Skip to main content
Calcimator

PPO Fee Schedule Analyzer Calculator

Compare PPO reimbursement vs. UCR fees, analyze write-offs, profit margins, and evaluate dropping insurance plans.

About this calculator

Write-Off per Procedure is a straightforward subtraction -- Your UCR Fee minus PPO Allowed Fee -- so only those two figures move it; Fee-for-Service Fee, Procedures per Month, Chair Time, Overhead Cost per Hour, and PPO Patient % all feed other outputs on this page but have zero effect on the headline write-off figure itself. Because it is a plain subtraction, a one-dollar change to UCR Fee and a one-dollar change to PPO Allowed Fee move the write-off amount by exactly the same dollar amount in opposite directions -- raising UCR Fee increases the write-off, and raising PPO Allowed Fee shrinks it by the same amount. Neither fee carries more analytical weight than the other; which one happens to move a given practice's write-off total more in a specific year depends only on which fee actually changed and by how much, not on anything structural in the formula.

PPO Profit and FFS Profit per procedure instead subtract a per-minute overhead cost (Overhead Cost per Hour converted to a per-chair-time rate) from each fee, which is why Chair Time Minutes and Overhead Cost per Hour matter for profitability even though they play no role in the simple UCR-minus-PPO write-off calculation. FFS Patients to Replace estimates how many additional fee-for-service patients a practice would need to see to make up the revenue if it dropped this PPO plan entirely, assuming those replacement patients are available to be scheduled -- an availability assumption the calculator does not itself verify.

Inputs

%

Results

Write-Off / Procedure

$60.00

Write-Off Percentage30%
Annual Write-Offs$57,600.00
PPO Profit / Procedure-$122.50
FFS Profit / Procedure-$62.50
PPO Profit Margin-87.5%
FFS Profit Margin-31.2%
PPO Effective Hourly Rate$187.00
FFS Effective Hourly Rate$267.00
Annual Revenue Impact$37,440.00
FFS Patients to Replace37
Net Patients Needed0
How to Use This Calculator
  1. Enter your UCR Fee, PPO Allowed Fee, and Fee-for-Service Fee for the procedure being analyzed.
  2. Input Procedures per Month and Chair Time in minutes.
  3. Enter your Overhead Cost per Hour to calculate profit margins.
  4. Set the PPO Patient % to model your current payer mix.
  5. Review Write-Off per Procedure, Annual Write-Offs, and PPO vs. FFS Profit to evaluate plan participation.

How the result changes with Your UCR Fee ($)

Your UCR Fee ($)Write-Off / Procedure
100-$40.00
150$10.00
300$160.00
500$360.00

What each input means

Your UCR Fee ($)
Your usual, customary, and reasonable fee for the procedure.
PPO Allowed Fee ($)
The PPO plan's maximum allowed reimbursement for this procedure.
Fee-for-Service Fee ($)
What non-PPO (fee-for-service) patients pay for this procedure.
Procedures / Month
Average number of this procedure performed per month.
Chair Time (Minutes)
Average chair time for this procedure.
Overhead Cost / Hour ($)
Practice overhead cost per clinical hour (typically $300-$500).
PPO Patient %
Percentage of patients on this PPO plan.

What each result means

Write-Off / Procedure
Contractual adjustment (UCR minus PPO allowed) per procedure.
Write-Off Percentage
Percentage of your UCR fee written off under the PPO.
Annual Write-Offs
Total annual contractual adjustments for this procedure.
PPO Profit / Procedure
Profit per procedure at PPO rate after overhead.
FFS Profit / Procedure
Profit per procedure at fee-for-service rate after overhead.
PPO Profit Margin
Profit margin on PPO-reimbursed procedures.
FFS Profit Margin
Profit margin on fee-for-service procedures.
PPO Effective Hourly Rate
Effective hourly revenue at PPO reimbursement level.
FFS Effective Hourly Rate
Effective hourly revenue at fee-for-service level.
Annual Revenue Impact
Annual revenue reduction from PPO vs. all fee-for-service.
FFS Patients to Replace
Number of FFS patients needed to replace revenue if dropping this PPO.

How this is calculated

Worked example, using the default values

  1. Identify Input Parameters
    7 parameters
    Your UCR Fee ($) = 200, PPO Allowed Fee ($) = 140, Fee-for-Service Fee ($) = 200, Procedures / Month = 80, Chair Time (Minutes) = 45, Overhead Cost / Hour ($) = 350, PPO Patient % = 65 = 7 input(s) provided
  2. Calculate Write-Off / Procedure
    Write-Off / Procedure = ucr - ppoAllowedFee
    60 = $60
  3. Calculate Write-Off Percentage
    30 = 30%
  4. Calculate Annual Write-Offs
    Annual Write-Offs = monthlyWriteOff * 12
    57600 = $57,600

Engine last updated . Checked against 1 independently-derived test — how we verify calculators. Built by Paul Gunder, a software engineer, not a licensed financial, medical, or legal professional.

Frequently Asked Questions

Why does Write-Off per Procedure not change when I adjust Procedures per Month?

Write-Off per Procedure is calculated as Your UCR Fee minus PPO Allowed Fee for a single procedure, and Procedures per Month is only used afterward to scale that per-procedure figure into Annual Write-Offs. Changing procedure volume changes the total dollar amount written off across the practice, but it has no effect on the per-procedure write-off number itself.

If my PPO renegotiates its allowed fee, does that move my write-off by the same amount as raising my own UCR fee?

Yes, dollar for dollar in the opposite direction -- Write-Off per Procedure is UCR Fee minus PPO Allowed Fee, so a $10 increase in either one moves the write-off by exactly $10, just in opposite directions (UCR up widens the write-off, PPO Allowed Fee up narrows it). Neither fee structurally matters more than the other; which one drives more of a given year's change simply depends on which one actually moved and by how much.

Does Chair Time Minutes affect the Write-Off per Procedure calculation?

No -- Chair Time Minutes feeds only the profit-margin outputs (PPO Profit per Procedure, FFS Profit per Procedure, and the effective hourly rates), where it is used to convert Overhead Cost per Hour into a per-procedure overhead charge. Write-Off per Procedure is purely UCR Fee minus PPO Allowed Fee and does not reference chair time at all.

What does FFS Patients to Replace assume about patient availability?

FFS Patients to Replace calculates how many fee-for-service patients would need to be seen to replace the revenue currently generated by PPO patients if the practice dropped that plan, based purely on the dollar-for-dollar revenue math. It does not verify whether that many new fee-for-service patients are actually available to schedule, so a practice considering dropping a PPO plan should separately confirm it can realistically attract and retain that patient volume.

Related Calculators

The questions that sit next to this one — chosen by subject, including calculators filed under a different category.

Dental Practice

Dental Supply Cost Calculator

Analyze dental supply and lab costs as a percentage of collections and identify savings opportunities.

Dental Practice

Dental Practice Valuation Calculator

Estimate practice value using collections, overhead, SDE, and asset-based methods with industry-standard multipliers.

Photography Business

Photography Tax Deductions Calculator

Estimate common tax deductions for photography businesses including equipment, mileage, home office, software, and marketing.

Dental Practice

Hygiene Department Revenue Calculator

Calculate hygiene department production goals from hygienist count, schedule, patient volume, and additional services.

More in Medical & Clinical.