|
PR CLOSED TREATMENT SESAMOID FRACTURE
|
Professional
|
Both
|
$345.00
|
|
|
Service Code
|
HCPCS 28530
|
| Min. Negotiated Rate |
$67.31 |
| Max. Negotiated Rate |
$1,243.09 |
| Rate for Payer: Aetna Commercial |
$131.07
|
| Rate for Payer: Aetna Medicare |
$97.81
|
| Rate for Payer: BCBS Complete |
$70.68
|
| Rate for Payer: BCBS MAPPO |
$97.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,243.09
|
| Rate for Payer: BCN Commercial |
$171.04
|
| Rate for Payer: BCN Medicare Advantage |
$97.81
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cofinity Commercial |
$140.85
|
| Rate for Payer: Cofinity Commercial |
$131.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.81
|
| Rate for Payer: Healthscope Commercial |
$117.37
|
| Rate for Payer: Healthscope Whirlpool |
$117.37
|
| Rate for Payer: Meridian Medicaid |
$70.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.70
|
| Rate for Payer: PACE SWMI |
$97.81
|
| Rate for Payer: PHP Medicare Advantage |
$97.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.24
|
| Rate for Payer: Priority Health Medicare |
$97.81
|
| Rate for Payer: Priority Health Narrow Network |
$155.24
|
| Rate for Payer: UHC Medicare Advantage |
$100.74
|
|
|
PR CLOSED TREATMENT STERNUM FRACTURE
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 21820
|
| Min. Negotiated Rate |
$98.19 |
| Max. Negotiated Rate |
$230.81 |
| Rate for Payer: Aetna Commercial |
$194.50
|
| Rate for Payer: Aetna Medicare |
$145.15
|
| Rate for Payer: BCBS Complete |
$103.10
|
| Rate for Payer: BCBS MAPPO |
$145.15
|
| Rate for Payer: BCBS Trust/PPO |
$99.81
|
| Rate for Payer: BCN Commercial |
$224.30
|
| Rate for Payer: BCN Medicare Advantage |
$145.15
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cofinity Commercial |
$194.50
|
| Rate for Payer: Cofinity Commercial |
$209.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.15
|
| Rate for Payer: Healthscope Commercial |
$174.18
|
| Rate for Payer: Healthscope Whirlpool |
$174.18
|
| Rate for Payer: Meridian Medicaid |
$103.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$152.41
|
| Rate for Payer: PACE SWMI |
$145.15
|
| Rate for Payer: PHP Medicare Advantage |
$145.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$230.81
|
| Rate for Payer: Priority Health Medicare |
$145.15
|
| Rate for Payer: Priority Health Narrow Network |
$230.81
|
| Rate for Payer: UHC Medicare Advantage |
$149.50
|
|
|
PR CLOSED TREATMENT ULNAR STYLOID FRACTURE
|
Professional
|
Both
|
$817.00
|
|
|
Service Code
|
HCPCS 25650
|
| Min. Negotiated Rate |
$204.05 |
| Max. Negotiated Rate |
$1,117.88 |
| Rate for Payer: Aetna Commercial |
$409.18
|
| Rate for Payer: Aetna Medicare |
$305.36
|
| Rate for Payer: BCBS Complete |
$214.25
|
| Rate for Payer: BCBS MAPPO |
$305.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,117.88
|
| Rate for Payer: BCN Commercial |
$498.94
|
| Rate for Payer: BCN Medicare Advantage |
$305.36
|
| Rate for Payer: Cash Price |
$653.60
|
| Rate for Payer: Cash Price |
$653.60
|
| Rate for Payer: Cofinity Commercial |
$439.72
|
| Rate for Payer: Cofinity Commercial |
$409.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.36
|
| Rate for Payer: Healthscope Commercial |
$366.43
|
| Rate for Payer: Healthscope Whirlpool |
$366.43
|
| Rate for Payer: Meridian Medicaid |
$214.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$320.63
|
| Rate for Payer: PACE SWMI |
$305.36
|
| Rate for Payer: PHP Medicare Advantage |
$305.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$204.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$571.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$483.07
|
| Rate for Payer: Priority Health Medicare |
$305.36
|
| Rate for Payer: Priority Health Narrow Network |
$483.07
|
| Rate for Payer: UHC Medicare Advantage |
$314.52
|
|
|
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
|
|
|
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 |
$515.36
|
| Rate for Payer: Aetna Medicare |
$384.60
|
| Rate for Payer: BCBS Complete |
$268.38
|
| Rate for Payer: BCBS MAPPO |
$384.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,414.69
|
| Rate for Payer: BCN Commercial |
$577.62
|
| Rate for Payer: BCN Medicare Advantage |
$384.60
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cofinity Commercial |
$515.36
|
| Rate for Payer: Cofinity Commercial |
$553.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$384.60
|
| Rate for Payer: Healthscope Commercial |
$461.52
|
| Rate for Payer: Healthscope Whirlpool |
$461.52
|
| Rate for Payer: Meridian Medicaid |
$268.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$403.83
|
| Rate for Payer: PACE SWMI |
$384.60
|
| Rate for Payer: PHP Medicare Advantage |
$384.60
|
| 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 Medicare |
$384.60
|
| Rate for Payer: Priority Health Narrow Network |
$603.59
|
| Rate for Payer: UHC Medicare Advantage |
$396.14
|
|
|
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 |
$570.12
|
| Rate for Payer: Aetna Medicare |
$425.46
|
| Rate for Payer: BCBS Complete |
$296.78
|
| Rate for Payer: BCBS MAPPO |
$425.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,867.08
|
| Rate for Payer: BCN Commercial |
$710.05
|
| Rate for Payer: BCN Medicare Advantage |
$425.46
|
| Rate for Payer: Cash Price |
$933.60
|
| Rate for Payer: Cash Price |
$933.60
|
| Rate for Payer: Cofinity Commercial |
$612.66
|
| Rate for Payer: Cofinity Commercial |
$570.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$425.46
|
| Rate for Payer: Healthscope Commercial |
$510.55
|
| Rate for Payer: Healthscope Whirlpool |
$510.55
|
| Rate for Payer: Meridian Medicaid |
$296.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$446.73
|
| Rate for Payer: PACE SWMI |
$425.46
|
| Rate for Payer: PHP Medicare Advantage |
$425.46
|
| 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 Medicare |
$425.46
|
| Rate for Payer: Priority Health Narrow Network |
$667.43
|
| Rate for Payer: UHC Medicare Advantage |
$438.22
|
|
|
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 |
$405.30
|
| Rate for Payer: Aetna Medicare |
$302.46
|
| Rate for Payer: BCBS Complete |
$214.03
|
| Rate for Payer: BCBS MAPPO |
$302.46
|
| Rate for Payer: BCBS Trust/PPO |
$556.11
|
| Rate for Payer: BCN Commercial |
$503.83
|
| Rate for Payer: BCN Medicare Advantage |
$302.46
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cofinity Commercial |
$405.30
|
| Rate for Payer: Cofinity Commercial |
$435.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$302.46
|
| Rate for Payer: Healthscope Commercial |
$362.95
|
| Rate for Payer: Healthscope Whirlpool |
$362.95
|
| Rate for Payer: Meridian Medicaid |
$214.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$317.58
|
| Rate for Payer: PACE SWMI |
$302.46
|
| Rate for Payer: PHP Medicare Advantage |
$302.46
|
| 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 Medicare |
$302.46
|
| Rate for Payer: Priority Health Narrow Network |
$480.01
|
| Rate for Payer: UHC Medicare Advantage |
$311.53
|
|
|
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 |
$537.98
|
| Rate for Payer: Aetna Medicare |
$401.48
|
| Rate for Payer: BCBS Complete |
$280.91
|
| Rate for Payer: BCBS MAPPO |
$401.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,513.05
|
| Rate for Payer: BCN Commercial |
$673.40
|
| Rate for Payer: BCN Medicare Advantage |
$401.48
|
| Rate for Payer: Cash Price |
$912.80
|
| Rate for Payer: Cash Price |
$912.80
|
| Rate for Payer: Cofinity Commercial |
$578.13
|
| Rate for Payer: Cofinity Commercial |
$537.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$401.48
|
| Rate for Payer: Healthscope Commercial |
$481.78
|
| Rate for Payer: Healthscope Whirlpool |
$481.78
|
| Rate for Payer: Meridian Medicaid |
$280.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$421.55
|
| Rate for Payer: PACE SWMI |
$401.48
|
| Rate for Payer: PHP Medicare Advantage |
$401.48
|
| 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 Medicare |
$401.48
|
| Rate for Payer: Priority Health Narrow Network |
$631.67
|
| Rate for Payer: UHC Medicare Advantage |
$413.52
|
|
|
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 |
$302.02
|
| Rate for Payer: Aetna Medicare |
$225.39
|
| Rate for Payer: BCBS Complete |
$159.92
|
| Rate for Payer: BCBS MAPPO |
$225.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,304.90
|
| Rate for Payer: BCN Commercial |
$368.95
|
| Rate for Payer: BCN Medicare Advantage |
$225.39
|
| Rate for Payer: Cash Price |
$563.20
|
| Rate for Payer: Cash Price |
$563.20
|
| Rate for Payer: Cofinity Commercial |
$302.02
|
| Rate for Payer: Cofinity Commercial |
$324.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.39
|
| Rate for Payer: Healthscope Commercial |
$270.47
|
| Rate for Payer: Healthscope Whirlpool |
$270.47
|
| Rate for Payer: Meridian Medicaid |
$159.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$236.66
|
| Rate for Payer: PACE SWMI |
$225.39
|
| Rate for Payer: PHP Medicare Advantage |
$225.39
|
| 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 Medicare |
$225.39
|
| Rate for Payer: Priority Health Narrow Network |
$357.97
|
| Rate for Payer: UHC Medicare Advantage |
$232.15
|
|
|
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 |
$590.73
|
| Rate for Payer: Aetna Medicare |
$440.84
|
| Rate for Payer: BCBS Complete |
$309.98
|
| Rate for Payer: BCBS MAPPO |
$440.84
|
| Rate for Payer: BCBS Trust/PPO |
$939.26
|
| Rate for Payer: BCN Commercial |
$735.95
|
| Rate for Payer: BCN Medicare Advantage |
$440.84
|
| Rate for Payer: Cash Price |
$592.80
|
| Rate for Payer: Cash Price |
$592.80
|
| Rate for Payer: Cofinity Commercial |
$590.73
|
| Rate for Payer: Cofinity Commercial |
$634.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$440.84
|
| Rate for Payer: Healthscope Commercial |
$529.01
|
| Rate for Payer: Healthscope Whirlpool |
$529.01
|
| Rate for Payer: Meridian Medicaid |
$309.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$462.88
|
| Rate for Payer: PACE SWMI |
$440.84
|
| Rate for Payer: PHP Medicare Advantage |
$440.84
|
| 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 Medicare |
$440.84
|
| Rate for Payer: Priority Health Narrow Network |
$696.52
|
| Rate for Payer: UHC Medicare Advantage |
$454.07
|
|
|
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 |
$378.04
|
| Rate for Payer: Aetna Medicare |
$282.12
|
| Rate for Payer: BCBS Complete |
$199.50
|
| Rate for Payer: BCBS MAPPO |
$282.12
|
| Rate for Payer: BCBS Trust/PPO |
$939.26
|
| Rate for Payer: BCN Commercial |
$373.03
|
| Rate for Payer: BCN Medicare Advantage |
$282.12
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Cofinity Commercial |
$406.25
|
| Rate for Payer: Cofinity Commercial |
$378.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$282.12
|
| Rate for Payer: Healthscope Commercial |
$338.54
|
| Rate for Payer: Healthscope Whirlpool |
$338.54
|
| Rate for Payer: Meridian Medicaid |
$199.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$296.23
|
| Rate for Payer: PACE SWMI |
$282.12
|
| Rate for Payer: PHP Medicare Advantage |
$282.12
|
| 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 Medicare |
$282.12
|
| Rate for Payer: Priority Health Narrow Network |
$447.84
|
| Rate for Payer: UHC Medicare Advantage |
$290.58
|
|
|
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 |
$549.57
|
| Rate for Payer: Aetna Medicare |
$410.13
|
| Rate for Payer: BCBS Complete |
$287.40
|
| Rate for Payer: BCBS MAPPO |
$410.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,123.17
|
| Rate for Payer: BCN Commercial |
$685.13
|
| Rate for Payer: BCN Medicare Advantage |
$410.13
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cofinity Commercial |
$549.57
|
| Rate for Payer: Cofinity Commercial |
$590.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$410.13
|
| Rate for Payer: Healthscope Commercial |
$492.16
|
| Rate for Payer: Healthscope Whirlpool |
$492.16
|
| Rate for Payer: Meridian Medicaid |
$287.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$430.64
|
| Rate for Payer: PACE SWMI |
$410.13
|
| Rate for Payer: PHP Medicare Advantage |
$410.13
|
| 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 Medicare |
$410.13
|
| Rate for Payer: Priority Health Narrow Network |
$644.96
|
| Rate for Payer: UHC Medicare Advantage |
$422.43
|
|
|
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 |
$721.71
|
| Rate for Payer: Aetna Medicare |
$538.59
|
| Rate for Payer: BCBS Complete |
$372.60
|
| Rate for Payer: BCBS MAPPO |
$538.59
|
| Rate for Payer: BCBS Trust/PPO |
$3,411.76
|
| Rate for Payer: BCN Commercial |
$805.83
|
| Rate for Payer: BCN Medicare Advantage |
$538.59
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cofinity Commercial |
$775.57
|
| Rate for Payer: Cofinity Commercial |
$721.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$538.59
|
| Rate for Payer: Healthscope Commercial |
$646.31
|
| Rate for Payer: Healthscope Whirlpool |
$646.31
|
| Rate for Payer: Meridian Medicaid |
$372.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$565.52
|
| Rate for Payer: PACE SWMI |
$538.59
|
| Rate for Payer: PHP Medicare Advantage |
$538.59
|
| 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 Medicare |
$538.59
|
| Rate for Payer: Priority Health Narrow Network |
$842.06
|
| Rate for Payer: UHC Medicare Advantage |
$554.75
|
|
|
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 |
$639.69
|
| Rate for Payer: Aetna Medicare |
$477.38
|
| Rate for Payer: BCBS Complete |
$329.66
|
| Rate for Payer: BCBS MAPPO |
$477.38
|
| Rate for Payer: BCBS Trust/PPO |
$2,223.09
|
| Rate for Payer: BCN Commercial |
$778.46
|
| Rate for Payer: BCN Medicare Advantage |
$477.38
|
| Rate for Payer: Cash Price |
$1,005.60
|
| Rate for Payer: Cash Price |
$1,005.60
|
| Rate for Payer: Cofinity Commercial |
$639.69
|
| Rate for Payer: Cofinity Commercial |
$687.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$477.38
|
| Rate for Payer: Healthscope Commercial |
$572.86
|
| Rate for Payer: Healthscope Whirlpool |
$572.86
|
| Rate for Payer: Meridian Medicaid |
$329.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$501.25
|
| Rate for Payer: PACE SWMI |
$477.38
|
| Rate for Payer: PHP Medicare Advantage |
$477.38
|
| 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 Medicare |
$477.38
|
| Rate for Payer: Priority Health Narrow Network |
$746.57
|
| Rate for Payer: UHC Medicare Advantage |
$491.70
|
|
|
PR CLOSED TX KNEE DISLOCATION W/ANESTHESIA
|
Professional
|
Both
|
$862.00
|
|
|
Service Code
|
HCPCS 27552
|
| Min. Negotiated Rate |
$413.43 |
| Max. Negotiated Rate |
$1,159.09 |
| Rate for Payer: Aetna Commercial |
$837.79
|
| Rate for Payer: Aetna Medicare |
$625.22
|
| Rate for Payer: BCBS Complete |
$434.10
|
| Rate for Payer: BCBS MAPPO |
$625.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,159.09
|
| Rate for Payer: BCN Commercial |
$936.30
|
| Rate for Payer: BCN Medicare Advantage |
$625.22
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Cofinity Commercial |
$837.79
|
| Rate for Payer: Cofinity Commercial |
$900.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.22
|
| Rate for Payer: Healthscope Commercial |
$750.26
|
| Rate for Payer: Healthscope Whirlpool |
$750.26
|
| Rate for Payer: Meridian Medicaid |
$434.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$656.48
|
| Rate for Payer: PACE SWMI |
$625.22
|
| Rate for Payer: PHP Medicare Advantage |
$625.22
|
| 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 Medicare |
$625.22
|
| Rate for Payer: Priority Health Narrow Network |
$978.41
|
| Rate for Payer: UHC Medicare Advantage |
$643.98
|
|
|
PR CLOSED TX KNEE DISLOCATION W/O ANESTHESIA
|
Professional
|
Both
|
$828.00
|
|
|
Service Code
|
HCPCS 27550
|
| Min. Negotiated Rate |
$309.06 |
| Max. Negotiated Rate |
$768.20 |
| Rate for Payer: Aetna Commercial |
$629.60
|
| Rate for Payer: Aetna Medicare |
$469.85
|
| Rate for Payer: BCBS Complete |
$324.51
|
| Rate for Payer: BCBS MAPPO |
$469.85
|
| Rate for Payer: BCBS Trust/PPO |
$710.04
|
| Rate for Payer: BCN Commercial |
$768.20
|
| Rate for Payer: BCN Medicare Advantage |
$469.85
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cofinity Commercial |
$629.60
|
| Rate for Payer: Cofinity Commercial |
$676.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$469.85
|
| Rate for Payer: Healthscope Commercial |
$563.82
|
| Rate for Payer: Healthscope Whirlpool |
$563.82
|
| Rate for Payer: Meridian Medicaid |
$324.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$493.34
|
| Rate for Payer: PACE SWMI |
$469.85
|
| Rate for Payer: PHP Medicare Advantage |
$469.85
|
| 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 Medicare |
$469.85
|
| Rate for Payer: Priority Health Narrow Network |
$736.35
|
| Rate for Payer: UHC Medicare Advantage |
$483.95
|
|
|
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 |
$651.76
|
| Rate for Payer: Aetna Medicare |
$486.39
|
| Rate for Payer: BCBS Complete |
$340.40
|
| Rate for Payer: BCBS MAPPO |
$486.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,554.86
|
| Rate for Payer: BCN Commercial |
$732.53
|
| Rate for Payer: BCN Medicare Advantage |
$486.39
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cofinity Commercial |
$700.40
|
| Rate for Payer: Cofinity Commercial |
$651.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$486.39
|
| Rate for Payer: Healthscope Commercial |
$583.67
|
| Rate for Payer: Healthscope Whirlpool |
$583.67
|
| Rate for Payer: Meridian Medicaid |
$340.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$510.71
|
| Rate for Payer: PACE SWMI |
$486.39
|
| Rate for Payer: PHP Medicare Advantage |
$486.39
|
| 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 Medicare |
$486.39
|
| Rate for Payer: Priority Health Narrow Network |
$765.47
|
| Rate for Payer: UHC Medicare Advantage |
$500.98
|
|
|
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 |
$825.27
|
| Rate for Payer: Aetna Medicare |
$615.87
|
| Rate for Payer: BCBS Complete |
$429.86
|
| Rate for Payer: BCBS MAPPO |
$615.87
|
| Rate for Payer: BCBS Trust/PPO |
$8,162.77
|
| Rate for Payer: BCN Commercial |
$1,130.31
|
| Rate for Payer: BCN Medicare Advantage |
$615.87
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cofinity Commercial |
$886.85
|
| Rate for Payer: Cofinity Commercial |
$825.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.87
|
| Rate for Payer: Healthscope Commercial |
$739.04
|
| Rate for Payer: Healthscope Whirlpool |
$739.04
|
| Rate for Payer: Meridian Medicaid |
$429.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$646.66
|
| Rate for Payer: PACE SWMI |
$615.87
|
| Rate for Payer: PHP Medicare Advantage |
$615.87
|
| 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 Medicare |
$615.87
|
| Rate for Payer: Priority Health Narrow Network |
$985.55
|
| Rate for Payer: UHC Medicare Advantage |
$634.35
|
|
|
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 |
$615.78
|
| Rate for Payer: Aetna Medicare |
$459.54
|
| Rate for Payer: BCBS Complete |
$322.51
|
| Rate for Payer: BCBS MAPPO |
$459.54
|
| Rate for Payer: BCBS Trust/PPO |
$10,328.77
|
| Rate for Payer: BCN Commercial |
$869.84
|
| Rate for Payer: BCN Medicare Advantage |
$459.54
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Cofinity Commercial |
$615.78
|
| Rate for Payer: Cofinity Commercial |
$661.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$459.54
|
| Rate for Payer: Healthscope Commercial |
$551.45
|
| Rate for Payer: Healthscope Whirlpool |
$551.45
|
| Rate for Payer: Meridian Medicaid |
$322.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$482.52
|
| Rate for Payer: PACE SWMI |
$459.54
|
| Rate for Payer: PHP Medicare Advantage |
$459.54
|
| 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 Medicare |
$459.54
|
| Rate for Payer: Priority Health Narrow Network |
$738.40
|
| Rate for Payer: UHC Medicare Advantage |
$473.33
|
|
|
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 |
$1,193.44
|
| Rate for Payer: Aetna Medicare |
$890.63
|
| Rate for Payer: BCBS Complete |
$624.66
|
| Rate for Payer: BCBS MAPPO |
$890.63
|
| Rate for Payer: BCBS Trust/PPO |
$8,162.77
|
| Rate for Payer: BCN Commercial |
$1,610.19
|
| Rate for Payer: BCN Medicare Advantage |
$890.63
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cofinity Commercial |
$1,282.51
|
| Rate for Payer: Cofinity Commercial |
$1,193.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$890.63
|
| Rate for Payer: Healthscope Commercial |
$1,068.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,068.76
|
| Rate for Payer: Meridian Medicaid |
$624.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$935.16
|
| Rate for Payer: PACE SWMI |
$890.63
|
| Rate for Payer: PHP Medicare Advantage |
$890.63
|
| 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 Medicare |
$890.63
|
| Rate for Payer: Priority Health Narrow Network |
$1,431.87
|
| Rate for Payer: UHC Medicare Advantage |
$917.35
|
|
|
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 |
$267.95
|
| Rate for Payer: Aetna Medicare |
$199.96
|
| Rate for Payer: BCBS Complete |
$142.68
|
| Rate for Payer: BCBS MAPPO |
$199.96
|
| Rate for Payer: BCBS Trust/PPO |
$915.02
|
| Rate for Payer: BCN Commercial |
$260.33
|
| Rate for Payer: BCN Medicare Advantage |
$199.96
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cofinity Commercial |
$267.95
|
| Rate for Payer: Cofinity Commercial |
$287.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.96
|
| Rate for Payer: Healthscope Commercial |
$239.95
|
| Rate for Payer: Healthscope Whirlpool |
$239.95
|
| Rate for Payer: Meridian Medicaid |
$142.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$209.96
|
| Rate for Payer: PACE SWMI |
$199.96
|
| Rate for Payer: PHP Medicare Advantage |
$199.96
|
| 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 Medicare |
$199.96
|
| Rate for Payer: Priority Health Narrow Network |
$318.14
|
| Rate for Payer: UHC Medicare Advantage |
$205.96
|
|
|
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 |
$778.45
|
| Rate for Payer: Aetna Medicare |
$580.93
|
| Rate for Payer: BCBS Complete |
$404.59
|
| Rate for Payer: BCBS MAPPO |
$580.93
|
| Rate for Payer: BCBS Trust/PPO |
$793.51
|
| Rate for Payer: BCN Commercial |
$872.29
|
| Rate for Payer: BCN Medicare Advantage |
$580.93
|
| Rate for Payer: Cash Price |
$1,286.40
|
| Rate for Payer: Cash Price |
$1,286.40
|
| Rate for Payer: Cofinity Commercial |
$836.54
|
| Rate for Payer: Cofinity Commercial |
$778.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$580.93
|
| Rate for Payer: Healthscope Commercial |
$697.12
|
| Rate for Payer: Healthscope Whirlpool |
$697.12
|
| Rate for Payer: Meridian Medicaid |
$404.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$609.98
|
| Rate for Payer: PACE SWMI |
$580.93
|
| Rate for Payer: PHP Medicare Advantage |
$580.93
|
| 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 Medicare |
$580.93
|
| Rate for Payer: Priority Health Narrow Network |
$911.52
|
| Rate for Payer: UHC Medicare Advantage |
$598.36
|
|
|
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 |
$79.61
|
| Rate for Payer: Aetna Medicare |
$59.41
|
| Rate for Payer: BCBS Complete |
$40.04
|
| Rate for Payer: BCBS MAPPO |
$59.41
|
| Rate for Payer: BCBS Trust/PPO |
$2,948.86
|
| Rate for Payer: BCN Commercial |
$222.83
|
| Rate for Payer: BCN Medicare Advantage |
$59.41
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cofinity Commercial |
$79.61
|
| Rate for Payer: Cofinity Commercial |
$85.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.41
|
| Rate for Payer: Healthscope Commercial |
$71.29
|
| Rate for Payer: Healthscope Whirlpool |
$71.29
|
| Rate for Payer: Meridian Medicaid |
$40.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$62.38
|
| Rate for Payer: PACE SWMI |
$59.41
|
| Rate for Payer: PHP Medicare Advantage |
$59.41
|
| 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 Medicare |
$59.41
|
| Rate for Payer: Priority Health Narrow Network |
$91.92
|
| Rate for Payer: UHC Medicare Advantage |
$61.19
|
|
|
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 |
$320.57 |
| Rate for Payer: Aetna Commercial |
$125.22
|
| Rate for Payer: Aetna Medicare |
$93.45
|
| Rate for Payer: BCBS Complete |
$63.75
|
| Rate for Payer: BCBS MAPPO |
$93.45
|
| Rate for Payer: BCBS Trust/PPO |
$140.42
|
| Rate for Payer: BCN Commercial |
$320.57
|
| Rate for Payer: BCN Medicare Advantage |
$93.45
|
| Rate for Payer: Cash Price |
$325.60
|
| Rate for Payer: Cash Price |
$325.60
|
| Rate for Payer: Cofinity Commercial |
$125.22
|
| Rate for Payer: Cofinity Commercial |
$134.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.45
|
| Rate for Payer: Healthscope Commercial |
$112.14
|
| Rate for Payer: Healthscope Whirlpool |
$112.14
|
| Rate for Payer: Meridian Medicaid |
$63.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$98.12
|
| Rate for Payer: PACE SWMI |
$93.45
|
| Rate for Payer: PHP Medicare Advantage |
$93.45
|
| 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 Medicare |
$93.45
|
| Rate for Payer: Priority Health Narrow Network |
$144.51
|
| Rate for Payer: UHC Medicare Advantage |
$96.25
|
|
|
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 |
$616.71 |
| Rate for Payer: Aetna Commercial |
$391.90
|
| Rate for Payer: Aetna Medicare |
$292.46
|
| Rate for Payer: BCBS Complete |
$204.41
|
| Rate for Payer: BCBS MAPPO |
$292.46
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$616.71
|
| Rate for Payer: BCN Medicare Advantage |
$292.46
|
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Cofinity Commercial |
$421.14
|
| Rate for Payer: Cofinity Commercial |
$391.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$292.46
|
| Rate for Payer: Healthscope Commercial |
$350.95
|
| Rate for Payer: Healthscope Whirlpool |
$350.95
|
| Rate for Payer: Meridian Medicaid |
$204.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$307.08
|
| Rate for Payer: PACE SWMI |
$292.46
|
| Rate for Payer: PHP Medicare Advantage |
$292.46
|
| 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 Medicare |
$292.46
|
| Rate for Payer: Priority Health Narrow Network |
$462.14
|
| Rate for Payer: UHC Medicare Advantage |
$301.23
|
|
