
$50.53 |
| Max. Negotiated Rate |
$89.05 |
| Rate for Payer: Aetna Commercial |
$67.71
|
| Rate for Payer: Aetna Medicare |
$52.55
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS MAPPO |
$50.53
|
| Rate for Payer: BCN Medicare Advantage |
$50.53
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cofinity Commercial |
$72.76
|
| Rate for Payer: Cofinity Commercial |
$67.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$60.64
|
| Rate for Payer: PACE SWMI |
$50.53
|
| Rate for Payer: PHP Medicare Advantage |
$50.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.05
|
| Rate for Payer: Priority Health Medicare |
$51.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.53
|
| Rate for Payer: UHC Exchange |
$50.53
|
| Rate for Payer: UHC Medicare Advantage |
$50.53
|
|
|
PR APPLICATION MODALITY 1/> AREAS HOT/COLD PACKS
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 97010
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Aetna Medicare |
$4.00
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.20
|
|
|
PR APPLICATION MODALITY 1/> AREAS WHIRLPOOL
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS 97022
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Aetna Commercial |
$19.72
|
| Rate for Payer: Aetna Medicare |
$15.31
|
| Rate for Payer: BCBS Complete |
$13.60
|
| Rate for Payer: BCBS MAPPO |
$14.72
|
| Rate for Payer: BCN Medicare Advantage |
$14.72
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Cofinity Commercial |
$19.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.46
|
| Rate for Payer: Nomi Health Commercial |
$17.66
|
| Rate for Payer: PACE SWMI |
$14.72
|
| Rate for Payer: PHP Medicare Advantage |
$14.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.10
|
| Rate for Payer: Priority Health Medicare |
$14.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.72
|
| Rate for Payer: UHC Exchange |
$14.72
|
| Rate for Payer: UHC Medicare Advantage |
$14.72
|
|
|
PR APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM
|
Professional
|
Both
|
$1,925.00
|
|
|
Service Code
|
HCPCS 20692
|
| Min. Negotiated Rate |
$770.00 |
| Max. Negotiated Rate |
$1,564.55 |
| Rate for Payer: Aetna Commercial |
$1,455.90
|
| Rate for Payer: Aetna Medicare |
$1,129.95
|
| Rate for Payer: BCBS Complete |
$770.00
|
| Rate for Payer: BCBS MAPPO |
$1,086.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,086.49
|
| Rate for Payer: Cash Price |
$1,540.00
|
| Rate for Payer: Cash Price |
$1,540.00
|
| Rate for Payer: Cofinity Commercial |
$1,455.90
|
| Rate for Payer: Cofinity Commercial |
$1,564.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,086.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,140.81
|
| Rate for Payer: Nomi Health Commercial |
$1,303.79
|
| Rate for Payer: PACE SWMI |
$1,086.49
|
| Rate for Payer: PHP Medicare Advantage |
$1,086.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,251.25
|
| Rate for Payer: Priority Health Medicare |
$1,097.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,086.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,086.49
|
| Rate for Payer: UHC Exchange |
$1,086.49
|
| Rate for Payer: UHC Medicare Advantage |
$1,086.49
|
|
|
PR APPLICATION OF SURFACE NEUROSTIMULATOR
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 64550
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
|
