|
PR CLOSED TX MANDIBULAR FX W/INTERDENTAL FIXATION
|
Professional
|
Both
|
$1,458.00
|
|
|
Service Code
|
HCPCS 21453
|
| Min. Negotiated Rate |
$568.71 |
| Max. Negotiated Rate |
$1,468.17 |
| Rate for Payer: Aetna Commercial |
$1,208.80
|
| Rate for Payer: Aetna Medicare |
$729.00
|
| Rate for Payer: BCBS Complete |
$597.15
|
| Rate for Payer: BCN Commercial |
$1,373.43
|
| Rate for Payer: Cash Price |
$1,166.40
|
| Rate for Payer: Cash Price |
$1,166.40
|
| Rate for Payer: Mclaren Medicaid |
$568.71
|
| Rate for Payer: Meridian Medicaid |
$597.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,093.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$568.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,468.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,468.17
|
| Rate for Payer: UHC Medicaid |
$568.71
|
| Rate for Payer: UHCCP Medicaid |
$568.71
|
|
|
PR CLOSED TX METARSAL FRACTURE W/MANIPULATION EACH
|
Professional
|
Both
|
$763.00
|
|
|
Service Code
|
HCPCS 28475
|
| Min. Negotiated Rate |
$143.14 |
| Max. Negotiated Rate |
$572.25 |
| Rate for Payer: Aetna Commercial |
$299.08
|
| Rate for Payer: Aetna Medicare |
$381.50
|
| Rate for Payer: BCBS Complete |
$150.30
|
| Rate for Payer: BCN Commercial |
$355.56
|
| Rate for Payer: Cash Price |
$610.40
|
| Rate for Payer: Cash Price |
$610.40
|
| Rate for Payer: Mclaren Medicaid |
$143.14
|
| Rate for Payer: Meridian Medicaid |
$150.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$572.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$380.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$380.08
|
| Rate for Payer: UHC Medicaid |
$143.14
|
| Rate for Payer: UHCCP Medicaid |
$143.14
|
|
|
PR CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MNPJ
|
Professional
|
Both
|
$1,689.00
|
|
|
Service Code
|
HCPCS 24620
|
| Min. Negotiated Rate |
$362.10 |
| Max. Negotiated Rate |
$1,266.75 |
| Rate for Payer: Aetna Commercial |
$749.39
|
| Rate for Payer: Aetna Medicare |
$844.50
|
| Rate for Payer: BCBS Complete |
$380.20
|
| Rate for Payer: BCN Commercial |
$909.32
|
| Rate for Payer: Cash Price |
$1,351.20
|
| Rate for Payer: Cash Price |
$1,351.20
|
| Rate for Payer: Mclaren Medicaid |
$362.10
|
| Rate for Payer: Meridian Medicaid |
$380.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,266.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$972.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$972.04
|
| Rate for Payer: UHC Medicaid |
$362.10
|
| Rate for Payer: UHCCP Medicaid |
$362.10
|
|
|
PR CLOSED TX NASAL BONE FX W/MNPJ W/O STABILIZATION
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 21315
|
| Min. Negotiated Rate |
$34.29 |
| Max. Negotiated Rate |
$348.75 |
| Rate for Payer: Aetna Commercial |
$201.65
|
| Rate for Payer: Aetna Medicare |
$232.50
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCN Commercial |
$90.13
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Mclaren Medicaid |
$34.29
|
| Rate for Payer: Meridian Medicaid |
$36.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$348.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$96.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.36
|
| Rate for Payer: UHC Medicaid |
$34.29
|
| Rate for Payer: UHCCP Medicaid |
$34.29
|
|
|
PR CLOSED TX NASAL BONE FX W/MNPJ W/STABILIZATION
|
Professional
|
Both
|
$427.00
|
|
|
Service Code
|
HCPCS 21320
|
| Min. Negotiated Rate |
$52.19 |
| Max. Negotiated Rate |
$320.25 |
| Rate for Payer: Aetna Commercial |
$176.51
|
| Rate for Payer: Aetna Medicare |
$213.50
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCN Commercial |
$142.42
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: Mclaren Medicaid |
$52.19
|
| Rate for Payer: Meridian Medicaid |
$54.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$320.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$152.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.24
|
| Rate for Payer: UHC Medicaid |
$52.19
|
| Rate for Payer: UHCCP Medicaid |
$52.19
|
|
|
PR CLOSED TX NASAL SEPTAL FRACT W/WO STABILIZATION
|
Professional
|
Both
|
$678.00
|
|
|
Service Code
|
HCPCS 21337
|
| Min. Negotiated Rate |
$179.77 |
| Max. Negotiated Rate |
$508.50 |
| Rate for Payer: Aetna Commercial |
$388.27
|
| Rate for Payer: Aetna Medicare |
$339.00
|
| Rate for Payer: BCBS Complete |
$188.76
|
| Rate for Payer: BCN Commercial |
$459.64
|
| Rate for Payer: Cash Price |
$542.40
|
| Rate for Payer: Cash Price |
$542.40
|
| Rate for Payer: Mclaren Medicaid |
$179.77
|
| Rate for Payer: Meridian Medicaid |
$188.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$508.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$491.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$491.34
|
| Rate for Payer: UHC Medicaid |
$179.77
|
| Rate for Payer: UHCCP Medicaid |
$179.77
|
|
|
PR CLOSED TX PALATAL/MAXILLARY FX W/FIXATION/SPLINT
|
Professional
|
Both
|
$1,368.00
|
|
|
Service Code
|
HCPCS 21421
|
| Min. Negotiated Rate |
$327.59 |
| Max. Negotiated Rate |
$1,026.00 |
| Rate for Payer: Aetna Commercial |
$736.23
|
| Rate for Payer: Aetna Medicare |
$684.00
|
| Rate for Payer: BCBS Complete |
$343.97
|
| Rate for Payer: BCN Commercial |
$825.16
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Mclaren Medicaid |
$327.59
|
| Rate for Payer: Meridian Medicaid |
$343.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,026.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$327.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$882.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$882.06
|
| Rate for Payer: UHC Medicaid |
$327.59
|
| Rate for Payer: UHCCP Medicaid |
$327.59
|
|
|
PR CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA
|
Professional
|
Both
|
$632.00
|
|
|
Service Code
|
HCPCS 27560
|
| Min. Negotiated Rate |
$253.90 |
| Max. Negotiated Rate |
$570.12 |
| Rate for Payer: Aetna Commercial |
$457.80
|
| Rate for Payer: Aetna Medicare |
$316.00
|
| Rate for Payer: BCBS Complete |
$266.60
|
| Rate for Payer: BCN Commercial |
$533.33
|
| Rate for Payer: Cash Price |
$505.60
|
| Rate for Payer: Cash Price |
$505.60
|
| Rate for Payer: Mclaren Medicaid |
$253.90
|
| Rate for Payer: Meridian Medicaid |
$266.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$474.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$253.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$570.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$570.12
|
| Rate for Payer: UHC Medicaid |
$253.90
|
| Rate for Payer: UHCCP Medicaid |
$253.90
|
|
|
PR CLOSED TX PATELLAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$671.00
|
|
|
Service Code
|
HCPCS 27520
|
| Min. Negotiated Rate |
$198.30 |
| Max. Negotiated Rate |
$507.30 |
| Rate for Payer: Aetna Commercial |
$396.99
|
| Rate for Payer: Aetna Medicare |
$335.50
|
| Rate for Payer: BCBS Complete |
$208.22
|
| Rate for Payer: BCN Commercial |
$474.58
|
| Rate for Payer: Cash Price |
$536.80
|
| Rate for Payer: Cash Price |
$536.80
|
| Rate for Payer: Mclaren Medicaid |
$198.30
|
| Rate for Payer: Meridian Medicaid |
$208.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$503.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$198.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$507.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$507.30
|
| Rate for Payer: UHC Medicaid |
$198.30
|
| Rate for Payer: UHCCP Medicaid |
$198.30
|
|
|
PR CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION
|
Professional
|
Both
|
$990.00
|
|
|
Service Code
|
HCPCS 24655
|
| Min. Negotiated Rate |
$281.80 |
| Max. Negotiated Rate |
$742.50 |
| Rate for Payer: Aetna Commercial |
$532.95
|
| Rate for Payer: Aetna Medicare |
$495.00
|
| Rate for Payer: BCBS Complete |
$295.89
|
| Rate for Payer: BCN Commercial |
$633.43
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Mclaren Medicaid |
$281.80
|
| Rate for Payer: Meridian Medicaid |
$295.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$742.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$677.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$677.13
|
| Rate for Payer: UHC Medicaid |
$281.80
|
| Rate for Payer: UHCCP Medicaid |
$281.80
|
|
|
PR CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION
|
Professional
|
Both
|
$664.00
|
|
|
Service Code
|
HCPCS 24650
|
| Min. Negotiated Rate |
$164.86 |
| Max. Negotiated Rate |
$498.00 |
| Rate for Payer: Aetna Commercial |
$323.50
|
| Rate for Payer: Aetna Medicare |
$332.00
|
| Rate for Payer: BCBS Complete |
$173.10
|
| Rate for Payer: BCN Commercial |
$309.05
|
| Rate for Payer: Cash Price |
$531.20
|
| Rate for Payer: Cash Price |
$531.20
|
| Rate for Payer: Mclaren Medicaid |
$164.86
|
| Rate for Payer: Meridian Medicaid |
$173.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$498.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$418.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$418.95
|
| Rate for Payer: UHC Medicaid |
$164.86
|
| Rate for Payer: UHCCP Medicaid |
$164.86
|
|
|
PR CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$1,308.00
|
|
|
Service Code
|
HCPCS 25505
|
| Min. Negotiated Rate |
$312.90 |
| Max. Negotiated Rate |
$981.00 |
| Rate for Payer: Aetna Commercial |
$609.77
|
| Rate for Payer: Aetna Medicare |
$654.00
|
| Rate for Payer: BCBS Complete |
$328.55
|
| Rate for Payer: BCN Commercial |
$718.09
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Mclaren Medicaid |
$312.90
|
| Rate for Payer: Meridian Medicaid |
$328.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$981.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$312.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$767.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$767.62
|
| Rate for Payer: UHC Medicaid |
$312.90
|
| Rate for Payer: UHCCP Medicaid |
$312.90
|
|
|
PR CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 25500
|
| Min. Negotiated Rate |
$174.02 |
| Max. Negotiated Rate |
$437.58 |
| Rate for Payer: Aetna Commercial |
$339.01
|
| Rate for Payer: Aetna Medicare |
$232.50
|
| Rate for Payer: BCBS Complete |
$182.72
|
| Rate for Payer: BCN Commercial |
$409.34
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Mclaren Medicaid |
$174.02
|
| Rate for Payer: Meridian Medicaid |
$182.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$348.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$437.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$437.58
|
| Rate for Payer: UHC Medicaid |
$174.02
|
| Rate for Payer: UHCCP Medicaid |
$174.02
|
|
|
PR CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MNPJ
|
Professional
|
Both
|
$1,471.00
|
|
|
Service Code
|
HCPCS 25565
|
| Min. Negotiated Rate |
$325.04 |
| Max. Negotiated Rate |
$1,103.25 |
| Rate for Payer: Aetna Commercial |
$619.55
|
| Rate for Payer: Aetna Medicare |
$735.50
|
| Rate for Payer: BCBS Complete |
$341.29
|
| Rate for Payer: BCN Commercial |
$721.07
|
| Rate for Payer: Cash Price |
$1,176.80
|
| Rate for Payer: Cash Price |
$1,176.80
|
| Rate for Payer: Mclaren Medicaid |
$325.04
|
| Rate for Payer: Meridian Medicaid |
$341.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,103.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$325.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$770.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$770.81
|
| Rate for Payer: UHC Medicaid |
$325.04
|
| Rate for Payer: UHCCP Medicaid |
$325.04
|
|
|
PR CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MNPJ
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
HCPCS 25560
|
| Min. Negotiated Rate |
$174.45 |
| Max. Negotiated Rate |
$551.25 |
| Rate for Payer: Aetna Commercial |
$340.68
|
| Rate for Payer: Aetna Medicare |
$367.50
|
| Rate for Payer: BCBS Complete |
$183.17
|
| Rate for Payer: BCN Commercial |
$324.37
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Mclaren Medicaid |
$174.45
|
| Rate for Payer: Meridian Medicaid |
$183.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$551.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$439.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$439.70
|
| Rate for Payer: UHC Medicaid |
$174.45
|
| Rate for Payer: UHCCP Medicaid |
$174.45
|
|
|
PR CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$632.00
|
|
|
Service Code
|
HCPCS 23570
|
| Min. Negotiated Rate |
$161.24 |
| Max. Negotiated Rate |
$474.00 |
| Rate for Payer: Aetna Commercial |
$319.45
|
| Rate for Payer: Aetna Medicare |
$316.00
|
| Rate for Payer: BCBS Complete |
$169.30
|
| Rate for Payer: BCN Commercial |
$385.44
|
| Rate for Payer: Cash Price |
$505.60
|
| Rate for Payer: Cash Price |
$505.60
|
| Rate for Payer: Mclaren Medicaid |
$161.24
|
| Rate for Payer: Meridian Medicaid |
$169.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$474.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$161.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$412.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$412.02
|
| Rate for Payer: UHC Medicaid |
$161.24
|
| Rate for Payer: UHCCP Medicaid |
$161.24
|
|
|
PR CLOSED TX STERNOCLAVICULAR DISLC W/MANIPULATION
|
Professional
|
Both
|
$806.00
|
|
|
Service Code
|
HCPCS 23525
|
| Min. Negotiated Rate |
$234.09 |
| Max. Negotiated Rate |
$611.12 |
| Rate for Payer: Aetna Commercial |
$478.72
|
| Rate for Payer: Aetna Medicare |
$403.00
|
| Rate for Payer: BCBS Complete |
$245.79
|
| Rate for Payer: BCN Commercial |
$571.68
|
| Rate for Payer: Cash Price |
$644.80
|
| Rate for Payer: Cash Price |
$644.80
|
| Rate for Payer: Mclaren Medicaid |
$234.09
|
| Rate for Payer: Meridian Medicaid |
$245.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$604.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$234.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$611.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$611.12
|
| Rate for Payer: UHC Medicaid |
$234.09
|
| Rate for Payer: UHCCP Medicaid |
$234.09
|
|
|
PR CLOSED TX TALOTARSAL JOINT DISLC W/O ANES
|
Professional
|
Both
|
$369.00
|
|
|
Service Code
|
HCPCS 28570
|
| Min. Negotiated Rate |
$130.78 |
| Max. Negotiated Rate |
$333.77 |
| Rate for Payer: Aetna Commercial |
$255.65
|
| Rate for Payer: Aetna Medicare |
$184.50
|
| Rate for Payer: BCBS Complete |
$137.32
|
| Rate for Payer: BCN Commercial |
$312.23
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Mclaren Medicaid |
$130.78
|
| Rate for Payer: Meridian Medicaid |
$137.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$333.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$333.77
|
| Rate for Payer: UHC Medicaid |
$130.78
|
| Rate for Payer: UHCCP Medicaid |
$130.78
|
|
|
PR CLOSED TX TALOTARSAL JOINT DISLOCATION W/ANES
|
Professional
|
Both
|
$832.00
|
|
|
Service Code
|
HCPCS 28575
|
| Min. Negotiated Rate |
$217.90 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$445.15
|
| Rate for Payer: Aetna Medicare |
$416.00
|
| Rate for Payer: BCBS Complete |
$228.79
|
| Rate for Payer: BCN Commercial |
$531.34
|
| Rate for Payer: Cash Price |
$665.60
|
| Rate for Payer: Cash Price |
$665.60
|
| Rate for Payer: Mclaren Medicaid |
$217.90
|
| Rate for Payer: Meridian Medicaid |
$228.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$624.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$217.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$568.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$568.00
|
| Rate for Payer: UHC Medicaid |
$217.90
|
| Rate for Payer: UHCCP Medicaid |
$217.90
|
|
|
PR CLOSED TX TALUS FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$832.00
|
|
|
Service Code
|
HCPCS 28435
|
| Min. Negotiated Rate |
$209.81 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$390.08
|
| Rate for Payer: Aetna Medicare |
$416.00
|
| Rate for Payer: BCBS Complete |
$220.30
|
| Rate for Payer: BCN Commercial |
$513.91
|
| Rate for Payer: Cash Price |
$665.60
|
| Rate for Payer: Cash Price |
$665.60
|
| Rate for Payer: Mclaren Medicaid |
$209.81
|
| Rate for Payer: Meridian Medicaid |
$220.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$624.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$549.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$549.37
|
| Rate for Payer: UHC Medicaid |
$209.81
|
| Rate for Payer: UHCCP Medicaid |
$209.81
|
|
|
PR CLOSED TX TALUS FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$693.00
|
|
|
Service Code
|
HCPCS 28430
|
| Min. Negotiated Rate |
$138.24 |
| Max. Negotiated Rate |
$519.75 |
| Rate for Payer: Aetna Commercial |
$277.32
|
| Rate for Payer: Aetna Medicare |
$346.50
|
| Rate for Payer: BCBS Complete |
$145.15
|
| Rate for Payer: BCN Commercial |
$329.66
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Mclaren Medicaid |
$138.24
|
| Rate for Payer: Meridian Medicaid |
$145.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$519.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$352.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$352.39
|
| Rate for Payer: UHC Medicaid |
$138.24
|
| Rate for Payer: UHCCP Medicaid |
$138.24
|
|
|
PR CLOSED TX TARSOMETATARSAL DISLOCATION W/ANES
|
Professional
|
Both
|
$832.00
|
|
|
Service Code
|
HCPCS 28605
|
| Min. Negotiated Rate |
$199.16 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$398.51
|
| Rate for Payer: Aetna Medicare |
$416.00
|
| Rate for Payer: BCBS Complete |
$209.12
|
| Rate for Payer: BCN Commercial |
$480.06
|
| Rate for Payer: Cash Price |
$665.60
|
| Rate for Payer: Cash Price |
$665.60
|
| Rate for Payer: Mclaren Medicaid |
$199.16
|
| Rate for Payer: Meridian Medicaid |
$209.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$624.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$199.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$513.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$513.16
|
| Rate for Payer: UHC Medicaid |
$199.16
|
| Rate for Payer: UHCCP Medicaid |
$199.16
|
|
|
PR CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
HCPCS 28600
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$310.87 |
| Rate for Payer: Aetna Commercial |
$242.75
|
| Rate for Payer: Aetna Medicare |
$194.00
|
| Rate for Payer: BCBS Complete |
$105.79
|
| Rate for Payer: BCN Commercial |
$290.82
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Mclaren Medicaid |
$100.75
|
| Rate for Payer: Meridian Medicaid |
$105.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$291.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$310.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$310.87
|
| Rate for Payer: UHC Medicaid |
$100.75
|
| Rate for Payer: UHCCP Medicaid |
$100.75
|
|
|
PR CLOSED TX TEMPOROMANDIBULAR DISLC COMP 1ST/SBSQ
|
Professional
|
Both
|
$1,121.00
|
|
|
Service Code
|
HCPCS 21485
|
| Min. Negotiated Rate |
$491.82 |
| Max. Negotiated Rate |
$1,231.81 |
| Rate for Payer: Aetna Commercial |
$1,032.91
|
| Rate for Payer: Aetna Medicare |
$560.50
|
| Rate for Payer: BCBS Complete |
$516.41
|
| Rate for Payer: BCN Commercial |
$1,152.33
|
| Rate for Payer: Cash Price |
$896.80
|
| Rate for Payer: Cash Price |
$896.80
|
| Rate for Payer: Mclaren Medicaid |
$491.82
|
| Rate for Payer: Meridian Medicaid |
$516.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$840.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$491.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,231.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,231.81
|
| Rate for Payer: UHC Medicaid |
$491.82
|
| Rate for Payer: UHCCP Medicaid |
$491.82
|
|
|
PR CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
HCPCS 21480
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$109.50 |
| Rate for Payer: Aetna Commercial |
$42.88
|
| Rate for Payer: Aetna Medicare |
$73.00
|
| Rate for Payer: BCBS Complete |
$20.35
|
| Rate for Payer: BCN Commercial |
$47.31
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Mclaren Medicaid |
$19.38
|
| Rate for Payer: Meridian Medicaid |
$20.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$50.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.57
|
| Rate for Payer: UHC Medicaid |
$19.38
|
| Rate for Payer: UHCCP Medicaid |
$19.38
|
|
