|
PR APPLICATION CYLINDER CAST THIGH ANKLE
|
Professional
|
Both
|
$252.00
|
|
|
Service Code
|
HCPCS 29365
|
| Min. Negotiated Rate |
$56.66 |
| Max. Negotiated Rate |
$701.58 |
| Rate for Payer: Aetna Commercial |
$112.20
|
| Rate for Payer: Aetna Medicare |
$87.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.57
|
| Rate for Payer: BCBS Complete |
$59.49
|
| Rate for Payer: BCBS MAPPO |
$83.73
|
| Rate for Payer: BCBS Trust/PPO |
$701.58
|
| Rate for Payer: BCN Commercial |
$182.28
|
| Rate for Payer: BCN Medicare Advantage |
$83.73
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$112.20
|
| Rate for Payer: Cofinity Commercial |
$120.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.92
|
| Rate for Payer: Meridian Medicaid |
$59.49
|
| Rate for Payer: Nomi Health Commercial |
$100.48
|
| Rate for Payer: PACE SWMI |
$83.73
|
| Rate for Payer: PHP Commercial |
$117.22
|
| Rate for Payer: PHP Medicare Advantage |
$83.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.85
|
| Rate for Payer: Priority Health Medicare |
$83.73
|
| Rate for Payer: Priority Health Narrow Network |
$134.85
|
| Rate for Payer: Priority Health SBD |
$134.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.73
|
| Rate for Payer: UHC Medicare Advantage |
$83.73
|
| Rate for Payer: UHCCP Medicaid |
$56.66
|
| Rate for Payer: UMR Bronson Commercial |
$115.92
|
|
|
PR APPLICATION FINGER SPLINT DYNAMIC
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 29131
|
| Min. Negotiated Rate |
$22.37 |
| Max. Negotiated Rate |
$2,121.65 |
| Rate for Payer: Aetna Commercial |
$44.49
|
| Rate for Payer: Aetna Medicare |
$34.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.81
|
| Rate for Payer: BCBS Complete |
$23.49
|
| Rate for Payer: BCBS MAPPO |
$33.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,121.65
|
| Rate for Payer: BCN Commercial |
$78.68
|
| Rate for Payer: BCN Medicare Advantage |
$33.20
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$44.49
|
| Rate for Payer: Cofinity Commercial |
$47.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.86
|
| Rate for Payer: Meridian Medicaid |
$23.49
|
| Rate for Payer: Nomi Health Commercial |
$39.84
|
| Rate for Payer: PACE SWMI |
$33.20
|
| Rate for Payer: PHP Commercial |
$46.48
|
| Rate for Payer: PHP Medicare Advantage |
$33.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.92
|
| Rate for Payer: Priority Health Medicare |
$33.20
|
| Rate for Payer: Priority Health Narrow Network |
$52.92
|
| Rate for Payer: Priority Health SBD |
$52.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.20
|
| Rate for Payer: UHC Medicare Advantage |
$33.20
|
| Rate for Payer: UHCCP Medicaid |
$22.37
|
| Rate for Payer: UMR Bronson Commercial |
$48.30
|
|
|
PR APPLICATION FINGER SPLINT STATIC
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 29130
|
| Min. Negotiated Rate |
$18.53 |
| Max. Negotiated Rate |
$2,436.52 |
| Rate for Payer: Aetna Commercial |
$37.18
|
| Rate for Payer: Aetna Medicare |
$28.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.96
|
| Rate for Payer: BCBS Complete |
$19.46
|
| Rate for Payer: BCBS MAPPO |
$27.75
|
| Rate for Payer: BCBS Trust/PPO |
$2,436.52
|
| Rate for Payer: BCN Commercial |
$61.58
|
| Rate for Payer: BCN Medicare Advantage |
$27.75
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cofinity Commercial |
$37.18
|
| Rate for Payer: Cofinity Commercial |
$39.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.14
|
| Rate for Payer: Meridian Medicaid |
$19.46
|
| Rate for Payer: Nomi Health Commercial |
$33.30
|
| Rate for Payer: PACE SWMI |
$27.75
|
| Rate for Payer: PHP Commercial |
$38.85
|
| Rate for Payer: PHP Medicare Advantage |
$27.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.27
|
| Rate for Payer: Priority Health Medicare |
$27.75
|
| Rate for Payer: Priority Health Narrow Network |
$44.27
|
| Rate for Payer: Priority Health SBD |
$44.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.75
|
| Rate for Payer: UHC Medicare Advantage |
$27.75
|
| Rate for Payer: UHCCP Medicaid |
$18.53
|
| Rate for Payer: UMR Bronson Commercial |
$43.24
|
|
|
PR APPLICATION HALO CRANIAL INCLUDING REMOVAL
|
Professional
|
Both
|
$1,099.00
|
|
|
Service Code
|
HCPCS 20661
|
| Min. Negotiated Rate |
$339.10 |
| Max. Negotiated Rate |
$32,076.33 |
| Rate for Payer: Aetna Commercial |
$669.36
|
| Rate for Payer: Aetna Medicare |
$519.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$669.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$719.31
|
| Rate for Payer: BCBS Complete |
$356.06
|
| Rate for Payer: BCBS MAPPO |
$499.52
|
| Rate for Payer: BCBS Trust/PPO |
$32,076.33
|
| Rate for Payer: BCN Commercial |
$841.55
|
| Rate for Payer: BCN Medicare Advantage |
$499.52
|
| Rate for Payer: Cash Price |
$879.20
|
| Rate for Payer: Cash Price |
$879.20
|
| Rate for Payer: Cofinity Commercial |
$669.36
|
| Rate for Payer: Cofinity Commercial |
$719.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$499.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$524.50
|
| Rate for Payer: Meridian Medicaid |
$356.06
|
| Rate for Payer: Nomi Health Commercial |
$599.42
|
| Rate for Payer: PACE SWMI |
$499.52
|
| Rate for Payer: PHP Commercial |
$699.33
|
| Rate for Payer: PHP Medicare Advantage |
$499.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$339.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$714.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$817.23
|
| Rate for Payer: Priority Health Medicare |
$499.52
|
| Rate for Payer: Priority Health Narrow Network |
$817.23
|
| Rate for Payer: Priority Health SBD |
$817.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$499.52
|
| Rate for Payer: UHC Medicare Advantage |
$499.52
|
| Rate for Payer: UHCCP Medicaid |
$339.10
|
| Rate for Payer: UMR Bronson Commercial |
$505.54
|
|
|
PR APPLICATION HIP SPICA CAST 1 LEG
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 29305
|
| Min. Negotiated Rate |
$103.52 |
| Max. Negotiated Rate |
$1,986.41 |
| Rate for Payer: Aetna Commercial |
$204.51
|
| Rate for Payer: Aetna Medicare |
$158.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.77
|
| Rate for Payer: BCBS Complete |
$108.70
|
| Rate for Payer: BCBS MAPPO |
$152.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,986.41
|
| Rate for Payer: BCN Commercial |
$365.04
|
| Rate for Payer: BCN Medicare Advantage |
$152.62
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cofinity Commercial |
$204.51
|
| Rate for Payer: Cofinity Commercial |
$219.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.25
|
| Rate for Payer: Meridian Medicaid |
$108.70
|
| Rate for Payer: Nomi Health Commercial |
$183.14
|
| Rate for Payer: PACE SWMI |
$152.62
|
| Rate for Payer: PHP Commercial |
$213.67
|
| Rate for Payer: PHP Medicare Advantage |
$152.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$243.23
|
| Rate for Payer: Priority Health Medicare |
$152.62
|
| Rate for Payer: Priority Health Narrow Network |
$243.23
|
| Rate for Payer: Priority Health SBD |
$243.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.62
|
| Rate for Payer: UHC Medicare Advantage |
$152.62
|
| Rate for Payer: UHCCP Medicaid |
$103.52
|
| Rate for Payer: UMR Bronson Commercial |
$225.40
|
|
|
PR APPLICATION INTERVERTEBRAL BIOMECHANICAL DEVICE
|
Professional
|
Both
|
$2,083.00
|
|
|
Service Code
|
HCPCS 22851
|
| Min. Negotiated Rate |
$833.20 |
| Max. Negotiated Rate |
$1,353.95 |
| Rate for Payer: Aetna Medicare |
$1,041.50
|
| Rate for Payer: BCBS Complete |
$833.20
|
| Rate for Payer: Cash Price |
$1,666.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,353.95
|
| Rate for Payer: UMR Bronson Commercial |
$958.18
|
|
|
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: Aetna New Business (MI Preferred) |
$54.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.31
|
| 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: 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 Commercial |
$56.69
|
| 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/Tiered Network |
$63.61
|
| Rate for Payer: Priority Health Medicare |
$40.49
|
| Rate for Payer: Priority Health Narrow Network |
$63.61
|
| Rate for Payer: Priority Health SBD |
$63.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.49
|
| Rate for Payer: UHC Medicare Advantage |
$40.49
|
| Rate for Payer: UHCCP Medicaid |
$26.63
|
| Rate for Payer: UMR Bronson Commercial |
$75.90
|
|
|
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: Aetna New Business (MI Preferred) |
$132.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.70
|
| 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 |
$132.79
|
| Rate for Payer: Cofinity Commercial |
$142.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.06
|
| Rate for Payer: Meridian Medicaid |
$70.22
|
| Rate for Payer: Nomi Health Commercial |
$118.92
|
| Rate for Payer: PACE SWMI |
$99.10
|
| Rate for Payer: PHP Commercial |
$138.74
|
| 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/Tiered Network |
$158.25
|
| Rate for Payer: Priority Health Medicare |
$99.10
|
| Rate for Payer: Priority Health Narrow Network |
$158.25
|
| Rate for Payer: Priority Health SBD |
$158.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.10
|
| Rate for Payer: UHC Medicare Advantage |
$99.10
|
| Rate for Payer: UHCCP Medicaid |
$66.88
|
| Rate for Payer: UMR Bronson Commercial |
$127.42
|
|
|
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: Aetna New Business (MI Preferred) |
$127.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.25
|
| 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 |
$127.72
|
| Rate for Payer: Cofinity Commercial |
$137.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.08
|
| Rate for Payer: Meridian Medicaid |
$67.55
|
| Rate for Payer: Nomi Health Commercial |
$114.37
|
| Rate for Payer: PACE SWMI |
$95.31
|
| Rate for Payer: PHP Commercial |
$133.43
|
| 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/Tiered Network |
$151.65
|
| Rate for Payer: Priority Health Medicare |
$95.31
|
| Rate for Payer: Priority Health Narrow Network |
$151.65
|
| Rate for Payer: Priority Health SBD |
$151.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.31
|
| Rate for Payer: UHC Medicare Advantage |
$95.31
|
| Rate for Payer: UHCCP Medicaid |
$64.33
|
| Rate for Payer: UMR Bronson Commercial |
$129.72
|
|
|
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: Aetna New Business (MI Preferred) |
$135.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.97
|
| 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 |
$135.84
|
| Rate for Payer: Cofinity Commercial |
$145.97
|
| 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: Meridian Medicaid |
$71.79
|
| 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 Choice Medicaid |
$68.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$162.84
|
| Rate for Payer: Priority Health Medicare |
$101.37
|
| Rate for Payer: Priority Health Narrow Network |
$162.84
|
| Rate for Payer: Priority Health SBD |
$162.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.37
|
| Rate for Payer: UHC Medicare Advantage |
$101.37
|
| Rate for Payer: UHCCP Medicaid |
$68.37
|
| 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 |
$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: Aetna New Business (MI Preferred) |
$67.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.76
|
| 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: 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 Commercial |
$70.74
|
| 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/Tiered Network |
$80.39
|
| Rate for Payer: Priority Health Medicare |
$50.53
|
| Rate for Payer: Priority Health Narrow Network |
$80.39
|
| Rate for Payer: Priority Health SBD |
$80.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.53
|
| Rate for Payer: UHC Medicare Advantage |
$50.53
|
| Rate for Payer: UHCCP Medicaid |
$34.29
|
| 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 |
$1,245.73 |
| Rate for Payer: Aetna Commercial |
$4.45
|
| Rate for Payer: Aetna Medicare |
$4.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.45
|
| 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/Tiered Network |
$77.25
|
| Rate for Payer: Priority Health Narrow Network |
$77.25
|
| Rate for Payer: Priority Health SBD |
$77.25
|
| 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 |
$1,929.88 |
| Rate for Payer: Aetna Commercial |
$19.72
|
| Rate for Payer: Aetna Medicare |
$15.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.72
|
| 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 |
$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 HMO/PPO/Tiered Network |
$77.25
|
| Rate for Payer: Priority Health Medicare |
$14.72
|
| Rate for Payer: Priority Health Narrow Network |
$77.25
|
| Rate for Payer: Priority Health SBD |
$77.25
|
| 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 |
$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: Aetna New Business (MI Preferred) |
$1,455.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,564.55
|
| 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: 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 Commercial |
$1,521.09
|
| 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/Tiered Network |
$1,734.70
|
| Rate for Payer: Priority Health Medicare |
$1,086.49
|
| Rate for Payer: Priority Health Narrow Network |
$1,734.70
|
| Rate for Payer: Priority Health SBD |
$1,734.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,086.49
|
| Rate for Payer: UHC Medicare Advantage |
$1,086.49
|
| Rate for Payer: UHCCP Medicaid |
$733.79
|
| 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 |
$56.23 |
| Max. Negotiated Rate |
$761.81 |
| 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 |
$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: 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 Commercial |
$116.52
|
| 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/Tiered Network |
$132.81
|
| Rate for Payer: Priority Health Medicare |
$83.23
|
| Rate for Payer: Priority Health Narrow Network |
$132.81
|
| Rate for Payer: Priority Health SBD |
$132.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.23
|
| Rate for Payer: UHC Medicare Advantage |
$83.23
|
| Rate for Payer: UHCCP Medicaid |
$56.23
|
| 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 |
$1,036.67 |
| 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: Aetna New Business (MI Preferred) |
$2,120.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,279.17
|
| 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 |
$2,120.90
|
| Rate for Payer: Cofinity Commercial |
$2,279.17
|
| 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: 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 Commercial |
$2,215.86
|
| 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/Tiered Network |
$2,581.48
|
| Rate for Payer: Priority Health Medicare |
$1,582.76
|
| Rate for Payer: Priority Health Narrow Network |
$2,581.48
|
| Rate for Payer: Priority Health SBD |
$2,581.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,582.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,582.76
|
| Rate for Payer: UHCCP Medicaid |
$1,036.67
|
| 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 |
$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: Aetna New Business (MI Preferred) |
$125.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.76
|
| 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 |
$125.40
|
| Rate for Payer: Cofinity Commercial |
$134.76
|
| 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: Meridian Medicaid |
$65.98
|
| 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 Choice Medicaid |
$62.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$150.12
|
| Rate for Payer: Priority Health Medicare |
$93.58
|
| Rate for Payer: Priority Health Narrow Network |
$150.12
|
| Rate for Payer: Priority Health SBD |
$150.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.58
|
| Rate for Payer: UHC Medicare Advantage |
$93.58
|
| Rate for Payer: UHCCP Medicaid |
$62.84
|
| 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 |
$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: Aetna New Business (MI Preferred) |
$63.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.11
|
| 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 |
$63.38
|
| Rate for Payer: Cofinity Commercial |
$68.11
|
| 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: Meridian Medicaid |
$33.77
|
| 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 Choice Medicaid |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.82
|
| Rate for Payer: Priority Health Medicare |
$47.30
|
| Rate for Payer: Priority Health Narrow Network |
$75.82
|
| Rate for Payer: Priority Health SBD |
$75.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.30
|
| Rate for Payer: UHC Medicare Advantage |
$47.30
|
| Rate for Payer: UHCCP Medicaid |
$32.16
|
| 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 |
$26.20 |
| Max. Negotiated Rate |
$1,005.88 |
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Aetna Commercial |
$51.40
|
| Rate for Payer: Aetna Medicare |
$39.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.24
|
| 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: Cofinity Commercial |
$51.40
|
| Rate for Payer: Cofinity Commercial |
$55.24
|
| 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: Meridian Medicaid |
$27.51
|
| 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 Choice Medicaid |
$26.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.08
|
| Rate for Payer: Priority Health Medicare |
$38.36
|
| Rate for Payer: Priority Health Narrow Network |
$62.08
|
| Rate for Payer: Priority Health SBD |
$62.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.36
|
| Rate for Payer: UHC Medicare Advantage |
$38.36
|
| Rate for Payer: UHCCP Medicaid |
$26.20
|
| 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 |
$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: Aetna New Business (MI Preferred) |
$75.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.86
|
| 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 |
$75.24
|
| Rate for Payer: Cofinity Commercial |
$80.86
|
| 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: Meridian Medicaid |
$40.04
|
| 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 Choice Medicaid |
$38.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.07
|
| Rate for Payer: Priority Health Medicare |
$56.15
|
| Rate for Payer: Priority Health Narrow Network |
$90.07
|
| Rate for Payer: Priority Health SBD |
$90.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.15
|
| Rate for Payer: UHC Medicare Advantage |
$56.15
|
| Rate for Payer: UHCCP Medicaid |
$38.13
|
| 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 |
$35.15 |
| Max. Negotiated Rate |
$925.58 |
| Rate for Payer: Aetna Commercial |
$69.37
|
| Rate for Payer: Aetna Medicare |
$53.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.55
|
| 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 |
$69.37
|
| Rate for Payer: Cofinity Commercial |
$74.55
|
| 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: Meridian Medicaid |
$36.91
|
| 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 Choice Medicaid |
$35.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.95
|
| Rate for Payer: Priority Health Medicare |
$51.77
|
| Rate for Payer: Priority Health Narrow Network |
$82.95
|
| Rate for Payer: Priority Health SBD |
$82.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.77
|
| Rate for Payer: UHC Medicare Advantage |
$51.77
|
| Rate for Payer: UHCCP Medicaid |
$35.15
|
| 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 |
$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: Aetna New Business (MI Preferred) |
$64.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.99
|
| 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 |
$64.20
|
| Rate for Payer: Cofinity Commercial |
$68.99
|
| 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: Meridian Medicaid |
$34.00
|
| 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 Choice Medicaid |
$32.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.33
|
| Rate for Payer: Priority Health Medicare |
$47.91
|
| Rate for Payer: Priority Health Narrow Network |
$76.33
|
| Rate for Payer: Priority Health SBD |
$76.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.91
|
| Rate for Payer: UHC Medicare Advantage |
$47.91
|
| Rate for Payer: UHCCP Medicaid |
$32.38
|
| 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 |
$6.18 |
| Max. Negotiated Rate |
$413.66 |
| Rate for Payer: Aetna Commercial |
$11.43
|
| Rate for Payer: Aetna Medicare |
$17.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.43
|
| 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: 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/Tiered Network |
$13.11
|
| Rate for Payer: Priority Health Narrow Network |
$13.11
|
| Rate for Payer: Priority Health SBD |
$13.11
|
| Rate for Payer: UHCCP Medicaid |
$6.18
|
| 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 |
$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: Aetna New Business (MI Preferred) |
$772.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$830.10
|
| 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 |
$830.10
|
| Rate for Payer: Cofinity Commercial |
$772.46
|
| 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: Meridian Medicaid |
$407.26
|
| 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 Choice Medicaid |
$387.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$666.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$917.99
|
| Rate for Payer: Priority Health Medicare |
$576.46
|
| Rate for Payer: Priority Health Narrow Network |
$917.99
|
| Rate for Payer: Priority Health SBD |
$917.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$576.46
|
| Rate for Payer: UHC Medicare Advantage |
$576.46
|
| Rate for Payer: UHCCP Medicaid |
$387.87
|
| Rate for Payer: UMR Bronson Commercial |
$471.50
|
|
