|
PR APPLICATION LONG ARM SPLINT SHOULDER HAND
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 29105
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$950.41 |
| Rate for Payer: Aetna Commercial |
$54.26
|
| Rate for Payer: Aetna Medicare |
$42.11
|
| Rate for Payer: BCBS Complete |
$27.96
|
| Rate for Payer: BCBS MAPPO |
$40.49
|
| Rate for Payer: BCBS Trust/PPO |
$950.41
|
| Rate for Payer: BCN Commercial |
$122.17
|
| 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: Mclaren Medicaid |
$26.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.51
|
| Rate for Payer: Meridian Medicaid |
$27.96
|
| 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 Choice Medicaid |
$26.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.25
|
| Rate for Payer: Priority Health HMO/PPO |
$63.61
|
| Rate for Payer: Priority Health Medicare |
$40.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.61
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$26.63
|
|
|
PR APPLICATION LONG LEG CAST BRACE
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
HCPCS 29358
|
| Min. Negotiated Rate |
$66.88 |
| Max. Negotiated Rate |
$236.52 |
| Rate for Payer: Aetna Commercial |
$132.79
|
| Rate for Payer: Aetna Medicare |
$103.06
|
| Rate for Payer: BCBS Complete |
$70.22
|
| Rate for Payer: BCBS MAPPO |
$99.10
|
| Rate for Payer: BCBS Trust/PPO |
$104.08
|
| Rate for Payer: BCN Commercial |
$236.52
|
| 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: Mclaren Medicaid |
$66.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.06
|
| Rate for Payer: Meridian Medicaid |
$70.22
|
| 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 Choice Medicaid |
$66.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.05
|
| Rate for Payer: Priority Health HMO/PPO |
$158.25
|
| Rate for Payer: Priority Health Medicare |
$100.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$158.25
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$66.88
|
|
|
PR APPLICATION LONG LEG CAST THIGH-TOE
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
HCPCS 29345
|
| Min. Negotiated Rate |
$64.33 |
| Max. Negotiated Rate |
$221.36 |
| Rate for Payer: Aetna Commercial |
$127.72
|
| Rate for Payer: Aetna Medicare |
$99.12
|
| Rate for Payer: BCBS Complete |
$67.55
|
| Rate for Payer: BCBS MAPPO |
$95.31
|
| Rate for Payer: BCBS Trust/PPO |
$221.36
|
| Rate for Payer: BCN Commercial |
$199.38
|
| 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: Mclaren Medicaid |
$64.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.08
|
| Rate for Payer: Meridian Medicaid |
$67.55
|
| 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 Choice Medicaid |
$64.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.30
|
| Rate for Payer: Priority Health HMO/PPO |
$151.65
|
| Rate for Payer: Priority Health Medicare |
$96.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.65
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$64.33
|
|
|
PR APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE
|
Professional
|
Both
|
$252.00
|
|
|
Service Code
|
HCPCS 29355
|
| Min. Negotiated Rate |
$68.37 |
| Max. Negotiated Rate |
$585.88 |
| Rate for Payer: Aetna Commercial |
$135.84
|
| Rate for Payer: Aetna Medicare |
$105.42
|
| Rate for Payer: BCBS Complete |
$71.79
|
| Rate for Payer: BCBS MAPPO |
$101.37
|
| Rate for Payer: BCBS Trust/PPO |
$585.88
|
| Rate for Payer: BCN Commercial |
$209.15
|
| 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: Mclaren Medicaid |
$68.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.44
|
| Rate for Payer: Meridian Medicaid |
$71.79
|
| 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 Choice Medicaid |
$68.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health HMO/PPO |
$162.84
|
| Rate for Payer: Priority Health Medicare |
$102.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.84
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$68.37
|
|
|
PR APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 29505
|
| Min. Negotiated Rate |
$34.29 |
| Max. Negotiated Rate |
$1,145.35 |
| Rate for Payer: Aetna Commercial |
$67.71
|
| Rate for Payer: Aetna Medicare |
$52.55
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS MAPPO |
$50.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,145.35
|
| Rate for Payer: BCN Commercial |
$129.99
|
| 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 |
$67.71
|
| Rate for Payer: Cofinity Commercial |
$72.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.53
|
| Rate for Payer: Mclaren Medicaid |
$34.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.06
|
| Rate for Payer: Meridian Medicaid |
$36.00
|
| 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 Choice Medicaid |
$34.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.05
|
| Rate for Payer: Priority Health HMO/PPO |
$80.39
|
| Rate for Payer: Priority Health Medicare |
$51.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.39
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$34.29
|
|
|
PR APPLICATION MODALITY 1/> AREAS HOT/COLD PACKS
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 97010
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$1,245.73 |
| Rate for Payer: Aetna Commercial |
$4.45
|
| Rate for Payer: Aetna Medicare |
$4.00
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,245.73
|
| Rate for Payer: BCN Commercial |
$6.20
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.20
|
| Rate for Payer: Priority Health HMO/PPO |
$77.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.25
|
|
|
PR APPLICATION MODALITY 1/> AREAS WHIRLPOOL
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS 97022
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$1,929.88 |
| 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: BCBS Trust/PPO |
$1,929.88
|
| Rate for Payer: BCN Commercial |
$16.64
|
| 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 HMO/PPO |
$77.25
|
| Rate for Payer: Priority Health Medicare |
$14.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.25
|
| 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 |
$733.79 |
| Max. Negotiated Rate |
$3,350.93 |
| Rate for Payer: Aetna Commercial |
$1,455.90
|
| Rate for Payer: Aetna Medicare |
$1,129.95
|
| Rate for Payer: BCBS Complete |
$770.48
|
| Rate for Payer: BCBS MAPPO |
$1,086.49
|
| Rate for Payer: BCBS Trust/PPO |
$3,350.93
|
| Rate for Payer: BCN Commercial |
$1,643.42
|
| 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: Mclaren Medicaid |
$733.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,140.81
|
| Rate for Payer: Meridian Medicaid |
$770.48
|
| 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 Choice Medicaid |
$733.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,251.25
|
| Rate for Payer: Priority Health HMO/PPO |
$1,734.70
|
| Rate for Payer: Priority Health Medicare |
$1,097.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,734.70
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$733.79
|
|
|
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
|
|
|
PR APPLICATION PATELLAR TENDON BEARING CAST
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
HCPCS 29435
|
| Min. Negotiated Rate |
$56.23 |
| Max. Negotiated Rate |
$761.81 |
| Rate for Payer: Aetna Commercial |
$111.53
|
| Rate for Payer: Aetna Medicare |
$86.56
|
| Rate for Payer: BCBS Complete |
$59.04
|
| Rate for Payer: BCBS MAPPO |
$83.23
|
| Rate for Payer: BCBS Trust/PPO |
$761.81
|
| Rate for Payer: BCN Commercial |
$169.08
|
| Rate for Payer: BCN Medicare Advantage |
$83.23
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cofinity Commercial |
$119.85
|
| Rate for Payer: Cofinity Commercial |
$111.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.23
|
| Rate for Payer: Mclaren Medicaid |
$56.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.39
|
| Rate for Payer: Meridian Medicaid |
$59.04
|
| Rate for Payer: Nomi Health Commercial |
$99.88
|
| Rate for Payer: PACE SWMI |
$83.23
|
| Rate for Payer: PHP Medicare Advantage |
$83.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.85
|
| Rate for Payer: Priority Health HMO/PPO |
$132.81
|
| Rate for Payer: Priority Health Medicare |
$84.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$132.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.23
|
| Rate for Payer: UHC Exchange |
$83.23
|
| Rate for Payer: UHC Medicare Advantage |
$83.23
|
| Rate for Payer: UHCCP Medicaid |
$56.23
|
|
|
PR APPLICATION RIGHT & LEFT PULMONARY ARTERY BAND
|
Professional
|
Both
|
$3,361.00
|
|
|
Service Code
|
HCPCS 33620
|
| Min. Negotiated Rate |
$1,036.67 |
| Max. Negotiated Rate |
$2,581.48 |
| Rate for Payer: Aetna Commercial |
$2,120.90
|
| Rate for Payer: Aetna Medicare |
$1,646.07
|
| Rate for Payer: BCBS Complete |
$1,088.50
|
| Rate for Payer: BCBS MAPPO |
$1,582.76
|
| Rate for Payer: BCN Commercial |
$2,362.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,582.76
|
| Rate for Payer: Cash Price |
$2,688.80
|
| Rate for Payer: Cash Price |
$2,688.80
|
| Rate for Payer: Cofinity Commercial |
$2,279.17
|
| Rate for Payer: Cofinity Commercial |
$2,120.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,582.76
|
| Rate for Payer: Mclaren Medicaid |
$1,036.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,661.90
|
| Rate for Payer: Meridian Medicaid |
$1,088.50
|
| Rate for Payer: Nomi Health Commercial |
$1,899.31
|
| Rate for Payer: PACE SWMI |
$1,582.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,582.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,036.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,184.65
|
| Rate for Payer: Priority Health HMO/PPO |
$2,581.48
|
| Rate for Payer: Priority Health Medicare |
$1,598.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,581.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,582.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,582.76
|
| Rate for Payer: UHC Exchange |
$1,582.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,582.76
|
| Rate for Payer: UHCCP Medicaid |
$1,036.67
|
|
|
PR APPLICATION RIGID TOTAL CONTACT LEG CAST
|
Professional
|
Both
|
$377.00
|
|
|
Service Code
|
HCPCS 29445
|
| Min. Negotiated Rate |
$62.84 |
| Max. Negotiated Rate |
$1,242.56 |
| Rate for Payer: Aetna Commercial |
$125.40
|
| Rate for Payer: Aetna Medicare |
$97.32
|
| Rate for Payer: BCBS Complete |
$65.98
|
| Rate for Payer: BCBS MAPPO |
$93.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,242.56
|
| Rate for Payer: BCN Commercial |
$150.00
|
| Rate for Payer: BCN Medicare Advantage |
$93.58
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cofinity Commercial |
$134.76
|
| Rate for Payer: Cofinity Commercial |
$125.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.58
|
| Rate for Payer: Mclaren Medicaid |
$62.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.26
|
| Rate for Payer: Meridian Medicaid |
$65.98
|
| Rate for Payer: Nomi Health Commercial |
$112.30
|
| Rate for Payer: PACE SWMI |
$93.58
|
| Rate for Payer: PHP Medicare Advantage |
$93.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.05
|
| Rate for Payer: Priority Health HMO/PPO |
$150.12
|
| Rate for Payer: Priority Health Medicare |
$94.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.58
|
| Rate for Payer: UHC Exchange |
$93.58
|
| Rate for Payer: UHC Medicare Advantage |
$93.58
|
| Rate for Payer: UHCCP Medicaid |
$62.84
|
|
|
PR APPLICATION SHORT ARM SPLINT DYNAMIC
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
HCPCS 29126
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$1,873.35 |
| Rate for Payer: Aetna Commercial |
$63.38
|
| Rate for Payer: Aetna Medicare |
$49.19
|
| Rate for Payer: BCBS Complete |
$33.77
|
| Rate for Payer: BCBS MAPPO |
$47.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,873.35
|
| Rate for Payer: BCN Commercial |
$113.86
|
| Rate for Payer: BCN Medicare Advantage |
$47.30
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cofinity Commercial |
$68.11
|
| Rate for Payer: Cofinity Commercial |
$63.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.30
|
| Rate for Payer: Mclaren Medicaid |
$32.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.66
|
| Rate for Payer: Meridian Medicaid |
$33.77
|
| Rate for Payer: Nomi Health Commercial |
$56.76
|
| Rate for Payer: PACE SWMI |
$47.30
|
| Rate for Payer: PHP Medicare Advantage |
$47.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.80
|
| Rate for Payer: Priority Health HMO/PPO |
$75.82
|
| Rate for Payer: Priority Health Medicare |
$47.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.30
|
| Rate for Payer: UHC Exchange |
$47.30
|
| Rate for Payer: UHC Medicare Advantage |
$47.30
|
| Rate for Payer: UHCCP Medicaid |
$32.16
|
|
|
PR APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 29125
|
| Min. Negotiated Rate |
$26.20 |
| Max. Negotiated Rate |
$1,005.88 |
| Rate for Payer: Aetna Commercial |
$51.40
|
| Rate for Payer: Aetna Medicare |
$39.89
|
| Rate for Payer: BCBS Complete |
$27.51
|
| Rate for Payer: BCBS MAPPO |
$38.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,005.88
|
| Rate for Payer: BCN Commercial |
$97.74
|
| Rate for Payer: BCN Medicare Advantage |
$38.36
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cofinity Commercial |
$55.24
|
| Rate for Payer: Cofinity Commercial |
$51.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.36
|
| Rate for Payer: Mclaren Medicaid |
$26.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.28
|
| Rate for Payer: Meridian Medicaid |
$27.51
|
| Rate for Payer: Nomi Health Commercial |
$46.03
|
| Rate for Payer: PACE SWMI |
$38.36
|
| Rate for Payer: PHP Medicare Advantage |
$38.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.30
|
| Rate for Payer: Priority Health HMO/PPO |
$62.08
|
| Rate for Payer: Priority Health Medicare |
$38.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.36
|
| Rate for Payer: UHC Exchange |
$38.36
|
| Rate for Payer: UHC Medicare Advantage |
$38.36
|
| Rate for Payer: UHCCP Medicaid |
$26.20
|
|
|
PR APPLICATION SHORT LEG CAST BELOW KNEE-TOE
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
HCPCS 29405
|
| Min. Negotiated Rate |
$38.13 |
| Max. Negotiated Rate |
$1,199.24 |
| Rate for Payer: Aetna Commercial |
$75.24
|
| Rate for Payer: Aetna Medicare |
$58.40
|
| Rate for Payer: BCBS Complete |
$40.04
|
| Rate for Payer: BCBS MAPPO |
$56.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,199.24
|
| Rate for Payer: BCN Commercial |
$94.24
|
| Rate for Payer: BCN Medicare Advantage |
$56.15
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cofinity Commercial |
$80.86
|
| Rate for Payer: Cofinity Commercial |
$75.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.15
|
| Rate for Payer: Mclaren Medicaid |
$38.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.96
|
| Rate for Payer: Meridian Medicaid |
$40.04
|
| Rate for Payer: Nomi Health Commercial |
$67.38
|
| Rate for Payer: PACE SWMI |
$56.15
|
| Rate for Payer: PHP Medicare Advantage |
$56.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.45
|
| Rate for Payer: Priority Health HMO/PPO |
$90.07
|
| Rate for Payer: Priority Health Medicare |
$56.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.15
|
| Rate for Payer: UHC Exchange |
$56.15
|
| Rate for Payer: UHC Medicare Advantage |
$56.15
|
| Rate for Payer: UHCCP Medicaid |
$38.13
|
|
|
PR APPLICATION SHORT LEG CAST WALKING/AMBULATORY
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
HCPCS 29425
|
| Min. Negotiated Rate |
$35.15 |
| Max. Negotiated Rate |
$925.58 |
| Rate for Payer: Aetna Commercial |
$69.37
|
| Rate for Payer: Aetna Medicare |
$53.84
|
| Rate for Payer: BCBS Complete |
$36.91
|
| Rate for Payer: BCBS MAPPO |
$51.77
|
| Rate for Payer: BCBS Trust/PPO |
$925.58
|
| Rate for Payer: BCN Commercial |
$88.35
|
| Rate for Payer: BCN Medicare Advantage |
$51.77
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cofinity Commercial |
$74.55
|
| Rate for Payer: Cofinity Commercial |
$69.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.77
|
| Rate for Payer: Mclaren Medicaid |
$35.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.36
|
| Rate for Payer: Meridian Medicaid |
$36.91
|
| Rate for Payer: Nomi Health Commercial |
$62.12
|
| Rate for Payer: PACE SWMI |
$51.77
|
| Rate for Payer: PHP Medicare Advantage |
$51.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.15
|
| Rate for Payer: Priority Health HMO/PPO |
$82.95
|
| Rate for Payer: Priority Health Medicare |
$52.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.77
|
| Rate for Payer: UHC Exchange |
$51.77
|
| Rate for Payer: UHC Medicare Advantage |
$51.77
|
| Rate for Payer: UHCCP Medicaid |
$35.15
|
|
|
PR APPLICATION SHORT LEG SPLINT CALF FOOT
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
HCPCS 29515
|
| Min. Negotiated Rate |
$32.38 |
| Max. Negotiated Rate |
$1,249.96 |
| Rate for Payer: Aetna Commercial |
$64.20
|
| Rate for Payer: Aetna Medicare |
$49.83
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: BCBS MAPPO |
$47.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,249.96
|
| Rate for Payer: BCN Commercial |
$105.06
|
| Rate for Payer: BCN Medicare Advantage |
$47.91
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cofinity Commercial |
$68.99
|
| Rate for Payer: Cofinity Commercial |
$64.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.91
|
| Rate for Payer: Mclaren Medicaid |
$32.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.31
|
| Rate for Payer: Meridian Medicaid |
$34.00
|
| Rate for Payer: Nomi Health Commercial |
$57.49
|
| Rate for Payer: PACE SWMI |
$47.91
|
| Rate for Payer: PHP Medicare Advantage |
$47.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.90
|
| Rate for Payer: Priority Health HMO/PPO |
$76.33
|
| Rate for Payer: Priority Health Medicare |
$48.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.91
|
| Rate for Payer: UHC Exchange |
$47.91
|
| Rate for Payer: UHC Medicare Advantage |
$47.91
|
| Rate for Payer: UHCCP Medicaid |
$32.38
|
|
|
PR APPLICATION TOPICAL FLUORIDE VARNISH BY PHS/QHP
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 99188
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$413.66 |
| Rate for Payer: Aetna Commercial |
$11.43
|
| Rate for Payer: Aetna Medicare |
$17.50
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS Trust/PPO |
$413.66
|
| Rate for Payer: BCN Commercial |
$17.10
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Mclaren Medicaid |
$6.18
|
| Rate for Payer: Meridian Medicaid |
$6.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.75
|
| Rate for Payer: Priority Health HMO/PPO |
$13.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.11
|
| Rate for Payer: UHCCP Medicaid |
$6.18
|
|
|
PR APPLICATION UNIPLANE EXTERNAL FIXATION SYSTEM
|
Professional
|
Both
|
$1,025.00
|
|
|
Service Code
|
HCPCS 20690
|
| Min. Negotiated Rate |
$387.87 |
| Max. Negotiated Rate |
$8,162.77 |
| Rate for Payer: Aetna Commercial |
$772.46
|
| Rate for Payer: Aetna Medicare |
$599.52
|
| Rate for Payer: BCBS Complete |
$407.26
|
| Rate for Payer: BCBS MAPPO |
$576.46
|
| Rate for Payer: BCBS Trust/PPO |
$8,162.77
|
| Rate for Payer: BCN Commercial |
$874.25
|
| Rate for Payer: BCN Medicare Advantage |
$576.46
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cofinity Commercial |
$772.46
|
| Rate for Payer: Cofinity Commercial |
$830.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$576.46
|
| Rate for Payer: Mclaren Medicaid |
$387.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$605.28
|
| Rate for Payer: Meridian Medicaid |
$407.26
|
| Rate for Payer: Nomi Health Commercial |
$691.75
|
| Rate for Payer: PACE SWMI |
$576.46
|
| Rate for Payer: PHP Medicare Advantage |
$576.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$387.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$666.25
|
| Rate for Payer: Priority Health HMO/PPO |
$917.99
|
| Rate for Payer: Priority Health Medicare |
$582.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$917.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$576.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$576.46
|
| Rate for Payer: UHC Exchange |
$576.46
|
| Rate for Payer: UHC Medicare Advantage |
$576.46
|
| Rate for Payer: UHCCP Medicaid |
$387.87
|
|
|
PR APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC
|
Professional
|
Both
|
$1,803.00
|
|
|
Service Code
|
HCPCS 21110
|
| Min. Negotiated Rate |
$580.95 |
| Max. Negotiated Rate |
$1,268.61 |
| Rate for Payer: Aetna Commercial |
$867.03
|
| Rate for Payer: Aetna Medicare |
$672.92
|
| Rate for Payer: BCBS Complete |
$721.20
|
| Rate for Payer: BCBS MAPPO |
$647.04
|
| Rate for Payer: BCBS Trust/PPO |
$580.95
|
| Rate for Payer: BCN Commercial |
$1,268.61
|
| Rate for Payer: BCN Medicare Advantage |
$647.04
|
| Rate for Payer: Cash Price |
$1,442.40
|
| Rate for Payer: Cash Price |
$1,442.40
|
| Rate for Payer: Cofinity Commercial |
$867.03
|
| Rate for Payer: Cofinity Commercial |
$931.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$647.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$679.39
|
| Rate for Payer: Nomi Health Commercial |
$776.45
|
| Rate for Payer: PACE SWMI |
$647.04
|
| Rate for Payer: PHP Medicare Advantage |
$647.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.95
|
| Rate for Payer: Priority Health HMO/PPO |
$1,084.89
|
| Rate for Payer: Priority Health Medicare |
$653.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,084.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$647.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$647.04
|
| Rate for Payer: UHC Exchange |
$647.04
|
| Rate for Payer: UHC Medicare Advantage |
$647.04
|
|
|
PR APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT
|
Professional
|
Both
|
$195.00
|
|
|
Service Code
|
HCPCS 29581
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$1,232.52 |
| Rate for Payer: Aetna Commercial |
$33.62
|
| Rate for Payer: Aetna Medicare |
$26.09
|
| Rate for Payer: BCBS Complete |
$17.67
|
| Rate for Payer: BCBS MAPPO |
$25.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,232.52
|
| Rate for Payer: BCN Commercial |
$130.48
|
| Rate for Payer: BCN Medicare Advantage |
$25.09
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cofinity Commercial |
$36.13
|
| Rate for Payer: Cofinity Commercial |
$33.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.09
|
| Rate for Payer: Mclaren Medicaid |
$16.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.34
|
| Rate for Payer: Meridian Medicaid |
$17.67
|
| Rate for Payer: Nomi Health Commercial |
$30.11
|
| Rate for Payer: PACE SWMI |
$25.09
|
| Rate for Payer: PHP Medicare Advantage |
$25.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.75
|
| Rate for Payer: Priority Health HMO/PPO |
$40.20
|
| Rate for Payer: Priority Health Medicare |
$25.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.09
|
| Rate for Payer: UHC Exchange |
$25.09
|
| Rate for Payer: UHC Medicare Advantage |
$25.09
|
| Rate for Payer: UHCCP Medicaid |
$16.83
|
|
|
PR APPL MLTLAYR COMPRES SYSTEM UPPER & LOWER ARM
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS 29583
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$53.95 |
| Rate for Payer: Aetna Medicare |
$41.50
|
| Rate for Payer: BCBS Complete |
$33.20
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.95
|
|
|
PR APPL MLTLAYR COMPRES SYS UPARM LWARM HAND&FING
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 29584
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$1,140.60 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna Medicare |
$15.54
|
| Rate for Payer: BCBS Complete |
$10.51
|
| Rate for Payer: BCBS MAPPO |
$14.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,140.60
|
| Rate for Payer: BCN Commercial |
$119.72
|
| Rate for Payer: BCN Medicare Advantage |
$14.94
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$21.51
|
| Rate for Payer: Cofinity Commercial |
$20.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.94
|
| Rate for Payer: Mclaren Medicaid |
$10.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.69
|
| Rate for Payer: Meridian Medicaid |
$10.51
|
| Rate for Payer: Nomi Health Commercial |
$17.93
|
| Rate for Payer: PACE SWMI |
$14.94
|
| Rate for Payer: PHP Medicare Advantage |
$14.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| Rate for Payer: Priority Health HMO/PPO |
$23.40
|
| Rate for Payer: Priority Health Medicare |
$15.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.94
|
| Rate for Payer: UHC Exchange |
$14.94
|
| Rate for Payer: UHC Medicare Advantage |
$14.94
|
| Rate for Payer: UHCCP Medicaid |
$10.01
|
|
|
PR APPL MLTLAYR COMPRES THGH LEG ANKLE FT WHEN DONE
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 29582
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$85.80 |
| Rate for Payer: Aetna Medicare |
$66.00
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
|
|
PR APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 97014
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$1,449.66 |
| Rate for Payer: Aetna Commercial |
$9.73
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,449.66
|
| Rate for Payer: BCN Commercial |
$12.07
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: Priority Health HMO/PPO |
$77.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.25
|
|
