|
PR APPLICATION CAST SHOULDER HAND LONG ARM
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS 29065
|
| Min. Negotiated Rate |
$65.15 |
| Max. Negotiated Rate |
$168.35 |
| Rate for Payer: Aetna Commercial |
$87.30
|
| Rate for Payer: Aetna Medicare |
$65.15
|
| Rate for Payer: BCBS Complete |
$103.60
|
| Rate for Payer: BCBS MAPPO |
$65.15
|
| Rate for Payer: BCN Medicare Advantage |
$65.15
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cofinity Commercial |
$93.82
|
| Rate for Payer: Cofinity Commercial |
$87.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.15
|
| Rate for Payer: Healthscope Commercial |
$78.18
|
| Rate for Payer: Healthscope Whirlpool |
$78.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.41
|
| Rate for Payer: Nomi Health Commercial |
$78.18
|
| Rate for Payer: PACE SWMI |
$65.15
|
| Rate for Payer: PHP Medicare Advantage |
$65.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.35
|
| Rate for Payer: Priority Health Medicare |
$65.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.15
|
| Rate for Payer: UHC Medicare Advantage |
$65.15
|
| Rate for Payer: UHCCP DNSP |
$65.15
|
|
|
PR APPLICATION CYLINDER CAST THIGH ANKLE
|
Professional
|
Both
|
$252.00
|
|
|
Service Code
|
HCPCS 29365
|
| Min. Negotiated Rate |
$83.73 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Aetna Commercial |
$112.20
|
| Rate for Payer: Aetna Medicare |
$83.73
|
| Rate for Payer: BCBS Complete |
$100.80
|
| Rate for Payer: BCBS MAPPO |
$83.73
|
| 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 |
$120.57
|
| Rate for Payer: Cofinity Commercial |
$112.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.73
|
| Rate for Payer: Healthscope Commercial |
$100.48
|
| Rate for Payer: Healthscope Whirlpool |
$100.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.92
|
| Rate for Payer: Nomi Health Commercial |
$100.48
|
| Rate for Payer: PACE SWMI |
$83.73
|
| Rate for Payer: PHP Medicare Advantage |
$83.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health Medicare |
$83.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.73
|
| Rate for Payer: UHC Medicare Advantage |
$83.73
|
| Rate for Payer: UHCCP DNSP |
$83.73
|
|
|
PR APPLICATION FINGER SPLINT DYNAMIC
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 29131
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Aetna Commercial |
$44.49
|
| Rate for Payer: Aetna Medicare |
$33.20
|
| Rate for Payer: BCBS Complete |
$42.00
|
| Rate for Payer: BCBS MAPPO |
$33.20
|
| 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 |
$47.81
|
| Rate for Payer: Cofinity Commercial |
$44.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.20
|
| Rate for Payer: Healthscope Commercial |
$39.84
|
| Rate for Payer: Healthscope Whirlpool |
$39.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.86
|
| Rate for Payer: Nomi Health Commercial |
$39.84
|
| Rate for Payer: PACE SWMI |
$33.20
|
| Rate for Payer: PHP Medicare Advantage |
$33.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.25
|
| Rate for Payer: Priority Health Medicare |
$33.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.20
|
| Rate for Payer: UHC Medicare Advantage |
$33.20
|
| Rate for Payer: UHCCP DNSP |
$33.20
|
|
|
PR APPLICATION FINGER SPLINT STATIC
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 29130
|
| Min. Negotiated Rate |
$27.75 |
| Max. Negotiated Rate |
$61.10 |
| Rate for Payer: Aetna Commercial |
$37.19
|
| Rate for Payer: Aetna Medicare |
$27.75
|
| Rate for Payer: BCBS Complete |
$37.60
|
| Rate for Payer: BCBS MAPPO |
$27.75
|
| 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 |
$39.96
|
| Rate for Payer: Cofinity Commercial |
$37.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.75
|
| Rate for Payer: Healthscope Commercial |
$33.30
|
| Rate for Payer: Healthscope Whirlpool |
$33.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.14
|
| Rate for Payer: Nomi Health Commercial |
$33.30
|
| Rate for Payer: PACE SWMI |
$27.75
|
| Rate for Payer: PHP Medicare Advantage |
$27.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.10
|
| Rate for Payer: Priority Health Medicare |
$27.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.75
|
| Rate for Payer: UHC Medicare Advantage |
$27.75
|
| Rate for Payer: UHCCP DNSP |
$27.75
|
|
|
PR APPLICATION HALO CRANIAL INCLUDING REMOVAL
|
Professional
|
Both
|
$1,099.00
|
|
|
Service Code
|
HCPCS 20661
|
| Min. Negotiated Rate |
$439.60 |
| Max. Negotiated Rate |
$719.31 |
| Rate for Payer: Aetna Commercial |
$669.36
|
| Rate for Payer: Aetna Medicare |
$499.52
|
| Rate for Payer: BCBS Complete |
$439.60
|
| Rate for Payer: BCBS MAPPO |
$499.52
|
| 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 |
$719.31
|
| Rate for Payer: Cofinity Commercial |
$669.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$499.52
|
| Rate for Payer: Healthscope Commercial |
$599.42
|
| Rate for Payer: Healthscope Whirlpool |
$599.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$524.50
|
| Rate for Payer: Nomi Health Commercial |
$599.42
|
| Rate for Payer: PACE SWMI |
$499.52
|
| Rate for Payer: PHP Medicare Advantage |
$499.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$714.35
|
| Rate for Payer: Priority Health Medicare |
$499.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$499.52
|
| Rate for Payer: UHC Medicare Advantage |
$499.52
|
| Rate for Payer: UHCCP DNSP |
$499.52
|
|
|
PR APPLICATION HIP SPICA CAST 1 LEG
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 29305
|
| Min. Negotiated Rate |
$152.62 |
| Max. Negotiated Rate |
$318.50 |
| Rate for Payer: Aetna Commercial |
$204.51
|
| Rate for Payer: Aetna Medicare |
$152.62
|
| Rate for Payer: BCBS Complete |
$196.00
|
| Rate for Payer: BCBS MAPPO |
$152.62
|
| 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 |
$219.77
|
| Rate for Payer: Cofinity Commercial |
$204.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.62
|
| Rate for Payer: Healthscope Commercial |
$183.14
|
| Rate for Payer: Healthscope Whirlpool |
$183.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.25
|
| Rate for Payer: Nomi Health Commercial |
$183.14
|
| Rate for Payer: PACE SWMI |
$152.62
|
| Rate for Payer: PHP Medicare Advantage |
$152.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.50
|
| Rate for Payer: Priority Health Medicare |
$152.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.62
|
| Rate for Payer: UHC Medicare Advantage |
$152.62
|
| Rate for Payer: UHCCP DNSP |
$152.62
|
|
|
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
|
|
|
PR APPLICATION LONG ARM SPLINT SHOULDER HAND
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 29105
|
| Min. Negotiated Rate |
$40.49 |
| Max. Negotiated Rate |
$107.25 |
| Rate for Payer: Aetna Commercial |
$54.26
|
| Rate for Payer: Aetna Medicare |
$40.49
|
| Rate for Payer: BCBS Complete |
$66.00
|
| Rate for Payer: BCBS MAPPO |
$40.49
|
| 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: Healthscope Commercial |
$48.59
|
| Rate for Payer: Healthscope Whirlpool |
$48.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.51
|
| Rate for Payer: Nomi Health Commercial |
$48.59
|
| Rate for Payer: PACE SWMI |
$40.49
|
| Rate for Payer: PHP Medicare Advantage |
$40.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.25
|
| Rate for Payer: Priority Health Medicare |
$40.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.49
|
| Rate for Payer: UHC Medicare Advantage |
$40.49
|
| Rate for Payer: UHCCP DNSP |
$40.49
|
|
|
PR APPLICATION LONG LEG CAST BRACE
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
HCPCS 29358
|
| Min. Negotiated Rate |
$99.10 |
| Max. Negotiated Rate |
$180.05 |
| Rate for Payer: Aetna Commercial |
$132.79
|
| Rate for Payer: Aetna Medicare |
$99.10
|
| Rate for Payer: BCBS Complete |
$110.80
|
| Rate for Payer: BCBS MAPPO |
$99.10
|
| Rate for Payer: BCN Medicare Advantage |
$99.10
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cofinity Commercial |
$142.70
|
| Rate for Payer: Cofinity Commercial |
$132.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.10
|
| Rate for Payer: Healthscope Commercial |
$118.92
|
| Rate for Payer: Healthscope Whirlpool |
$118.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.06
|
| Rate for Payer: Nomi Health Commercial |
$118.92
|
| Rate for Payer: PACE SWMI |
$99.10
|
| Rate for Payer: PHP Medicare Advantage |
$99.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.05
|
| Rate for Payer: Priority Health Medicare |
$99.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.10
|
| Rate for Payer: UHC Medicare Advantage |
$99.10
|
| Rate for Payer: UHCCP DNSP |
$99.10
|
|
|
PR APPLICATION LONG LEG CAST THIGH-TOE
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
HCPCS 29345
|
| Min. Negotiated Rate |
$95.31 |
| Max. Negotiated Rate |
$183.30 |
| Rate for Payer: Aetna Commercial |
$127.72
|
| Rate for Payer: Aetna Medicare |
$95.31
|
| Rate for Payer: BCBS Complete |
$112.80
|
| Rate for Payer: BCBS MAPPO |
$95.31
|
| Rate for Payer: BCN Medicare Advantage |
$95.31
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$137.25
|
| Rate for Payer: Cofinity Commercial |
$127.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.31
|
| Rate for Payer: Healthscope Commercial |
$114.37
|
| Rate for Payer: Healthscope Whirlpool |
$114.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.08
|
| Rate for Payer: Nomi Health Commercial |
$114.37
|
| Rate for Payer: PACE SWMI |
$95.31
|
| Rate for Payer: PHP Medicare Advantage |
$95.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.30
|
| Rate for Payer: Priority Health Medicare |
$95.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.31
|
| Rate for Payer: UHC Medicare Advantage |
$95.31
|
| Rate for Payer: UHCCP DNSP |
$95.31
|
|
|
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 |
$101.37
|
| 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: Healthscope Commercial |
$121.64
|
| Rate for Payer: Healthscope Whirlpool |
$121.64
|
| 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 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: UHCCP DNSP |
$101.37
|
|
|
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 |
$50.53
|
| 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: Healthscope Commercial |
$60.64
|
| Rate for Payer: Healthscope Whirlpool |
$60.64
|
| 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 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: UHCCP DNSP |
$50.53
|
|
|
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
|
|
|
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 |
$14.72
|
| 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 |
$21.20
|
| Rate for Payer: Cofinity Commercial |
$19.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.72
|
| Rate for Payer: Healthscope Commercial |
$17.66
|
| Rate for Payer: Healthscope Whirlpool |
$17.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.46
|
| Rate for Payer: Nomi Health Commercial |
$17.66
|
| Rate for Payer: PACE SWMI |
$14.72
|
| Rate for Payer: PHP Medicare Advantage |
$14.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.10
|
| Rate for Payer: Priority Health Medicare |
$14.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.72
|
| Rate for Payer: UHC Medicare Advantage |
$14.72
|
| Rate for Payer: UHCCP DNSP |
$14.72
|
|
|
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 |
$1,086.49
|
| 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: Healthscope Commercial |
$1,303.79
|
| Rate for Payer: Healthscope Whirlpool |
$1,303.79
|
| 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 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: UHCCP DNSP |
$1,086.49
|
|
|
PR APPLICATION OF SURFACE NEUROSTIMULATOR
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 64550
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
|
|
PR APPLICATION PATELLAR TENDON BEARING CAST
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
HCPCS 29435
|
| Min. Negotiated Rate |
$83.23 |
| Max. Negotiated Rate |
$226.85 |
| Rate for Payer: Aetna Commercial |
$111.53
|
| Rate for Payer: Aetna Medicare |
$83.23
|
| 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 |
$119.85
|
| Rate for Payer: Cofinity Commercial |
$111.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$99.88
|
| Rate for Payer: Healthscope Whirlpool |
$99.88
|
| 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 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: UHCCP DNSP |
$83.23
|
|
|
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 |
$1,582.76
|
| 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: Healthscope Commercial |
$1,899.31
|
| Rate for Payer: Healthscope Whirlpool |
$1,899.31
|
| 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 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: UHCCP DNSP |
$1,582.76
|
|
|
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 |
$93.58
|
| 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: Healthscope Commercial |
$112.30
|
| Rate for Payer: Healthscope Whirlpool |
$112.30
|
| 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 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: UHCCP DNSP |
$93.58
|
|
|
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 |
$47.30
|
| 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: Healthscope Commercial |
$56.76
|
| Rate for Payer: Healthscope Whirlpool |
$56.76
|
| 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 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: UHCCP DNSP |
$47.30
|
|
|
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 |
$38.36
|
| 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: Healthscope Commercial |
$46.03
|
| Rate for Payer: Healthscope Whirlpool |
$46.03
|
| 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 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: UHCCP DNSP |
$38.36
|
|
|
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 |
$56.15
|
| 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: Healthscope Commercial |
$67.38
|
| Rate for Payer: Healthscope Whirlpool |
$67.38
|
| 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 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: UHCCP DNSP |
$56.15
|
|
|
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 |
$51.77
|
| 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: Healthscope Commercial |
$62.12
|
| Rate for Payer: Healthscope Whirlpool |
$62.12
|
| 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 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: UHCCP DNSP |
$51.77
|
|
|
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 |
$47.91
|
| 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: Healthscope Commercial |
$57.49
|
| Rate for Payer: Healthscope Whirlpool |
$57.49
|
| 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 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: UHCCP DNSP |
$47.91
|
|
|
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
|
|
