|
PR CLOSED TREAT SPINE PROCESS FX
|
Professional
|
Both
|
$415.00
|
|
|
Service Code
|
HCPCS 22305
|
| Min. Negotiated Rate |
$166.00 |
| Max. Negotiated Rate |
$290.50 |
| Rate for Payer: BCBS Complete |
$166.00
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.50
|
| Rate for Payer: UMR Bronson Commercial |
$190.90
|
|
|
PR CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA
|
Professional
|
Both
|
$903.00
|
|
|
Service Code
|
HCPCS 27840
|
| Min. Negotiated Rate |
$255.60 |
| Max. Negotiated Rate |
$1,414.69 |
| Rate for Payer: Aetna Commercial |
$504.89
|
| Rate for Payer: BCBS Complete |
$268.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,414.69
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Meridian Medicaid |
$268.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$255.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$632.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$603.59
|
| Rate for Payer: Priority Health Narrow Network |
$603.59
|
| Rate for Payer: Priority Health SBD |
$603.59
|
| Rate for Payer: UMR Bronson Commercial |
$415.38
|
|
|
PR CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ
|
Professional
|
Both
|
$1,167.00
|
|
|
Service Code
|
HCPCS 27810
|
| Min. Negotiated Rate |
$282.65 |
| Max. Negotiated Rate |
$2,867.08 |
| Rate for Payer: Aetna Commercial |
$566.31
|
| Rate for Payer: BCBS Complete |
$296.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,867.08
|
| Rate for Payer: Cash Price |
$933.60
|
| Rate for Payer: Cash Price |
$933.60
|
| Rate for Payer: Meridian Medicaid |
$296.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$816.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$667.43
|
| Rate for Payer: Priority Health Narrow Network |
$667.43
|
| Rate for Payer: Priority Health SBD |
$667.43
|
| Rate for Payer: UMR Bronson Commercial |
$536.82
|
|
|
PR CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ
|
Professional
|
Both
|
$855.00
|
|
|
Service Code
|
HCPCS 27808
|
| Min. Negotiated Rate |
$203.84 |
| Max. Negotiated Rate |
$598.50 |
| Rate for Payer: Aetna Commercial |
$403.72
|
| Rate for Payer: BCBS Complete |
$214.03
|
| Rate for Payer: BCBS Trust/PPO |
$556.11
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Meridian Medicaid |
$214.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$203.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$480.01
|
| Rate for Payer: Priority Health Narrow Network |
$480.01
|
| Rate for Payer: Priority Health SBD |
$480.01
|
| Rate for Payer: UMR Bronson Commercial |
$393.30
|
|
|
PR CLOSED TX CALCANEAL FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$1,141.00
|
|
|
Service Code
|
HCPCS 28405
|
| Min. Negotiated Rate |
$267.53 |
| Max. Negotiated Rate |
$1,513.05 |
| Rate for Payer: Aetna Commercial |
$471.72
|
| Rate for Payer: BCBS Complete |
$280.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,513.05
|
| Rate for Payer: Cash Price |
$912.80
|
| Rate for Payer: Cash Price |
$912.80
|
| Rate for Payer: Meridian Medicaid |
$280.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$798.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$631.67
|
| Rate for Payer: Priority Health Narrow Network |
$631.67
|
| Rate for Payer: Priority Health SBD |
$631.67
|
| Rate for Payer: UMR Bronson Commercial |
$524.86
|
|
|
PR CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$704.00
|
|
|
Service Code
|
HCPCS 28400
|
| Min. Negotiated Rate |
$152.30 |
| Max. Negotiated Rate |
$1,304.90 |
| Rate for Payer: Aetna Commercial |
$299.58
|
| Rate for Payer: BCBS Complete |
$159.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,304.90
|
| Rate for Payer: Cash Price |
$563.20
|
| Rate for Payer: Cash Price |
$563.20
|
| Rate for Payer: Meridian Medicaid |
$159.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$357.97
|
| Rate for Payer: Priority Health Narrow Network |
$357.97
|
| Rate for Payer: Priority Health SBD |
$357.97
|
| Rate for Payer: UMR Bronson Commercial |
$323.84
|
|
|
PR CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ
|
Professional
|
Both
|
$741.00
|
|
|
Service Code
|
HCPCS 25624
|
| Min. Negotiated Rate |
$295.22 |
| Max. Negotiated Rate |
$939.26 |
| Rate for Payer: Aetna Commercial |
$588.21
|
| Rate for Payer: BCBS Complete |
$309.98
|
| Rate for Payer: BCBS Trust/PPO |
$939.26
|
| Rate for Payer: Cash Price |
$592.80
|
| Rate for Payer: Cash Price |
$592.80
|
| Rate for Payer: Meridian Medicaid |
$309.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$295.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$518.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$696.52
|
| Rate for Payer: Priority Health Narrow Network |
$696.52
|
| Rate for Payer: Priority Health SBD |
$696.52
|
| Rate for Payer: UMR Bronson Commercial |
$340.86
|
|
|
PR CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ
|
Professional
|
Both
|
$778.00
|
|
|
Service Code
|
HCPCS 25622
|
| Min. Negotiated Rate |
$190.00 |
| Max. Negotiated Rate |
$939.26 |
| Rate for Payer: Aetna Commercial |
$373.80
|
| Rate for Payer: BCBS Complete |
$199.50
|
| Rate for Payer: BCBS Trust/PPO |
$939.26
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Meridian Medicaid |
$199.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$190.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$447.84
|
| Rate for Payer: Priority Health Narrow Network |
$447.84
|
| Rate for Payer: Priority Health SBD |
$447.84
|
| Rate for Payer: UMR Bronson Commercial |
$357.88
|
|
|
PR CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ
|
Professional
|
Both
|
$1,011.00
|
|
|
Service Code
|
HCPCS 25675
|
| Min. Negotiated Rate |
$273.71 |
| Max. Negotiated Rate |
$1,123.17 |
| Rate for Payer: Aetna Commercial |
$536.39
|
| Rate for Payer: BCBS Complete |
$287.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,123.17
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Meridian Medicaid |
$287.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$273.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$644.96
|
| Rate for Payer: Priority Health Narrow Network |
$644.96
|
| Rate for Payer: Priority Health SBD |
$644.96
|
| Rate for Payer: UMR Bronson Commercial |
$465.06
|
|
|
PR CLOSED TX FEMORAL FRACTURE PROX HEAD W/MANJ
|
Professional
|
Both
|
$789.00
|
|
|
Service Code
|
HCPCS 27268
|
| Min. Negotiated Rate |
$354.86 |
| Max. Negotiated Rate |
$3,411.76 |
| Rate for Payer: Aetna Commercial |
$725.37
|
| Rate for Payer: BCBS Complete |
$372.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,411.76
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Meridian Medicaid |
$372.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$354.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$552.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$842.06
|
| Rate for Payer: Priority Health Narrow Network |
$842.06
|
| Rate for Payer: Priority Health SBD |
$842.06
|
| Rate for Payer: UMR Bronson Commercial |
$362.94
|
|
|
PR CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION
|
Professional
|
Both
|
$1,257.00
|
|
|
Service Code
|
HCPCS 27500
|
| Min. Negotiated Rate |
$313.96 |
| Max. Negotiated Rate |
$2,223.09 |
| Rate for Payer: Aetna Commercial |
$641.93
|
| Rate for Payer: BCBS Complete |
$329.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,223.09
|
| Rate for Payer: Cash Price |
$1,005.60
|
| Rate for Payer: Cash Price |
$1,005.60
|
| Rate for Payer: Meridian Medicaid |
$329.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$313.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$879.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$746.57
|
| Rate for Payer: Priority Health Narrow Network |
$746.57
|
| Rate for Payer: Priority Health SBD |
$746.57
|
| Rate for Payer: UMR Bronson Commercial |
$578.22
|
|
|
PR CLOSED TX KNEE DISLOCATION W/ANESTHESIA
|
Professional
|
Both
|
$862.00
|
|
|
Service Code
|
HCPCS 27552
|
| Min. Negotiated Rate |
$396.52 |
| Max. Negotiated Rate |
$1,159.09 |
| Rate for Payer: Aetna Commercial |
$844.11
|
| Rate for Payer: BCBS Complete |
$434.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,159.09
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Meridian Medicaid |
$434.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$413.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$603.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$978.41
|
| Rate for Payer: Priority Health Narrow Network |
$978.41
|
| Rate for Payer: Priority Health SBD |
$978.41
|
| Rate for Payer: UMR Bronson Commercial |
$396.52
|
|
|
PR CLOSED TX KNEE DISLOCATION W/O ANESTHESIA
|
Professional
|
Both
|
$828.00
|
|
|
Service Code
|
HCPCS 27550
|
| Min. Negotiated Rate |
$309.06 |
| Max. Negotiated Rate |
$736.35 |
| Rate for Payer: Aetna Commercial |
$647.69
|
| Rate for Payer: BCBS Complete |
$324.51
|
| Rate for Payer: BCBS Trust/PPO |
$710.04
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Meridian Medicaid |
$324.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$309.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$579.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$736.35
|
| Rate for Payer: Priority Health Narrow Network |
$736.35
|
| Rate for Payer: Priority Health SBD |
$736.35
|
| Rate for Payer: UMR Bronson Commercial |
$380.88
|
|
|
PR CLOSED TX LUNATE DISLOCATION W/MANIPULATION
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 25690
|
| Min. Negotiated Rate |
$324.19 |
| Max. Negotiated Rate |
$2,554.86 |
| Rate for Payer: Aetna Commercial |
$651.62
|
| Rate for Payer: BCBS Complete |
$340.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,554.86
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Meridian Medicaid |
$340.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$324.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$765.47
|
| Rate for Payer: Priority Health Narrow Network |
$765.47
|
| Rate for Payer: Priority Health SBD |
$765.47
|
| Rate for Payer: UMR Bronson Commercial |
$379.50
|
|
|
PR CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$1,183.00
|
|
|
Service Code
|
HCPCS 21451
|
| Min. Negotiated Rate |
$409.39 |
| Max. Negotiated Rate |
$8,162.77 |
| Rate for Payer: Aetna Commercial |
$849.59
|
| Rate for Payer: BCBS Complete |
$429.86
|
| Rate for Payer: BCBS Trust/PPO |
$8,162.77
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Meridian Medicaid |
$429.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$409.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$828.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$985.55
|
| Rate for Payer: Priority Health Narrow Network |
$985.55
|
| Rate for Payer: Priority Health SBD |
$985.55
|
| Rate for Payer: UMR Bronson Commercial |
$544.18
|
|
|
PR CLOSED TX MANDIBULAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$1,147.00
|
|
|
Service Code
|
HCPCS 21450
|
| Min. Negotiated Rate |
$307.15 |
| Max. Negotiated Rate |
$10,328.77 |
| Rate for Payer: Aetna Commercial |
$634.10
|
| Rate for Payer: BCBS Complete |
$322.51
|
| Rate for Payer: BCBS Trust/PPO |
$10,328.77
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Meridian Medicaid |
$322.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$307.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$802.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.40
|
| Rate for Payer: Priority Health Narrow Network |
$738.40
|
| Rate for Payer: Priority Health SBD |
$738.40
|
| Rate for Payer: UMR Bronson Commercial |
$527.62
|
|
|
PR CLOSED TX MANDIBULAR FX W/INTERDENTAL FIXATION
|
Professional
|
Both
|
$1,388.00
|
|
|
Service Code
|
HCPCS 21453
|
| Min. Negotiated Rate |
$594.91 |
| Max. Negotiated Rate |
$8,162.77 |
| Rate for Payer: Aetna Commercial |
$1,208.80
|
| Rate for Payer: BCBS Complete |
$624.66
|
| Rate for Payer: BCBS Trust/PPO |
$8,162.77
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Meridian Medicaid |
$624.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$594.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$971.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,431.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,431.87
|
| Rate for Payer: Priority Health SBD |
$1,431.87
|
| Rate for Payer: UMR Bronson Commercial |
$638.48
|
|
|
PR CLOSED TX METATARSAL FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$528.00
|
|
|
Service Code
|
HCPCS 28470
|
| Min. Negotiated Rate |
$135.89 |
| Max. Negotiated Rate |
$915.02 |
| Rate for Payer: Aetna Commercial |
$268.17
|
| Rate for Payer: BCBS Complete |
$142.68
|
| Rate for Payer: BCBS Trust/PPO |
$915.02
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Meridian Medicaid |
$142.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$135.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$318.14
|
| Rate for Payer: Priority Health Narrow Network |
$318.14
|
| Rate for Payer: Priority Health SBD |
$318.14
|
| Rate for Payer: UMR Bronson Commercial |
$242.88
|
|
|
PR CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ
|
Professional
|
Both
|
$1,608.00
|
|
|
Service Code
|
HCPCS 24620
|
| Min. Negotiated Rate |
$385.32 |
| Max. Negotiated Rate |
$1,125.60 |
| Rate for Payer: Aetna Commercial |
$749.39
|
| Rate for Payer: BCBS Complete |
$404.59
|
| Rate for Payer: BCBS Trust/PPO |
$793.51
|
| Rate for Payer: Cash Price |
$1,286.40
|
| Rate for Payer: Cash Price |
$1,286.40
|
| Rate for Payer: Meridian Medicaid |
$404.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,125.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$911.52
|
| Rate for Payer: Priority Health Narrow Network |
$911.52
|
| Rate for Payer: Priority Health SBD |
$911.52
|
| Rate for Payer: UMR Bronson Commercial |
$739.68
|
|
|
PR CLOSED TX NASAL BONE FX W/MNPJ W/O STABILIZATION
|
Professional
|
Both
|
$442.00
|
|
|
Service Code
|
HCPCS 21315
|
| Min. Negotiated Rate |
$38.13 |
| Max. Negotiated Rate |
$2,948.86 |
| Rate for Payer: Aetna Commercial |
$201.65
|
| Rate for Payer: BCBS Complete |
$40.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,948.86
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Meridian Medicaid |
$40.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.92
|
| Rate for Payer: Priority Health Narrow Network |
$91.92
|
| Rate for Payer: Priority Health SBD |
$91.92
|
| Rate for Payer: UMR Bronson Commercial |
$203.32
|
|
|
PR CLOSED TX NASAL BONE FX W/MNPJ W/STABILIZATION
|
Professional
|
Both
|
$407.00
|
|
|
Service Code
|
HCPCS 21320
|
| Min. Negotiated Rate |
$60.71 |
| Max. Negotiated Rate |
$284.90 |
| Rate for Payer: Aetna Commercial |
$176.51
|
| Rate for Payer: BCBS Complete |
$63.75
|
| Rate for Payer: BCBS Trust/PPO |
$140.42
|
| Rate for Payer: Cash Price |
$325.60
|
| Rate for Payer: Cash Price |
$325.60
|
| Rate for Payer: Meridian Medicaid |
$63.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.51
|
| Rate for Payer: Priority Health Narrow Network |
$144.51
|
| Rate for Payer: Priority Health SBD |
$144.51
|
| Rate for Payer: UMR Bronson Commercial |
$187.22
|
|
|
PR CLOSED TX NASAL SEPTAL FRACT W/WO STABILIZATION
|
Professional
|
Both
|
$645.00
|
|
|
Service Code
|
HCPCS 21337
|
| Min. Negotiated Rate |
$57.48 |
| Max. Negotiated Rate |
$462.14 |
| Rate for Payer: Aetna Commercial |
$388.27
|
| Rate for Payer: BCBS Complete |
$204.41
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Meridian Medicaid |
$204.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$451.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$462.14
|
| Rate for Payer: Priority Health Narrow Network |
$462.14
|
| Rate for Payer: Priority Health SBD |
$462.14
|
| Rate for Payer: UMR Bronson Commercial |
$296.70
|
|
|
PR CLOSED TX PALATAL/MAXILLARY FX W/FIXATION/SPLINT
|
Professional
|
Both
|
$1,302.00
|
|
|
Service Code
|
HCPCS 21421
|
| Min. Negotiated Rate |
$348.26 |
| Max. Negotiated Rate |
$3,350.93 |
| Rate for Payer: Aetna Commercial |
$736.23
|
| Rate for Payer: BCBS Complete |
$365.67
|
| Rate for Payer: BCBS Trust/PPO |
$3,350.93
|
| Rate for Payer: Cash Price |
$1,041.60
|
| Rate for Payer: Cash Price |
$1,041.60
|
| Rate for Payer: Meridian Medicaid |
$365.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$911.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$832.87
|
| Rate for Payer: Priority Health Narrow Network |
$832.87
|
| Rate for Payer: Priority Health SBD |
$832.87
|
| Rate for Payer: UMR Bronson Commercial |
$598.92
|
|
|
PR CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA
|
Professional
|
Both
|
$602.00
|
|
|
Service Code
|
HCPCS 27560
|
| Min. Negotiated Rate |
$226.63 |
| Max. Negotiated Rate |
$2,121.65 |
| Rate for Payer: Aetna Commercial |
$457.80
|
| Rate for Payer: BCBS Complete |
$237.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,121.65
|
| Rate for Payer: Cash Price |
$481.60
|
| Rate for Payer: Cash Price |
$481.60
|
| Rate for Payer: Meridian Medicaid |
$237.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$226.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$421.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$536.69
|
| Rate for Payer: Priority Health Narrow Network |
$536.69
|
| Rate for Payer: Priority Health SBD |
$536.69
|
| Rate for Payer: UMR Bronson Commercial |
$276.92
|
|
|
PR CLOSED TX PATELLAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$638.00
|
|
|
Service Code
|
HCPCS 27520
|
| Min. Negotiated Rate |
$49.13 |
| Max. Negotiated Rate |
$473.37 |
| Rate for Payer: Aetna Commercial |
$396.99
|
| Rate for Payer: BCBS Complete |
$210.68
|
| Rate for Payer: BCBS Trust/PPO |
$49.13
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Meridian Medicaid |
$210.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$446.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$473.37
|
| Rate for Payer: Priority Health Narrow Network |
$473.37
|
| Rate for Payer: Priority Health SBD |
$473.37
|
| Rate for Payer: UMR Bronson Commercial |
$293.48
|
|
