|
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: Aetna New Business (MI Preferred) |
$145.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.84
|
| 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 Commercial |
$141.92
|
| Rate for Payer: PHP Medicare Advantage |
$101.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health Medicare |
$101.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.37
|
| Rate for Payer: UHC Medicare Advantage |
$101.37
|
| Rate for Payer: UMR Bronson Commercial |
$115.92
|
|
|
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: Aetna New Business (MI Preferred) |
$72.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.71
|
| 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 Commercial |
$70.74
|
| Rate for Payer: PHP Medicare Advantage |
$50.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.05
|
| Rate for Payer: Priority Health Medicare |
$50.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.53
|
| Rate for Payer: UHC Medicare Advantage |
$50.53
|
| Rate for Payer: UMR Bronson Commercial |
$63.02
|
|
|
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
|
| Rate for Payer: UMR Bronson Commercial |
$3.68
|
|
|
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: Aetna New Business (MI Preferred) |
$19.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.20
|
| 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 |
$19.72
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| 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 Commercial |
$20.61
|
| Rate for Payer: PHP Medicare Advantage |
$14.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.10
|
| Rate for Payer: Priority Health Medicare |
$14.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.72
|
| Rate for Payer: UHC Medicare Advantage |
$14.72
|
| Rate for Payer: UMR Bronson Commercial |
$15.64
|
|
|
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: Aetna New Business (MI Preferred) |
$1,564.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,455.90
|
| 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 |
$1,564.55
|
| Rate for Payer: Cofinity Commercial |
$1,455.90
|
| 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 Commercial |
$1,521.09
|
| 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 |
$1,086.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,086.49
|
| Rate for Payer: UHC Medicare Advantage |
$1,086.49
|
| Rate for Payer: UMR Bronson Commercial |
$885.50
|
|
|
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
|
| Rate for Payer: UMR Bronson Commercial |
$15.18
|
|
|
PR APPLICATION PATELLAR TENDON BEARING CAST
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
HCPCS 29435
|
| Min. Negotiated Rate |
$83.23 |
| Max. Negotiated Rate |
$226.85 |
| Rate for Payer: Aetna Commercial |
$111.53
|
| Rate for Payer: Aetna Medicare |
$86.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.85
|
| Rate for Payer: BCBS Complete |
$139.60
|
| Rate for Payer: BCBS MAPPO |
$83.23
|
| 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 |
$111.53
|
| Rate for Payer: Cofinity Commercial |
$119.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.39
|
| Rate for Payer: Nomi Health Commercial |
$99.88
|
| Rate for Payer: PACE SWMI |
$83.23
|
| Rate for Payer: PHP Commercial |
$116.52
|
| Rate for Payer: PHP Medicare Advantage |
$83.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.85
|
| Rate for Payer: Priority Health Medicare |
$83.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.23
|
| Rate for Payer: UHC Medicare Advantage |
$83.23
|
| Rate for Payer: UMR Bronson Commercial |
$160.54
|
|
|
PR APPLICATION RIGHT & LEFT PULMONARY ARTERY BAND
|
Professional
|
Both
|
$3,361.00
|
|
|
Service Code
|
HCPCS 33620
|
| Min. Negotiated Rate |
$1,344.40 |
| Max. Negotiated Rate |
$2,279.17 |
| Rate for Payer: Aetna Commercial |
$2,120.90
|
| Rate for Payer: Aetna Medicare |
$1,646.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,279.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,120.90
|
| Rate for Payer: BCBS Complete |
$1,344.40
|
| Rate for Payer: BCBS MAPPO |
$1,582.76
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,661.90
|
| Rate for Payer: Nomi Health Commercial |
$1,899.31
|
| Rate for Payer: PACE SWMI |
$1,582.76
|
| Rate for Payer: PHP Commercial |
$2,215.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,582.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,184.65
|
| Rate for Payer: Priority Health Medicare |
$1,582.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,582.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,582.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,546.06
|
|
|
PR APPLICATION RIGID TOTAL CONTACT LEG CAST
|
Professional
|
Both
|
$377.00
|
|
|
Service Code
|
HCPCS 29445
|
| Min. Negotiated Rate |
$93.58 |
| Max. Negotiated Rate |
$245.05 |
| Rate for Payer: Aetna Commercial |
$125.40
|
| Rate for Payer: Aetna Medicare |
$97.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.40
|
| Rate for Payer: BCBS Complete |
$150.80
|
| Rate for Payer: BCBS MAPPO |
$93.58
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.26
|
| Rate for Payer: Nomi Health Commercial |
$112.30
|
| Rate for Payer: PACE SWMI |
$93.58
|
| Rate for Payer: PHP Commercial |
$131.01
|
| Rate for Payer: PHP Medicare Advantage |
$93.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.05
|
| Rate for Payer: Priority Health Medicare |
$93.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.58
|
| Rate for Payer: UHC Medicare Advantage |
$93.58
|
| Rate for Payer: UMR Bronson Commercial |
$173.42
|
|
|
PR APPLICATION SHORT ARM SPLINT DYNAMIC
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
HCPCS 29126
|
| Min. Negotiated Rate |
$47.30 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$63.38
|
| Rate for Payer: Aetna Medicare |
$49.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.38
|
| Rate for Payer: BCBS Complete |
$76.80
|
| Rate for Payer: BCBS MAPPO |
$47.30
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.66
|
| Rate for Payer: Nomi Health Commercial |
$56.76
|
| Rate for Payer: PACE SWMI |
$47.30
|
| Rate for Payer: PHP Commercial |
$66.22
|
| Rate for Payer: PHP Medicare Advantage |
$47.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.80
|
| Rate for Payer: Priority Health Medicare |
$47.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.30
|
| Rate for Payer: UHC Medicare Advantage |
$47.30
|
| Rate for Payer: UMR Bronson Commercial |
$88.32
|
|
|
PR APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 29125
|
| Min. Negotiated Rate |
$38.36 |
| Max. Negotiated Rate |
$92.30 |
| Rate for Payer: Aetna Commercial |
$51.40
|
| Rate for Payer: Aetna Medicare |
$39.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.40
|
| Rate for Payer: BCBS Complete |
$56.80
|
| Rate for Payer: BCBS MAPPO |
$38.36
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.28
|
| Rate for Payer: Nomi Health Commercial |
$46.03
|
| Rate for Payer: PACE SWMI |
$38.36
|
| Rate for Payer: PHP Commercial |
$53.70
|
| Rate for Payer: PHP Medicare Advantage |
$38.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.30
|
| Rate for Payer: Priority Health Medicare |
$38.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.36
|
| Rate for Payer: UHC Medicare Advantage |
$38.36
|
| Rate for Payer: UMR Bronson Commercial |
$65.32
|
|
|
PR APPLICATION SHORT LEG CAST BELOW KNEE-TOE
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
HCPCS 29405
|
| Min. Negotiated Rate |
$56.15 |
| Max. Negotiated Rate |
$151.45 |
| Rate for Payer: Aetna Commercial |
$75.24
|
| Rate for Payer: Aetna Medicare |
$58.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.24
|
| Rate for Payer: BCBS Complete |
$93.20
|
| Rate for Payer: BCBS MAPPO |
$56.15
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.96
|
| Rate for Payer: Nomi Health Commercial |
$67.38
|
| Rate for Payer: PACE SWMI |
$56.15
|
| Rate for Payer: PHP Commercial |
$78.61
|
| Rate for Payer: PHP Medicare Advantage |
$56.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.45
|
| Rate for Payer: Priority Health Medicare |
$56.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.15
|
| Rate for Payer: UHC Medicare Advantage |
$56.15
|
| Rate for Payer: UMR Bronson Commercial |
$107.18
|
|
|
PR APPLICATION SHORT LEG CAST WALKING/AMBULATORY
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
HCPCS 29425
|
| Min. Negotiated Rate |
$51.77 |
| Max. Negotiated Rate |
$176.15 |
| Rate for Payer: Aetna Commercial |
$69.37
|
| Rate for Payer: Aetna Medicare |
$53.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.37
|
| Rate for Payer: BCBS Complete |
$108.40
|
| Rate for Payer: BCBS MAPPO |
$51.77
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.36
|
| Rate for Payer: Nomi Health Commercial |
$62.12
|
| Rate for Payer: PACE SWMI |
$51.77
|
| Rate for Payer: PHP Commercial |
$72.48
|
| Rate for Payer: PHP Medicare Advantage |
$51.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.15
|
| Rate for Payer: Priority Health Medicare |
$51.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.77
|
| Rate for Payer: UHC Medicare Advantage |
$51.77
|
| Rate for Payer: UMR Bronson Commercial |
$124.66
|
|
|
PR APPLICATION SHORT LEG SPLINT CALF FOOT
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
HCPCS 29515
|
| Min. Negotiated Rate |
$47.91 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Aetna Commercial |
$64.20
|
| Rate for Payer: Aetna Medicare |
$49.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.20
|
| Rate for Payer: BCBS Complete |
$50.40
|
| Rate for Payer: BCBS MAPPO |
$47.91
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.31
|
| Rate for Payer: Nomi Health Commercial |
$57.49
|
| Rate for Payer: PACE SWMI |
$47.91
|
| Rate for Payer: PHP Commercial |
$67.07
|
| Rate for Payer: PHP Medicare Advantage |
$47.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.90
|
| Rate for Payer: Priority Health Medicare |
$47.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.91
|
| Rate for Payer: UHC Medicare Advantage |
$47.91
|
| Rate for Payer: UMR Bronson Commercial |
$57.96
|
|
|
PR APPLICATION TOPICAL FLUORIDE VARNISH BY PHS/QHP
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 99188
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Aetna Medicare |
$17.50
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.75
|
| Rate for Payer: UMR Bronson Commercial |
$16.10
|
|
|
PR APPLICATION UNIPLANE EXTERNAL FIXATION SYSTEM
|
Professional
|
Both
|
$1,025.00
|
|
|
Service Code
|
HCPCS 20690
|
| Min. Negotiated Rate |
$410.00 |
| Max. Negotiated Rate |
$830.10 |
| Rate for Payer: Aetna Commercial |
$772.46
|
| Rate for Payer: Aetna Medicare |
$599.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$772.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$830.10
|
| Rate for Payer: BCBS Complete |
$410.00
|
| Rate for Payer: BCBS MAPPO |
$576.46
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$605.28
|
| Rate for Payer: Nomi Health Commercial |
$691.75
|
| Rate for Payer: PACE SWMI |
$576.46
|
| Rate for Payer: PHP Commercial |
$807.04
|
| Rate for Payer: PHP Medicare Advantage |
$576.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$666.25
|
| Rate for Payer: Priority Health Medicare |
$576.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$576.46
|
| Rate for Payer: UHC Medicare Advantage |
$576.46
|
| Rate for Payer: UMR Bronson Commercial |
$471.50
|
|
|
PR APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC
|
Professional
|
Both
|
$1,803.00
|
|
|
Service Code
|
HCPCS 21110
|
| Min. Negotiated Rate |
$647.04 |
| Max. Negotiated Rate |
$1,171.95 |
| Rate for Payer: Aetna Commercial |
$867.03
|
| Rate for Payer: Aetna Medicare |
$672.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$931.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$867.03
|
| Rate for Payer: BCBS Complete |
$721.20
|
| Rate for Payer: BCBS MAPPO |
$647.04
|
| 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 |
$931.74
|
| Rate for Payer: Cofinity Commercial |
$867.03
|
| 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 Commercial |
$905.86
|
| Rate for Payer: PHP Medicare Advantage |
$647.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.95
|
| Rate for Payer: Priority Health Medicare |
$647.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$647.04
|
| Rate for Payer: UHC Medicare Advantage |
$647.04
|
| Rate for Payer: UMR Bronson Commercial |
$829.38
|
|
|
PR APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT
|
Professional
|
Both
|
$195.00
|
|
|
Service Code
|
HCPCS 29581
|
| Min. Negotiated Rate |
$25.09 |
| Max. Negotiated Rate |
$126.75 |
| Rate for Payer: Aetna Commercial |
$33.62
|
| Rate for Payer: Aetna Medicare |
$26.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.62
|
| Rate for Payer: BCBS Complete |
$78.00
|
| Rate for Payer: BCBS MAPPO |
$25.09
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.34
|
| Rate for Payer: Nomi Health Commercial |
$30.11
|
| Rate for Payer: PACE SWMI |
$25.09
|
| Rate for Payer: PHP Commercial |
$35.13
|
| Rate for Payer: PHP Medicare Advantage |
$25.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.75
|
| Rate for Payer: Priority Health Medicare |
$25.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.09
|
| Rate for Payer: UHC Medicare Advantage |
$25.09
|
| Rate for Payer: UMR Bronson Commercial |
$89.70
|
|
|
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
|
| Rate for Payer: UMR Bronson Commercial |
$38.18
|
|
|
PR APPL MLTLAYR COMPRES SYS UPARM LWARM HAND&FING
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 29584
|
| Min. Negotiated Rate |
$14.94 |
| Max. Negotiated Rate |
$85.80 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna Medicare |
$15.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.51
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: BCBS MAPPO |
$14.94
|
| 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 |
$20.02
|
| Rate for Payer: Cofinity Commercial |
$21.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.69
|
| Rate for Payer: Nomi Health Commercial |
$17.93
|
| Rate for Payer: PACE SWMI |
$14.94
|
| Rate for Payer: PHP Commercial |
$20.92
|
| Rate for Payer: PHP Medicare Advantage |
$14.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| Rate for Payer: Priority Health Medicare |
$14.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.94
|
| Rate for Payer: UHC Medicare Advantage |
$14.94
|
| Rate for Payer: UMR Bronson Commercial |
$60.72
|
|
|
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
|
| Rate for Payer: UMR Bronson Commercial |
$60.72
|
|
|
PR APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 97014
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: UMR Bronson Commercial |
$11.96
|
|
|
PR APPL MODALITY 1+ AREAS ESTIM EA 15 MIN
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 97032
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Commercial |
$18.45
|
| Rate for Payer: Aetna Medicare |
$14.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.45
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$13.77
|
| Rate for Payer: BCN Medicare Advantage |
$13.77
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$18.45
|
| Rate for Payer: Cofinity Commercial |
$19.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.46
|
| Rate for Payer: Nomi Health Commercial |
$16.52
|
| Rate for Payer: PACE SWMI |
$13.77
|
| Rate for Payer: PHP Commercial |
$19.28
|
| Rate for Payer: PHP Medicare Advantage |
$13.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health Medicare |
$13.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.77
|
| Rate for Payer: UHC Medicare Advantage |
$13.77
|
| Rate for Payer: UMR Bronson Commercial |
$14.26
|
|
|
PR APPL MODALITY 1+ AREAS IONTOPHORESIS EA 15 MIN
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 97033
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$30.55 |
| Rate for Payer: Aetna Commercial |
$24.01
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.01
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS MAPPO |
$17.92
|
| Rate for Payer: BCN Medicare Advantage |
$17.92
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$24.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.82
|
| Rate for Payer: Nomi Health Commercial |
$21.50
|
| Rate for Payer: PACE SWMI |
$17.92
|
| Rate for Payer: PHP Commercial |
$25.09
|
| Rate for Payer: PHP Medicare Advantage |
$17.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health Medicare |
$17.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.92
|
| Rate for Payer: UHC Medicare Advantage |
$17.92
|
| Rate for Payer: UMR Bronson Commercial |
$21.62
|
|
|
PR APPL MODALITY 1+ AREAS ULTRASOUND EA 15 MIN
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS 97035
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$19.24 |
| Rate for Payer: Aetna Commercial |
$17.90
|
| Rate for Payer: Aetna Medicare |
$13.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.90
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: BCBS MAPPO |
$13.36
|
| Rate for Payer: BCN Medicare Advantage |
$13.36
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cofinity Commercial |
$19.24
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.03
|
| Rate for Payer: Nomi Health Commercial |
$16.03
|
| Rate for Payer: PACE SWMI |
$13.36
|
| Rate for Payer: PHP Commercial |
$18.70
|
| Rate for Payer: PHP Medicare Advantage |
$13.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.30
|
| Rate for Payer: Priority Health Medicare |
$13.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.36
|
| Rate for Payer: UHC Medicare Advantage |
$13.36
|
| Rate for Payer: UMR Bronson Commercial |
$10.12
|
|
