|
PR APPLICATION INTERVERTEBRAL BIOMECHANICAL DEVICE
|
Professional
|
Both
|
$2,042.00
|
|
|
Service Code
|
HCPCS 22851
|
| Min. Negotiated Rate |
$816.80 |
| Max. Negotiated Rate |
$1,429.40 |
| Rate for Payer: BCBS Complete |
$816.80
|
| Rate for Payer: Cash Price |
$1,633.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,429.40
|
|
|
PR APPLICATION LONG ARM SPLINT SHOULDER HAND
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
HCPCS 29105
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$950.41 |
| Rate for Payer: Aetna Commercial |
$56.63
|
| Rate for Payer: Aetna Medicare |
$42.26
|
| Rate for Payer: BCBS Complete |
$27.96
|
| Rate for Payer: BCBS MAPPO |
$42.26
|
| Rate for Payer: BCBS Trust/PPO |
$950.41
|
| Rate for Payer: BCN Commercial |
$122.17
|
| Rate for Payer: BCN Medicare Advantage |
$42.26
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cofinity Commercial |
$60.85
|
| Rate for Payer: Cofinity Commercial |
$56.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.26
|
| Rate for Payer: Healthscope Commercial |
$50.71
|
| Rate for Payer: Healthscope Whirlpool |
$50.71
|
| Rate for Payer: Meridian Medicaid |
$27.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.37
|
| Rate for Payer: PACE SWMI |
$42.26
|
| Rate for Payer: PHP Medicare Advantage |
$42.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.35
|
| Rate for Payer: Priority Health Medicare |
$42.26
|
| Rate for Payer: Priority Health Narrow Network |
$64.35
|
| Rate for Payer: UHC Medicare Advantage |
$43.53
|
|
|
PR APPLICATION LONG LEG CAST BRACE
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS 29358
|
| Min. Negotiated Rate |
$66.24 |
| Max. Negotiated Rate |
$236.52 |
| Rate for Payer: Aetna Commercial |
$134.95
|
| Rate for Payer: Aetna Medicare |
$100.71
|
| Rate for Payer: BCBS Complete |
$69.55
|
| Rate for Payer: BCBS MAPPO |
$100.71
|
| Rate for Payer: BCBS Trust/PPO |
$104.08
|
| Rate for Payer: BCN Commercial |
$236.52
|
| Rate for Payer: BCN Medicare Advantage |
$100.71
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cofinity Commercial |
$145.02
|
| Rate for Payer: Cofinity Commercial |
$134.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.71
|
| Rate for Payer: Healthscope Commercial |
$120.85
|
| Rate for Payer: Healthscope Whirlpool |
$120.85
|
| Rate for Payer: Meridian Medicaid |
$69.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$105.75
|
| Rate for Payer: PACE SWMI |
$100.71
|
| Rate for Payer: PHP Medicare Advantage |
$100.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$156.76
|
| Rate for Payer: Priority Health Medicare |
$100.71
|
| Rate for Payer: Priority Health Narrow Network |
$156.76
|
| Rate for Payer: UHC Medicare Advantage |
$103.73
|
|
|
PR APPLICATION LONG LEG CAST THIGH-TOE
|
Professional
|
Both
|
$276.00
|
|
|
Service Code
|
HCPCS 29345
|
| Min. Negotiated Rate |
$63.47 |
| Max. Negotiated Rate |
$221.36 |
| Rate for Payer: Aetna Commercial |
$130.54
|
| Rate for Payer: Aetna Medicare |
$97.42
|
| Rate for Payer: BCBS Complete |
$66.64
|
| Rate for Payer: BCBS MAPPO |
$97.42
|
| Rate for Payer: BCBS Trust/PPO |
$221.36
|
| Rate for Payer: BCN Commercial |
$199.38
|
| Rate for Payer: BCN Medicare Advantage |
$97.42
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$140.28
|
| Rate for Payer: Cofinity Commercial |
$130.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.42
|
| Rate for Payer: Healthscope Commercial |
$116.90
|
| Rate for Payer: Healthscope Whirlpool |
$116.90
|
| Rate for Payer: Meridian Medicaid |
$66.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.29
|
| Rate for Payer: PACE SWMI |
$97.42
|
| Rate for Payer: PHP Medicare Advantage |
$97.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$151.66
|
| Rate for Payer: Priority Health Medicare |
$97.42
|
| Rate for Payer: Priority Health Narrow Network |
$151.66
|
| Rate for Payer: UHC Medicare Advantage |
$100.34
|
|
|
PR APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 29355
|
| Min. Negotiated Rate |
$68.16 |
| Max. Negotiated Rate |
$585.88 |
| Rate for Payer: Aetna Commercial |
$139.49
|
| Rate for Payer: Aetna Medicare |
$104.10
|
| Rate for Payer: BCBS Complete |
$71.57
|
| Rate for Payer: BCBS MAPPO |
$104.10
|
| Rate for Payer: BCBS Trust/PPO |
$585.88
|
| Rate for Payer: BCN Commercial |
$209.15
|
| Rate for Payer: BCN Medicare Advantage |
$104.10
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$149.90
|
| Rate for Payer: Cofinity Commercial |
$139.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.10
|
| Rate for Payer: Healthscope Commercial |
$124.92
|
| Rate for Payer: Healthscope Whirlpool |
$124.92
|
| Rate for Payer: Meridian Medicaid |
$71.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$109.30
|
| Rate for Payer: PACE SWMI |
$104.10
|
| Rate for Payer: PHP Medicare Advantage |
$104.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$161.87
|
| Rate for Payer: Priority Health Medicare |
$104.10
|
| Rate for Payer: Priority Health Narrow Network |
$161.87
|
| Rate for Payer: UHC Medicare Advantage |
$107.22
|
|
|
PR APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 29505
|
| Min. Negotiated Rate |
$33.65 |
| Max. Negotiated Rate |
$1,145.35 |
| Rate for Payer: Aetna Commercial |
$67.80
|
| Rate for Payer: Aetna Medicare |
$50.60
|
| Rate for Payer: BCBS Complete |
$35.33
|
| Rate for Payer: BCBS MAPPO |
$50.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,145.35
|
| Rate for Payer: BCN Commercial |
$129.99
|
| Rate for Payer: BCN Medicare Advantage |
$50.60
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cofinity Commercial |
$67.80
|
| Rate for Payer: Cofinity Commercial |
$72.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.60
|
| Rate for Payer: Healthscope Commercial |
$60.72
|
| Rate for Payer: Healthscope Whirlpool |
$60.72
|
| Rate for Payer: Meridian Medicaid |
$35.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.13
|
| Rate for Payer: PACE SWMI |
$50.60
|
| Rate for Payer: PHP Medicare Advantage |
$50.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.16
|
| Rate for Payer: Priority Health Medicare |
$50.60
|
| Rate for Payer: Priority Health Narrow Network |
$79.16
|
| Rate for Payer: UHC Medicare Advantage |
$52.12
|
|
|
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: 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 |
$5.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.00
|
| Rate for Payer: Priority Health Narrow Network |
$75.00
|
|
|
PR APPLICATION MODALITY 1/> AREAS WHIRLPOOL
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 97022
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$1,929.88 |
| Rate for Payer: Aetna Commercial |
$21.86
|
| Rate for Payer: Aetna Medicare |
$16.31
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS MAPPO |
$16.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,929.88
|
| Rate for Payer: BCN Commercial |
$16.64
|
| Rate for Payer: BCN Medicare Advantage |
$16.31
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$23.49
|
| Rate for Payer: Cofinity Commercial |
$21.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.31
|
| Rate for Payer: Healthscope Commercial |
$19.57
|
| Rate for Payer: Healthscope Whirlpool |
$19.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.13
|
| Rate for Payer: PACE SWMI |
$16.31
|
| Rate for Payer: PHP Medicare Advantage |
$16.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.00
|
| Rate for Payer: Priority Health Medicare |
$16.31
|
| Rate for Payer: Priority Health Narrow Network |
$75.00
|
| Rate for Payer: UHC Medicare Advantage |
$16.80
|
|
|
PR APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM
|
Professional
|
Both
|
$1,887.00
|
|
|
Service Code
|
HCPCS 20692
|
| Min. Negotiated Rate |
$726.12 |
| Max. Negotiated Rate |
$3,350.93 |
| Rate for Payer: Aetna Commercial |
$1,478.07
|
| Rate for Payer: Aetna Medicare |
$1,103.04
|
| Rate for Payer: BCBS Complete |
$762.43
|
| Rate for Payer: BCBS MAPPO |
$1,103.04
|
| Rate for Payer: BCBS Trust/PPO |
$3,350.93
|
| Rate for Payer: BCN Commercial |
$1,643.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,103.04
|
| Rate for Payer: Cash Price |
$1,509.60
|
| Rate for Payer: Cash Price |
$1,509.60
|
| Rate for Payer: Cofinity Commercial |
$1,478.07
|
| Rate for Payer: Cofinity Commercial |
$1,588.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,103.04
|
| Rate for Payer: Healthscope Commercial |
$1,323.65
|
| Rate for Payer: Healthscope Whirlpool |
$1,323.65
|
| Rate for Payer: Meridian Medicaid |
$762.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,158.19
|
| Rate for Payer: PACE SWMI |
$1,103.04
|
| Rate for Payer: PHP Medicare Advantage |
$1,103.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$726.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,717.32
|
| Rate for Payer: Priority Health Medicare |
$1,103.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,717.32
|
| Rate for Payer: UHC Medicare Advantage |
$1,136.13
|
|
|
PR APPLICATION OF SURFACE NEUROSTIMULATOR
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 64550
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
|
|
PR APPLICATION PATELLAR TENDON BEARING CAST
|
Professional
|
Both
|
$342.00
|
|
|
Service Code
|
HCPCS 29435
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$761.81 |
| Rate for Payer: Aetna Commercial |
$105.97
|
| Rate for Payer: Aetna Medicare |
$79.08
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$79.08
|
| Rate for Payer: BCBS Trust/PPO |
$761.81
|
| Rate for Payer: BCN Commercial |
$169.08
|
| Rate for Payer: BCN Medicare Advantage |
$79.08
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cofinity Commercial |
$113.88
|
| Rate for Payer: Cofinity Commercial |
$105.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.08
|
| Rate for Payer: Healthscope Commercial |
$94.90
|
| Rate for Payer: Healthscope Whirlpool |
$94.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$83.03
|
| Rate for Payer: PACE SWMI |
$79.08
|
| Rate for Payer: PHP Medicare Advantage |
$79.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$123.07
|
| Rate for Payer: Priority Health Medicare |
$79.08
|
| Rate for Payer: Priority Health Narrow Network |
$123.07
|
| Rate for Payer: UHC Medicare Advantage |
$81.45
|
|
|
PR APPLICATION RIGID TOTAL CONTACT LEG CAST
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 29445
|
| Min. Negotiated Rate |
$62.84 |
| Max. Negotiated Rate |
$1,242.56 |
| Rate for Payer: Aetna Commercial |
$129.00
|
| Rate for Payer: Aetna Medicare |
$96.27
|
| Rate for Payer: BCBS Complete |
$65.98
|
| Rate for Payer: BCBS MAPPO |
$96.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,242.56
|
| Rate for Payer: BCN Commercial |
$150.00
|
| Rate for Payer: BCN Medicare Advantage |
$96.27
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cofinity Commercial |
$129.00
|
| Rate for Payer: Cofinity Commercial |
$138.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.27
|
| Rate for Payer: Healthscope Commercial |
$115.52
|
| Rate for Payer: Healthscope Whirlpool |
$115.52
|
| Rate for Payer: Meridian Medicaid |
$65.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$101.08
|
| Rate for Payer: PACE SWMI |
$96.27
|
| Rate for Payer: PHP Medicare Advantage |
$96.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$148.60
|
| Rate for Payer: Priority Health Medicare |
$96.27
|
| Rate for Payer: Priority Health Narrow Network |
$148.60
|
| Rate for Payer: UHC Medicare Advantage |
$99.16
|
|
|
PR APPLICATION SHORT ARM SPLINT DYNAMIC
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS 29126
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$1,873.35 |
| Rate for Payer: Aetna Commercial |
$64.31
|
| Rate for Payer: Aetna Medicare |
$47.99
|
| Rate for Payer: BCBS Complete |
$33.33
|
| Rate for Payer: BCBS MAPPO |
$47.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,873.35
|
| Rate for Payer: BCN Commercial |
$113.86
|
| Rate for Payer: BCN Medicare Advantage |
$47.99
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$69.11
|
| Rate for Payer: Cofinity Commercial |
$64.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.99
|
| Rate for Payer: Healthscope Commercial |
$57.59
|
| Rate for Payer: Healthscope Whirlpool |
$57.59
|
| Rate for Payer: Meridian Medicaid |
$33.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50.39
|
| Rate for Payer: PACE SWMI |
$47.99
|
| Rate for Payer: PHP Medicare Advantage |
$47.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.06
|
| Rate for Payer: Priority Health Medicare |
$47.99
|
| Rate for Payer: Priority Health Narrow Network |
$75.06
|
| Rate for Payer: UHC Medicare Advantage |
$49.43
|
|
|
PR APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
HCPCS 29125
|
| Min. Negotiated Rate |
$25.99 |
| Max. Negotiated Rate |
$1,005.88 |
| Rate for Payer: Aetna Commercial |
$52.82
|
| Rate for Payer: Aetna Medicare |
$39.42
|
| Rate for Payer: BCBS Complete |
$27.29
|
| Rate for Payer: BCBS MAPPO |
$39.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,005.88
|
| Rate for Payer: BCN Commercial |
$97.74
|
| Rate for Payer: BCN Medicare Advantage |
$39.42
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cofinity Commercial |
$56.76
|
| Rate for Payer: Cofinity Commercial |
$52.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.42
|
| Rate for Payer: Healthscope Commercial |
$47.30
|
| Rate for Payer: Healthscope Whirlpool |
$47.30
|
| Rate for Payer: Meridian Medicaid |
$27.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$41.39
|
| Rate for Payer: PACE SWMI |
$39.42
|
| Rate for Payer: PHP Medicare Advantage |
$39.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.78
|
| Rate for Payer: Priority Health Medicare |
$39.42
|
| Rate for Payer: Priority Health Narrow Network |
$61.78
|
| Rate for Payer: UHC Medicare Advantage |
$40.60
|
|
|
PR APPLICATION SHORT LEG CAST BELOW KNEE-TOE
|
Professional
|
Both
|
$228.00
|
|
|
Service Code
|
HCPCS 29405
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$1,199.24 |
| Rate for Payer: Aetna Commercial |
$76.11
|
| Rate for Payer: Aetna Medicare |
$56.80
|
| Rate for Payer: BCBS Complete |
$39.58
|
| Rate for Payer: BCBS MAPPO |
$56.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,199.24
|
| Rate for Payer: BCN Commercial |
$94.24
|
| Rate for Payer: BCN Medicare Advantage |
$56.80
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cofinity Commercial |
$76.11
|
| Rate for Payer: Cofinity Commercial |
$81.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.80
|
| Rate for Payer: Healthscope Commercial |
$68.16
|
| Rate for Payer: Healthscope Whirlpool |
$68.16
|
| Rate for Payer: Meridian Medicaid |
$39.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$59.64
|
| Rate for Payer: PACE SWMI |
$56.80
|
| Rate for Payer: PHP Medicare Advantage |
$56.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.85
|
| Rate for Payer: Priority Health Medicare |
$56.80
|
| Rate for Payer: Priority Health Narrow Network |
$88.85
|
| Rate for Payer: UHC Medicare Advantage |
$58.50
|
|
|
PR APPLICATION SHORT LEG CAST WALKING/AMBULATORY
|
Professional
|
Both
|
$266.00
|
|
|
Service Code
|
HCPCS 29425
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$925.58 |
| Rate for Payer: Aetna Commercial |
$70.58
|
| Rate for Payer: Aetna Medicare |
$52.67
|
| Rate for Payer: BCBS Complete |
$36.46
|
| Rate for Payer: BCBS MAPPO |
$52.67
|
| Rate for Payer: BCBS Trust/PPO |
$925.58
|
| Rate for Payer: BCN Commercial |
$88.35
|
| Rate for Payer: BCN Medicare Advantage |
$52.67
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Cofinity Commercial |
$75.84
|
| Rate for Payer: Cofinity Commercial |
$70.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.67
|
| Rate for Payer: Healthscope Commercial |
$63.20
|
| Rate for Payer: Healthscope Whirlpool |
$63.20
|
| Rate for Payer: Meridian Medicaid |
$36.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$55.30
|
| Rate for Payer: PACE SWMI |
$52.67
|
| Rate for Payer: PHP Medicare Advantage |
$52.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.22
|
| Rate for Payer: Priority Health Medicare |
$52.67
|
| Rate for Payer: Priority Health Narrow Network |
$82.22
|
| Rate for Payer: UHC Medicare Advantage |
$54.25
|
|
|
PR APPLICATION SHORT LEG SPLINT CALF FOOT
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
HCPCS 29515
|
| Min. Negotiated Rate |
$31.95 |
| Max. Negotiated Rate |
$1,249.96 |
| Rate for Payer: Aetna Commercial |
$64.59
|
| Rate for Payer: Aetna Medicare |
$48.20
|
| Rate for Payer: BCBS Complete |
$33.55
|
| Rate for Payer: BCBS MAPPO |
$48.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,249.96
|
| Rate for Payer: BCN Commercial |
$105.06
|
| Rate for Payer: BCN Medicare Advantage |
$48.20
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cofinity Commercial |
$69.41
|
| Rate for Payer: Cofinity Commercial |
$64.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.20
|
| Rate for Payer: Healthscope Commercial |
$57.84
|
| Rate for Payer: Healthscope Whirlpool |
$57.84
|
| Rate for Payer: Meridian Medicaid |
$33.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50.61
|
| Rate for Payer: PACE SWMI |
$48.20
|
| Rate for Payer: PHP Medicare Advantage |
$48.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.06
|
| Rate for Payer: Priority Health Medicare |
$48.20
|
| Rate for Payer: Priority Health Narrow Network |
$75.06
|
| Rate for Payer: UHC Medicare Advantage |
$49.65
|
|
|
PR APPLICATION TOPICAL FLUORIDE VARNISH BY PHS/QHP
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS 99188
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$413.66 |
| Rate for Payer: Aetna Commercial |
$11.43
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS Trust/PPO |
$413.66
|
| Rate for Payer: BCN Commercial |
$17.10
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Meridian Medicaid |
$6.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.03
|
| Rate for Payer: Priority Health Narrow Network |
$13.03
|
|
|
PR APPLICATION UNIPLANE EXTERNAL FIXATION SYSTEM
|
Professional
|
Both
|
$1,005.00
|
|
|
Service Code
|
HCPCS 20690
|
| Min. Negotiated Rate |
$384.25 |
| Max. Negotiated Rate |
$8,162.77 |
| Rate for Payer: Aetna Commercial |
$788.05
|
| Rate for Payer: Aetna Medicare |
$588.10
|
| Rate for Payer: BCBS Complete |
$403.46
|
| Rate for Payer: BCBS MAPPO |
$588.10
|
| Rate for Payer: BCBS Trust/PPO |
$8,162.77
|
| Rate for Payer: BCN Commercial |
$874.25
|
| Rate for Payer: BCN Medicare Advantage |
$588.10
|
| Rate for Payer: Cash Price |
$804.00
|
| Rate for Payer: Cash Price |
$804.00
|
| Rate for Payer: Cofinity Commercial |
$846.86
|
| Rate for Payer: Cofinity Commercial |
$788.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$588.10
|
| Rate for Payer: Healthscope Commercial |
$705.72
|
| Rate for Payer: Healthscope Whirlpool |
$705.72
|
| Rate for Payer: Meridian Medicaid |
$403.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$617.50
|
| Rate for Payer: PACE SWMI |
$588.10
|
| Rate for Payer: PHP Medicare Advantage |
$588.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$384.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$703.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$913.55
|
| Rate for Payer: Priority Health Medicare |
$588.10
|
| Rate for Payer: Priority Health Narrow Network |
$913.55
|
| Rate for Payer: UHC Medicare Advantage |
$605.74
|
|
|
PR APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC
|
Professional
|
Both
|
$1,768.00
|
|
|
Service Code
|
HCPCS 21110
|
| Min. Negotiated Rate |
$580.95 |
| Max. Negotiated Rate |
$1,268.61 |
| Rate for Payer: Aetna Commercial |
$919.20
|
| Rate for Payer: Aetna Medicare |
$685.97
|
| Rate for Payer: BCBS Complete |
$707.20
|
| Rate for Payer: BCBS MAPPO |
$685.97
|
| Rate for Payer: BCBS Trust/PPO |
$580.95
|
| Rate for Payer: BCN Commercial |
$1,268.61
|
| Rate for Payer: BCN Medicare Advantage |
$685.97
|
| Rate for Payer: Cash Price |
$1,414.40
|
| Rate for Payer: Cash Price |
$1,414.40
|
| Rate for Payer: Cofinity Commercial |
$987.80
|
| Rate for Payer: Cofinity Commercial |
$919.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$685.97
|
| Rate for Payer: Healthscope Commercial |
$823.16
|
| Rate for Payer: Healthscope Whirlpool |
$823.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$720.27
|
| Rate for Payer: PACE SWMI |
$685.97
|
| Rate for Payer: PHP Medicare Advantage |
$685.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,237.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.43
|
| Rate for Payer: Priority Health Medicare |
$685.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,099.43
|
| Rate for Payer: UHC Medicare Advantage |
$706.55
|
|
|
PR APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
HCPCS 29581
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$1,232.52 |
| Rate for Payer: Aetna Commercial |
$35.18
|
| Rate for Payer: Aetna Medicare |
$26.25
|
| Rate for Payer: BCBS Complete |
$17.67
|
| Rate for Payer: BCBS MAPPO |
$26.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,232.52
|
| Rate for Payer: BCN Commercial |
$130.48
|
| Rate for Payer: BCN Medicare Advantage |
$26.25
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Cofinity Commercial |
$37.80
|
| Rate for Payer: Cofinity Commercial |
$35.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.25
|
| Rate for Payer: Healthscope Commercial |
$31.50
|
| Rate for Payer: Healthscope Whirlpool |
$31.50
|
| Rate for Payer: Meridian Medicaid |
$17.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.56
|
| Rate for Payer: PACE SWMI |
$26.25
|
| Rate for Payer: PHP Medicare Advantage |
$26.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.34
|
| Rate for Payer: Priority Health Medicare |
$26.25
|
| Rate for Payer: Priority Health Narrow Network |
$40.34
|
| Rate for Payer: UHC Medicare Advantage |
$27.04
|
|
|
PR APPL MLTLAYR COMPRES SYSTEM UPPER & LOWER ARM
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS 29583
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$56.70 |
| Rate for Payer: BCBS Complete |
$32.40
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.70
|
|
|
PR APPL MLTLAYR COMPRES SYS UPARM LWARM HAND&FING
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 29584
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$1,140.60 |
| Rate for Payer: Aetna Commercial |
$20.93
|
| Rate for Payer: Aetna Medicare |
$15.62
|
| Rate for Payer: BCBS Complete |
$10.29
|
| Rate for Payer: BCBS MAPPO |
$15.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,140.60
|
| Rate for Payer: BCN Commercial |
$119.72
|
| Rate for Payer: BCN Medicare Advantage |
$15.62
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$22.49
|
| Rate for Payer: Cofinity Commercial |
$20.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.62
|
| Rate for Payer: Healthscope Commercial |
$18.74
|
| Rate for Payer: Healthscope Whirlpool |
$18.74
|
| Rate for Payer: Meridian Medicaid |
$10.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.40
|
| Rate for Payer: PACE SWMI |
$15.62
|
| Rate for Payer: PHP Medicare Advantage |
$15.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.01
|
| Rate for Payer: Priority Health Medicare |
$15.62
|
| Rate for Payer: Priority Health Narrow Network |
$24.01
|
| Rate for Payer: UHC Medicare Advantage |
$16.09
|
|
|
PR APPL MLTLAYR COMPRES THGH LEG ANKLE FT WHEN DONE
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 29582
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$90.30 |
| Rate for Payer: BCBS Complete |
$51.60
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.30
|
|
|
PR APPL MODALITY 1/> AREAS ELEC STIMJ EA 15 MIN
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS 97032
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$831.54 |
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: Aetna Medicare |
$14.08
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS MAPPO |
$14.08
|
| Rate for Payer: BCBS Trust/PPO |
$831.54
|
| Rate for Payer: BCN Commercial |
$14.03
|
| Rate for Payer: BCN Medicare Advantage |
$14.08
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$18.87
|
| Rate for Payer: Cofinity Commercial |
$20.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.08
|
| Rate for Payer: Healthscope Commercial |
$16.90
|
| Rate for Payer: Healthscope Whirlpool |
$16.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.78
|
| Rate for Payer: PACE SWMI |
$14.08
|
| Rate for Payer: PHP Medicare Advantage |
$14.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.00
|
| Rate for Payer: Priority Health Medicare |
$14.08
|
| Rate for Payer: Priority Health Narrow Network |
$75.00
|
| Rate for Payer: UHC Medicare Advantage |
$14.50
|
|
