|
PR APPLICATION MODALITY 1/> AREAS WHIRLPOOL
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 97022
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$89.48 |
| Rate for Payer: Aetna Commercial |
$19.97
|
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.46
|
| Rate for Payer: BCBS MAPPO |
$14.90
|
| Rate for Payer: BCN Commercial |
$16.03
|
| Rate for Payer: BCN Medicare Advantage |
$14.90
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$21.46
|
| Rate for Payer: Cofinity Commercial |
$19.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.39
|
| Rate for Payer: Nomi Health Commercial |
$17.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.25
|
| Rate for Payer: PACE SWMI |
$14.90
|
| Rate for Payer: PHP Commercial |
$20.86
|
| Rate for Payer: PHP Medicare Advantage |
$14.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$89.48
|
| Rate for Payer: Priority Health Medicare |
$14.90
|
| Rate for Payer: Priority Health SBD |
$89.48
|
| Rate for Payer: Priority Health Tiered Network |
$89.48
|
| Rate for Payer: Railroad Medicare Medicare |
$14.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.65
|
| Rate for Payer: UHC Core |
$15.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.90
|
| Rate for Payer: UHC Exchange |
$15.65
|
| Rate for Payer: UMR Bronson Commercial |
$16.10
|
|
|
PR APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM
|
Professional
|
Both
|
$1,983.00
|
|
|
Service Code
|
HCPCS 20692
|
| Min. Negotiated Rate |
$667.76 |
| Max. Negotiated Rate |
$1,956.37 |
| Rate for Payer: Aetna Commercial |
$1,371.14
|
| Rate for Payer: Aetna Medicare |
$1,064.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,371.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,473.47
|
| Rate for Payer: BCBS Complete |
$701.15
|
| Rate for Payer: BCBS MAPPO |
$1,023.24
|
| Rate for Payer: BCN Commercial |
$1,715.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,023.24
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cofinity Commercial |
$1,371.14
|
| Rate for Payer: Cofinity Commercial |
$1,473.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,023.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,074.40
|
| Rate for Payer: Meridian Medicaid |
$701.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,125.56
|
| Rate for Payer: Nomi Health Commercial |
$1,227.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,487.25
|
| Rate for Payer: PACE SWMI |
$1,023.24
|
| Rate for Payer: PHP Commercial |
$1,432.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,023.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$667.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,833.87
|
| Rate for Payer: Priority Health Medicare |
$1,023.24
|
| Rate for Payer: Priority Health SBD |
$1,833.87
|
| Rate for Payer: Priority Health Tiered Network |
$1,833.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1,023.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,956.37
|
| Rate for Payer: UHC Core |
$1,956.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,023.24
|
| Rate for Payer: UHC Exchange |
$1,956.37
|
| Rate for Payer: UHC Medicaid |
$667.76
|
| Rate for Payer: UHCCP Medicaid |
$667.76
|
| Rate for Payer: UMR Bronson Commercial |
$912.18
|
|
|
PR APPLICATION OF SURFACE NEUROSTIMULATOR
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS 64550
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Medicare |
$17.00
|
| Rate for Payer: BCBS Complete |
$13.60
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.50
|
| Rate for Payer: UMR Bronson Commercial |
$15.64
|
|
|
PR APPLICATION PATELLAR TENDON BEARING CAST
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
HCPCS 29435
|
| Min. Negotiated Rate |
$51.76 |
| Max. Negotiated Rate |
$269.25 |
| Rate for Payer: Aetna Commercial |
$106.10
|
| Rate for Payer: Aetna Medicare |
$82.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.02
|
| Rate for Payer: BCBS Complete |
$54.35
|
| Rate for Payer: BCBS MAPPO |
$79.18
|
| Rate for Payer: BCN Commercial |
$131.47
|
| Rate for Payer: BCN Medicare Advantage |
$79.18
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cofinity Commercial |
$114.02
|
| Rate for Payer: Cofinity Commercial |
$106.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.14
|
| Rate for Payer: Meridian Medicaid |
$54.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$87.10
|
| Rate for Payer: Nomi Health Commercial |
$95.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.25
|
| Rate for Payer: PACE SWMI |
$79.18
|
| Rate for Payer: PHP Commercial |
$110.85
|
| Rate for Payer: PHP Medicare Advantage |
$79.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$140.53
|
| Rate for Payer: Priority Health Medicare |
$79.18
|
| Rate for Payer: Priority Health SBD |
$140.53
|
| Rate for Payer: Priority Health Tiered Network |
$140.53
|
| Rate for Payer: Railroad Medicare Medicare |
$79.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.44
|
| Rate for Payer: UHC Core |
$142.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$79.18
|
| Rate for Payer: UHC Exchange |
$142.44
|
| Rate for Payer: UHC Medicaid |
$51.76
|
| Rate for Payer: UHCCP Medicaid |
$51.76
|
| Rate for Payer: UMR Bronson Commercial |
$165.14
|
|
|
PR APPLICATION RIGHT & LEFT PULMONARY ARTERY BAND
|
Professional
|
Both
|
$3,462.00
|
|
|
Service Code
|
HCPCS 33620
|
| Min. Negotiated Rate |
$980.44 |
| Max. Negotiated Rate |
$2,940.98 |
| Rate for Payer: Aetna Commercial |
$2,066.19
|
| Rate for Payer: Aetna Medicare |
$1,603.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,066.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,220.38
|
| Rate for Payer: BCBS Complete |
$1,029.46
|
| Rate for Payer: BCBS MAPPO |
$1,541.93
|
| Rate for Payer: BCN Commercial |
$2,423.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,541.93
|
| Rate for Payer: Cash Price |
$2,769.60
|
| Rate for Payer: Cash Price |
$2,769.60
|
| Rate for Payer: Cofinity Commercial |
$2,066.19
|
| Rate for Payer: Cofinity Commercial |
$2,220.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,541.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,619.03
|
| Rate for Payer: Meridian Medicaid |
$1,029.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,696.12
|
| Rate for Payer: Nomi Health Commercial |
$1,850.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,596.50
|
| Rate for Payer: PACE SWMI |
$1,541.93
|
| Rate for Payer: PHP Commercial |
$2,158.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,541.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$980.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,606.35
|
| Rate for Payer: Priority Health Medicare |
$1,541.93
|
| Rate for Payer: Priority Health SBD |
$2,606.35
|
| Rate for Payer: Priority Health Tiered Network |
$2,606.35
|
| Rate for Payer: Railroad Medicare Medicare |
$1,541.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,940.98
|
| Rate for Payer: UHC Core |
$2,940.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,541.93
|
| Rate for Payer: UHC Exchange |
$2,940.98
|
| Rate for Payer: UHC Medicaid |
$980.44
|
| Rate for Payer: UHCCP Medicaid |
$980.44
|
| Rate for Payer: UMR Bronson Commercial |
$1,592.52
|
|
|
PR APPLICATION RIGID TOTAL CONTACT LEG CAST
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
HCPCS 29445
|
| Min. Negotiated Rate |
$57.72 |
| Max. Negotiated Rate |
$291.00 |
| Rate for Payer: Aetna Commercial |
$119.45
|
| Rate for Payer: Aetna Medicare |
$92.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.36
|
| Rate for Payer: BCBS Complete |
$60.61
|
| Rate for Payer: BCBS MAPPO |
$89.14
|
| Rate for Payer: BCN Commercial |
$115.85
|
| Rate for Payer: BCN Medicare Advantage |
$89.14
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Cofinity Commercial |
$119.45
|
| Rate for Payer: Cofinity Commercial |
$128.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.60
|
| Rate for Payer: Meridian Medicaid |
$60.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$98.05
|
| Rate for Payer: Nomi Health Commercial |
$106.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$291.00
|
| Rate for Payer: PACE SWMI |
$89.14
|
| Rate for Payer: PHP Commercial |
$124.80
|
| Rate for Payer: PHP Medicare Advantage |
$89.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$157.03
|
| Rate for Payer: Priority Health Medicare |
$89.14
|
| Rate for Payer: Priority Health SBD |
$157.03
|
| Rate for Payer: Priority Health Tiered Network |
$157.03
|
| Rate for Payer: Railroad Medicare Medicare |
$89.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.59
|
| Rate for Payer: UHC Core |
$179.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$89.14
|
| Rate for Payer: UHC Exchange |
$179.59
|
| Rate for Payer: UHC Medicaid |
$57.72
|
| Rate for Payer: UHCCP Medicaid |
$57.72
|
| Rate for Payer: UMR Bronson Commercial |
$178.48
|
|
|
PR APPLICATION SHORT ARM SPLINT DYNAMIC
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS 29126
|
| Min. Negotiated Rate |
$28.97 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Aetna Commercial |
$59.01
|
| Rate for Payer: Aetna Medicare |
$45.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.42
|
| Rate for Payer: BCBS Complete |
$30.42
|
| Rate for Payer: BCBS MAPPO |
$44.04
|
| Rate for Payer: BCN Commercial |
$75.19
|
| Rate for Payer: BCN Medicare Advantage |
$44.04
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cofinity Commercial |
$59.01
|
| Rate for Payer: Cofinity Commercial |
$63.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.24
|
| Rate for Payer: Meridian Medicaid |
$30.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$48.44
|
| Rate for Payer: Nomi Health Commercial |
$52.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.50
|
| Rate for Payer: PACE SWMI |
$44.04
|
| Rate for Payer: PHP Commercial |
$61.66
|
| Rate for Payer: PHP Medicare Advantage |
$44.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$80.38
|
| Rate for Payer: Priority Health Medicare |
$44.04
|
| Rate for Payer: Priority Health SBD |
$80.38
|
| Rate for Payer: Priority Health Tiered Network |
$80.38
|
| Rate for Payer: Railroad Medicare Medicare |
$44.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.55
|
| Rate for Payer: UHC Core |
$84.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$44.04
|
| Rate for Payer: UHC Exchange |
$84.55
|
| Rate for Payer: UHC Medicaid |
$28.97
|
| Rate for Payer: UHCCP Medicaid |
$28.97
|
| Rate for Payer: UMR Bronson Commercial |
$91.08
|
|
|
PR APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
HCPCS 29125
|
| Min. Negotiated Rate |
$26.20 |
| Max. Negotiated Rate |
$109.50 |
| Rate for Payer: Aetna Commercial |
$53.04
|
| Rate for Payer: Aetna Medicare |
$41.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.00
|
| Rate for Payer: BCBS Complete |
$27.51
|
| Rate for Payer: BCBS MAPPO |
$39.58
|
| Rate for Payer: BCN Commercial |
$61.25
|
| Rate for Payer: BCN Medicare Advantage |
$39.58
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$57.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.56
|
| Rate for Payer: Meridian Medicaid |
$27.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$43.54
|
| Rate for Payer: Nomi Health Commercial |
$47.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.50
|
| Rate for Payer: PACE SWMI |
$39.58
|
| Rate for Payer: PHP Commercial |
$55.41
|
| Rate for Payer: PHP Medicare Advantage |
$39.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$65.48
|
| Rate for Payer: Priority Health Medicare |
$39.58
|
| Rate for Payer: Priority Health SBD |
$65.48
|
| Rate for Payer: Priority Health Tiered Network |
$65.48
|
| Rate for Payer: Railroad Medicare Medicare |
$39.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.07
|
| Rate for Payer: UHC Core |
$68.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$39.58
|
| Rate for Payer: UHC Exchange |
$68.07
|
| Rate for Payer: UHC Medicaid |
$26.20
|
| Rate for Payer: UHCCP Medicaid |
$26.20
|
| Rate for Payer: UMR Bronson Commercial |
$67.16
|
|
|
PR APPLICATION SHORT LEG CAST BELOW KNEE-TOE
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 29405
|
| Min. Negotiated Rate |
$35.57 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$72.53
|
| Rate for Payer: Aetna Medicare |
$56.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.95
|
| Rate for Payer: BCBS Complete |
$37.35
|
| Rate for Payer: BCBS MAPPO |
$54.13
|
| Rate for Payer: BCN Commercial |
$70.29
|
| Rate for Payer: BCN Medicare Advantage |
$54.13
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cofinity Commercial |
$72.53
|
| Rate for Payer: Cofinity Commercial |
$77.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.84
|
| Rate for Payer: Meridian Medicaid |
$37.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$59.54
|
| Rate for Payer: Nomi Health Commercial |
$64.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.00
|
| Rate for Payer: PACE SWMI |
$54.13
|
| Rate for Payer: PHP Commercial |
$75.78
|
| Rate for Payer: PHP Medicare Advantage |
$54.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$95.29
|
| Rate for Payer: Priority Health Medicare |
$54.13
|
| Rate for Payer: Priority Health SBD |
$95.29
|
| Rate for Payer: Priority Health Tiered Network |
$95.29
|
| Rate for Payer: Railroad Medicare Medicare |
$54.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.02
|
| Rate for Payer: UHC Core |
$102.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$54.13
|
| Rate for Payer: UHC Exchange |
$102.02
|
| Rate for Payer: UHC Medicaid |
$35.57
|
| Rate for Payer: UHCCP Medicaid |
$35.57
|
| Rate for Payer: UMR Bronson Commercial |
$110.40
|
|
|
PR APPLICATION SHORT LEG CAST WALKING/AMBULATORY
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
HCPCS 29425
|
| Min. Negotiated Rate |
$32.59 |
| Max. Negotiated Rate |
$209.25 |
| Rate for Payer: Aetna Commercial |
$66.42
|
| Rate for Payer: Aetna Medicare |
$51.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.38
|
| Rate for Payer: BCBS Complete |
$34.22
|
| Rate for Payer: BCBS MAPPO |
$49.57
|
| Rate for Payer: BCN Commercial |
$64.80
|
| Rate for Payer: BCN Medicare Advantage |
$49.57
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cofinity Commercial |
$66.42
|
| Rate for Payer: Cofinity Commercial |
$71.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.05
|
| Rate for Payer: Meridian Medicaid |
$34.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.53
|
| Rate for Payer: Nomi Health Commercial |
$59.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.25
|
| Rate for Payer: PACE SWMI |
$49.57
|
| Rate for Payer: PHP Commercial |
$69.40
|
| Rate for Payer: PHP Medicare Advantage |
$49.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$87.83
|
| Rate for Payer: Priority Health Medicare |
$49.57
|
| Rate for Payer: Priority Health SBD |
$87.83
|
| Rate for Payer: Priority Health Tiered Network |
$87.83
|
| Rate for Payer: Railroad Medicare Medicare |
$49.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.20
|
| Rate for Payer: UHC Core |
$96.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.57
|
| Rate for Payer: UHC Exchange |
$96.20
|
| Rate for Payer: UHC Medicaid |
$32.59
|
| Rate for Payer: UHCCP Medicaid |
$32.59
|
| Rate for Payer: UMR Bronson Commercial |
$128.34
|
|
|
PR APPLICATION SHORT LEG SPLINT CALF TO FOOT
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 29515
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$97.50 |
| Rate for Payer: Aetna Commercial |
$64.82
|
| Rate for Payer: Aetna Medicare |
$50.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.65
|
| Rate for Payer: BCBS Complete |
$33.33
|
| Rate for Payer: BCBS MAPPO |
$48.37
|
| Rate for Payer: BCN Commercial |
$75.70
|
| Rate for Payer: BCN Medicare Advantage |
$48.37
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cofinity Commercial |
$64.82
|
| Rate for Payer: Cofinity Commercial |
$69.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.79
|
| Rate for Payer: Meridian Medicaid |
$33.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.21
|
| Rate for Payer: Nomi Health Commercial |
$58.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.50
|
| Rate for Payer: PACE SWMI |
$48.37
|
| Rate for Payer: PHP Commercial |
$67.72
|
| Rate for Payer: PHP Medicare Advantage |
$48.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$80.92
|
| Rate for Payer: Priority Health Medicare |
$48.37
|
| Rate for Payer: Priority Health SBD |
$80.92
|
| Rate for Payer: Priority Health Tiered Network |
$80.92
|
| Rate for Payer: Railroad Medicare Medicare |
$48.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.06
|
| Rate for Payer: UHC Core |
$86.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$48.37
|
| Rate for Payer: UHC Exchange |
$86.06
|
| Rate for Payer: UHC Medicaid |
$31.74
|
| Rate for Payer: UHCCP Medicaid |
$31.74
|
| Rate for Payer: UMR Bronson Commercial |
$59.80
|
|
|
PR APPLICATION TOPICAL FLUORIDE VARNISH BY PHS/QHP
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 99188
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$11.43
|
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.43
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCN Commercial |
$14.45
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Meridian Medicaid |
$5.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.32
|
| Rate for Payer: Priority Health SBD |
$13.32
|
| Rate for Payer: Priority Health Tiered Network |
$13.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.03
|
| Rate for Payer: UHC Core |
$17.03
|
| Rate for Payer: UHC Exchange |
$17.03
|
| Rate for Payer: UHC Medicaid |
$5.33
|
| Rate for Payer: UHCCP Medicaid |
$5.33
|
| Rate for Payer: UMR Bronson Commercial |
$16.56
|
|
|
PR APPLICATION UNIPLANE EXTERNAL FIXATION SYSTEM
|
Professional
|
Both
|
$1,056.00
|
|
|
Service Code
|
HCPCS 20690
|
| Min. Negotiated Rate |
$348.04 |
| Max. Negotiated Rate |
$1,044.99 |
| Rate for Payer: Aetna Commercial |
$717.76
|
| Rate for Payer: Aetna Medicare |
$557.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$717.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$771.32
|
| Rate for Payer: BCBS Complete |
$365.44
|
| Rate for Payer: BCBS MAPPO |
$535.64
|
| Rate for Payer: BCN Commercial |
$906.82
|
| Rate for Payer: BCN Medicare Advantage |
$535.64
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cofinity Commercial |
$771.32
|
| Rate for Payer: Cofinity Commercial |
$717.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$535.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$562.42
|
| Rate for Payer: Meridian Medicaid |
$365.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$589.20
|
| Rate for Payer: Nomi Health Commercial |
$642.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$792.00
|
| Rate for Payer: PACE SWMI |
$535.64
|
| Rate for Payer: PHP Commercial |
$749.90
|
| Rate for Payer: PHP Medicare Advantage |
$535.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$969.37
|
| Rate for Payer: Priority Health Medicare |
$535.64
|
| Rate for Payer: Priority Health SBD |
$969.37
|
| Rate for Payer: Priority Health Tiered Network |
$969.37
|
| Rate for Payer: Railroad Medicare Medicare |
$535.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,044.99
|
| Rate for Payer: UHC Core |
$1,044.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$535.64
|
| Rate for Payer: UHC Exchange |
$1,044.99
|
| Rate for Payer: UHC Medicaid |
$348.04
|
| Rate for Payer: UHCCP Medicaid |
$348.04
|
| Rate for Payer: UMR Bronson Commercial |
$485.76
|
|
|
PR APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC
|
Professional
|
Both
|
$1,857.00
|
|
|
Service Code
|
HCPCS 21110
|
| Min. Negotiated Rate |
$638.09 |
| Max. Negotiated Rate |
$1,392.75 |
| Rate for Payer: Aetna Commercial |
$855.04
|
| Rate for Payer: Aetna Medicare |
$663.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$855.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$918.85
|
| Rate for Payer: BCBS Complete |
$742.80
|
| Rate for Payer: BCBS MAPPO |
$638.09
|
| Rate for Payer: BCN Commercial |
$1,055.72
|
| Rate for Payer: BCN Medicare Advantage |
$638.09
|
| Rate for Payer: Cash Price |
$1,485.60
|
| Rate for Payer: Cash Price |
$1,485.60
|
| Rate for Payer: Cofinity Commercial |
$918.85
|
| Rate for Payer: Cofinity Commercial |
$855.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$638.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$669.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$701.90
|
| Rate for Payer: Nomi Health Commercial |
$765.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,392.75
|
| Rate for Payer: PACE SWMI |
$638.09
|
| Rate for Payer: PHP Commercial |
$893.33
|
| Rate for Payer: PHP Medicare Advantage |
$638.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,128.54
|
| Rate for Payer: Priority Health Medicare |
$638.09
|
| Rate for Payer: Priority Health SBD |
$1,128.54
|
| Rate for Payer: Priority Health Tiered Network |
$1,128.54
|
| Rate for Payer: Railroad Medicare Medicare |
$638.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,164.96
|
| Rate for Payer: UHC Core |
$1,164.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$638.09
|
| Rate for Payer: UHC Exchange |
$1,164.96
|
| Rate for Payer: UMR Bronson Commercial |
$854.22
|
|
|
PR APPL MLTLAYR CMPRN SYS LEG BELW KNE W/ANKLE&FOOT
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
HCPCS 29581
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$150.75 |
| Rate for Payer: Aetna Commercial |
$30.59
|
| Rate for Payer: Aetna Medicare |
$23.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.88
|
| Rate for Payer: BCBS Complete |
$15.44
|
| Rate for Payer: BCBS MAPPO |
$22.83
|
| Rate for Payer: BCN Commercial |
$39.34
|
| Rate for Payer: BCN Medicare Advantage |
$22.83
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cofinity Commercial |
$32.88
|
| Rate for Payer: Cofinity Commercial |
$30.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.97
|
| Rate for Payer: Meridian Medicaid |
$15.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.11
|
| Rate for Payer: Nomi Health Commercial |
$27.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.75
|
| Rate for Payer: PACE SWMI |
$22.83
|
| Rate for Payer: PHP Commercial |
$31.96
|
| Rate for Payer: PHP Medicare Advantage |
$22.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$42.05
|
| Rate for Payer: Priority Health Medicare |
$22.83
|
| Rate for Payer: Priority Health SBD |
$42.05
|
| Rate for Payer: Priority Health Tiered Network |
$42.05
|
| Rate for Payer: Railroad Medicare Medicare |
$22.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.28
|
| Rate for Payer: UHC Core |
$49.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.83
|
| Rate for Payer: UHC Exchange |
$49.28
|
| Rate for Payer: UHC Medicaid |
$14.70
|
| Rate for Payer: UHCCP Medicaid |
$14.70
|
| Rate for Payer: UMR Bronson Commercial |
$92.46
|
|
|
PR APPL MLTLAYR COMPRES SYSTEM UPPER & LOWER ARM
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 29583
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Aetna Medicare |
$42.50
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.75
|
| Rate for Payer: UMR Bronson Commercial |
$39.10
|
|
|
PR APPL MLTLAYR COMPRES THGH LEG ANKLE FT WHEN DONE
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 29582
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna Medicare |
$68.00
|
| Rate for Payer: BCBS Complete |
$54.40
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.00
|
| Rate for Payer: UMR Bronson Commercial |
$62.56
|
|
|
PR APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 97014
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$89.48 |
| Rate for Payer: Aetna Commercial |
$9.73
|
| Rate for Payer: Aetna Medicare |
$13.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.73
|
| Rate for Payer: BCN Commercial |
$12.69
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$89.48
|
| Rate for Payer: Priority Health SBD |
$89.48
|
| Rate for Payer: Priority Health Tiered Network |
$89.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.71
|
| Rate for Payer: UHC Core |
$12.71
|
| Rate for Payer: UHC Exchange |
$12.71
|
| Rate for Payer: UMR Bronson Commercial |
$12.42
|
|
|
PR APPL MODALITY 1+ AREAS ESTIM EA 15 MIN
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 97032
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$89.48 |
| Rate for Payer: Aetna Commercial |
$19.05
|
| Rate for Payer: Aetna Medicare |
$14.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.48
|
| Rate for Payer: BCBS MAPPO |
$14.22
|
| Rate for Payer: BCN Commercial |
$14.69
|
| Rate for Payer: BCN Medicare Advantage |
$14.22
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$20.48
|
| Rate for Payer: Cofinity Commercial |
$19.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.64
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.00
|
| Rate for Payer: PACE SWMI |
$14.22
|
| Rate for Payer: PHP Commercial |
$19.91
|
| Rate for Payer: PHP Medicare Advantage |
$14.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$89.48
|
| Rate for Payer: Priority Health Medicare |
$14.22
|
| Rate for Payer: Priority Health SBD |
$89.48
|
| Rate for Payer: Priority Health Tiered Network |
$89.48
|
| Rate for Payer: Railroad Medicare Medicare |
$14.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.20
|
| Rate for Payer: UHC Core |
$13.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.22
|
| Rate for Payer: UHC Exchange |
$13.20
|
| Rate for Payer: UMR Bronson Commercial |
$14.72
|
|
|
PR APPL MODALITY 1+ AREAS IONTOPHORESIS EA 15 MIN
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 97033
|
| Min. Negotiated Rate |
$18.21 |
| Max. Negotiated Rate |
$89.48 |
| Rate for Payer: Aetna Commercial |
$24.40
|
| Rate for Payer: Aetna Medicare |
$18.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.22
|
| Rate for Payer: BCBS MAPPO |
$18.21
|
| Rate for Payer: BCN Commercial |
$19.36
|
| Rate for Payer: BCN Medicare Advantage |
$18.21
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$24.40
|
| Rate for Payer: Cofinity Commercial |
$26.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.03
|
| Rate for Payer: Nomi Health Commercial |
$21.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.00
|
| Rate for Payer: PACE SWMI |
$18.21
|
| Rate for Payer: PHP Commercial |
$25.49
|
| Rate for Payer: PHP Medicare Advantage |
$18.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$89.48
|
| Rate for Payer: Priority Health Medicare |
$18.21
|
| Rate for Payer: Priority Health SBD |
$89.48
|
| Rate for Payer: Priority Health Tiered Network |
$89.48
|
| Rate for Payer: Railroad Medicare Medicare |
$18.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.28
|
| Rate for Payer: UHC Core |
$18.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.21
|
| Rate for Payer: UHC Exchange |
$18.28
|
| Rate for Payer: UMR Bronson Commercial |
$22.08
|
|
|
PR APPL MODALITY 1+ AREAS ULTRASOUND EA 15 MIN
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 97035
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$89.48 |
| Rate for Payer: Aetna Commercial |
$18.49
|
| Rate for Payer: Aetna Medicare |
$14.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.87
|
| Rate for Payer: BCBS MAPPO |
$13.80
|
| Rate for Payer: BCN Commercial |
$14.35
|
| Rate for Payer: BCN Medicare Advantage |
$13.80
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$19.87
|
| Rate for Payer: Cofinity Commercial |
$18.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.18
|
| Rate for Payer: Nomi Health Commercial |
$16.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.25
|
| Rate for Payer: PACE SWMI |
$13.80
|
| Rate for Payer: PHP Commercial |
$19.32
|
| Rate for Payer: PHP Medicare Advantage |
$13.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$89.48
|
| Rate for Payer: Priority Health Medicare |
$13.80
|
| Rate for Payer: Priority Health SBD |
$89.48
|
| Rate for Payer: Priority Health Tiered Network |
$89.48
|
| Rate for Payer: Railroad Medicare Medicare |
$13.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.79
|
| Rate for Payer: UHC Core |
$12.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.80
|
| Rate for Payer: UHC Exchange |
$12.79
|
| Rate for Payer: UMR Bronson Commercial |
$10.58
|
|
|
PR APPL MULTILAYR CMPRN SYS UPR ARM F/ARM HAND&FNGR
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 29584
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna Commercial |
$17.77
|
| Rate for Payer: Aetna Medicare |
$13.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.09
|
| Rate for Payer: BCBS Complete |
$8.95
|
| Rate for Payer: BCBS MAPPO |
$13.26
|
| Rate for Payer: BCN Commercial |
$23.40
|
| Rate for Payer: BCN Medicare Advantage |
$13.26
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.92
|
| Rate for Payer: Meridian Medicaid |
$8.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.59
|
| Rate for Payer: Nomi Health Commercial |
$15.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.00
|
| Rate for Payer: PACE SWMI |
$13.26
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: PHP Medicare Advantage |
$13.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25.01
|
| Rate for Payer: Priority Health Medicare |
$13.26
|
| Rate for Payer: Priority Health SBD |
$25.01
|
| Rate for Payer: Priority Health Tiered Network |
$25.01
|
| Rate for Payer: Railroad Medicare Medicare |
$13.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.92
|
| Rate for Payer: UHC Core |
$28.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.26
|
| Rate for Payer: UHC Exchange |
$28.92
|
| Rate for Payer: UHC Medicaid |
$8.52
|
| Rate for Payer: UHCCP Medicaid |
$8.52
|
| Rate for Payer: UMR Bronson Commercial |
$62.56
|
|
|
PR APPL SKIN CELL SSP AGRFT T/A/L 1ST 480 SQ CM/<
|
Professional
|
Both
|
$2,449.00
|
|
|
Service Code
|
HCPCS 15015
|
| Min. Negotiated Rate |
$360.51 |
| Max. Negotiated Rate |
$2,744.01 |
| Rate for Payer: Aetna Medicare |
$1,224.50
|
| Rate for Payer: BCBS Complete |
$378.54
|
| Rate for Payer: BCN Commercial |
$1,710.33
|
| Rate for Payer: Cash Price |
$1,959.20
|
| Rate for Payer: Cash Price |
$1,959.20
|
| Rate for Payer: Meridian Medicaid |
$378.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,836.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$360.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,744.01
|
| Rate for Payer: Priority Health SBD |
$2,744.01
|
| Rate for Payer: Priority Health Tiered Network |
$2,744.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,338.43
|
| Rate for Payer: UHC Core |
$1,338.43
|
| Rate for Payer: UHC Exchange |
$1,338.43
|
| Rate for Payer: UHC Medicaid |
$360.51
|
| Rate for Payer: UHCCP Medicaid |
$360.51
|
| Rate for Payer: UMR Bronson Commercial |
$1,126.54
|
|
|
PR APPL SKIN CELL SSP AGRFT T/A/L EA ADDL 480 SQ CM
|
Professional
|
Both
|
$2,449.00
|
|
|
Service Code
|
HCPCS 15016
|
| Min. Negotiated Rate |
$58.34 |
| Max. Negotiated Rate |
$1,836.75 |
| Rate for Payer: Aetna Medicare |
$1,224.50
|
| Rate for Payer: BCBS Complete |
$61.26
|
| Rate for Payer: Cash Price |
$1,959.20
|
| Rate for Payer: Cash Price |
$1,959.20
|
| Rate for Payer: Meridian Medicaid |
$61.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,836.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.80
|
| Rate for Payer: UHC Core |
$227.80
|
| Rate for Payer: UHC Exchange |
$227.80
|
| Rate for Payer: UHC Medicaid |
$58.34
|
| Rate for Payer: UHCCP Medicaid |
$58.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,126.54
|
|
|
PR APPL SKN CLL SSP AGRFT F/S/N/H/F/G/M/DGT 1ST 480
|
Professional
|
Both
|
$2,449.00
|
|
|
Service Code
|
HCPCS 15017
|
| Min. Negotiated Rate |
$380.83 |
| Max. Negotiated Rate |
$2,744.01 |
| Rate for Payer: Aetna Medicare |
$1,224.50
|
| Rate for Payer: BCBS Complete |
$399.87
|
| Rate for Payer: BCN Commercial |
$1,710.33
|
| Rate for Payer: Cash Price |
$1,959.20
|
| Rate for Payer: Cash Price |
$1,959.20
|
| Rate for Payer: Meridian Medicaid |
$399.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,836.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$380.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,744.01
|
| Rate for Payer: Priority Health SBD |
$2,744.01
|
| Rate for Payer: Priority Health Tiered Network |
$2,744.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,542.08
|
| Rate for Payer: UHC Core |
$1,542.08
|
| Rate for Payer: UHC Exchange |
$1,542.08
|
| Rate for Payer: UHC Medicaid |
$380.83
|
| Rate for Payer: UHCCP Medicaid |
$380.83
|
| Rate for Payer: UMR Bronson Commercial |
$1,126.54
|
|
