|
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 |
$703.23
|
| Rate for Payer: Aetna Medicare |
$524.80
|
| Rate for Payer: BCBS Complete |
$365.67
|
| Rate for Payer: BCBS MAPPO |
$524.80
|
| Rate for Payer: BCBS Trust/PPO |
$3,350.93
|
| Rate for Payer: BCN Commercial |
$943.64
|
| Rate for Payer: BCN Medicare Advantage |
$524.80
|
| Rate for Payer: Cash Price |
$1,041.60
|
| Rate for Payer: Cash Price |
$1,041.60
|
| Rate for Payer: Cofinity Commercial |
$703.23
|
| Rate for Payer: Cofinity Commercial |
$755.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$524.80
|
| Rate for Payer: Healthscope Commercial |
$629.76
|
| Rate for Payer: Healthscope Whirlpool |
$629.76
|
| Rate for Payer: Meridian Medicaid |
$365.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$551.04
|
| Rate for Payer: PACE SWMI |
$524.80
|
| Rate for Payer: PHP Medicare Advantage |
$524.80
|
| 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 Medicare |
$524.80
|
| Rate for Payer: Priority Health Narrow Network |
$832.87
|
| Rate for Payer: UHC Medicare Advantage |
$540.54
|
|
|
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 |
$456.82
|
| Rate for Payer: Aetna Medicare |
$340.91
|
| Rate for Payer: BCBS Complete |
$237.96
|
| Rate for Payer: BCBS MAPPO |
$340.91
|
| Rate for Payer: BCBS Trust/PPO |
$2,121.65
|
| Rate for Payer: BCN Commercial |
$561.98
|
| Rate for Payer: BCN Medicare Advantage |
$340.91
|
| Rate for Payer: Cash Price |
$481.60
|
| Rate for Payer: Cash Price |
$481.60
|
| Rate for Payer: Cofinity Commercial |
$490.91
|
| Rate for Payer: Cofinity Commercial |
$456.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$340.91
|
| Rate for Payer: Healthscope Commercial |
$409.09
|
| Rate for Payer: Healthscope Whirlpool |
$409.09
|
| Rate for Payer: Meridian Medicaid |
$237.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$357.96
|
| Rate for Payer: PACE SWMI |
$340.91
|
| Rate for Payer: PHP Medicare Advantage |
$340.91
|
| 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 Medicare |
$340.91
|
| Rate for Payer: Priority Health Narrow Network |
$536.69
|
| Rate for Payer: UHC Medicare Advantage |
$351.14
|
|
|
PR CLOSED TX PATELLAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$638.00
|
|
|
Service Code
|
HCPCS 27520
|
| Min. Negotiated Rate |
$49.13 |
| Max. Negotiated Rate |
$490.14 |
| Rate for Payer: Aetna Commercial |
$400.18
|
| Rate for Payer: Aetna Medicare |
$298.64
|
| Rate for Payer: BCBS Complete |
$210.68
|
| Rate for Payer: BCBS MAPPO |
$298.64
|
| Rate for Payer: BCBS Trust/PPO |
$49.13
|
| Rate for Payer: BCN Commercial |
$490.14
|
| Rate for Payer: BCN Medicare Advantage |
$298.64
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cofinity Commercial |
$400.18
|
| Rate for Payer: Cofinity Commercial |
$430.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.64
|
| Rate for Payer: Healthscope Commercial |
$358.37
|
| Rate for Payer: Healthscope Whirlpool |
$358.37
|
| Rate for Payer: Meridian Medicaid |
$210.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$313.57
|
| Rate for Payer: PACE SWMI |
$298.64
|
| Rate for Payer: PHP Medicare Advantage |
$298.64
|
| 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 Medicare |
$298.64
|
| Rate for Payer: Priority Health Narrow Network |
$473.37
|
| Rate for Payer: UHC Medicare Advantage |
$307.60
|
|
|
PR CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION
|
Professional
|
Both
|
$942.00
|
|
|
Service Code
|
HCPCS 24655
|
| Min. Negotiated Rate |
$269.66 |
| Max. Negotiated Rate |
$979.47 |
| Rate for Payer: Aetna Commercial |
$538.04
|
| Rate for Payer: Aetna Medicare |
$401.52
|
| Rate for Payer: BCBS Complete |
$283.14
|
| Rate for Payer: BCBS MAPPO |
$401.52
|
| Rate for Payer: BCBS Trust/PPO |
$979.47
|
| Rate for Payer: BCN Commercial |
$671.93
|
| Rate for Payer: BCN Medicare Advantage |
$401.52
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Cofinity Commercial |
$578.19
|
| Rate for Payer: Cofinity Commercial |
$538.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$401.52
|
| Rate for Payer: Healthscope Commercial |
$481.82
|
| Rate for Payer: Healthscope Whirlpool |
$481.82
|
| Rate for Payer: Meridian Medicaid |
$283.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$421.60
|
| Rate for Payer: PACE SWMI |
$401.52
|
| Rate for Payer: PHP Medicare Advantage |
$401.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$269.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$659.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$632.69
|
| Rate for Payer: Priority Health Medicare |
$401.52
|
| Rate for Payer: Priority Health Narrow Network |
$632.69
|
| Rate for Payer: UHC Medicare Advantage |
$413.57
|
|
|
PR CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION
|
Professional
|
Both
|
$632.00
|
|
|
Service Code
|
HCPCS 24650
|
| Min. Negotiated Rate |
$164.86 |
| Max. Negotiated Rate |
$1,113.13 |
| Rate for Payer: Aetna Commercial |
$326.20
|
| Rate for Payer: Aetna Medicare |
$243.43
|
| Rate for Payer: BCBS Complete |
$173.10
|
| Rate for Payer: BCBS MAPPO |
$243.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,113.13
|
| Rate for Payer: BCN Commercial |
$320.02
|
| Rate for Payer: BCN Medicare Advantage |
$243.43
|
| Rate for Payer: Cash Price |
$505.60
|
| Rate for Payer: Cash Price |
$505.60
|
| Rate for Payer: Cofinity Commercial |
$350.54
|
| Rate for Payer: Cofinity Commercial |
$326.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$243.43
|
| Rate for Payer: Healthscope Commercial |
$292.12
|
| Rate for Payer: Healthscope Whirlpool |
$292.12
|
| Rate for Payer: Meridian Medicaid |
$173.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$255.60
|
| Rate for Payer: PACE SWMI |
$243.43
|
| Rate for Payer: PHP Medicare Advantage |
$243.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$442.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$387.07
|
| Rate for Payer: Priority Health Medicare |
$243.43
|
| Rate for Payer: Priority Health Narrow Network |
$387.07
|
| Rate for Payer: UHC Medicare Advantage |
$250.73
|
|
|
PR CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$1,245.00
|
|
|
Service Code
|
HCPCS 25505
|
| Min. Negotiated Rate |
$305.23 |
| Max. Negotiated Rate |
$1,458.11 |
| Rate for Payer: Aetna Commercial |
$613.67
|
| Rate for Payer: Aetna Medicare |
$457.96
|
| Rate for Payer: BCBS Complete |
$320.49
|
| Rate for Payer: BCBS MAPPO |
$457.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,458.11
|
| Rate for Payer: BCN Commercial |
$760.38
|
| Rate for Payer: BCN Medicare Advantage |
$457.96
|
| Rate for Payer: Cash Price |
$996.00
|
| Rate for Payer: Cash Price |
$996.00
|
| Rate for Payer: Cofinity Commercial |
$659.46
|
| Rate for Payer: Cofinity Commercial |
$613.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$457.96
|
| Rate for Payer: Healthscope Commercial |
$549.55
|
| Rate for Payer: Healthscope Whirlpool |
$549.55
|
| Rate for Payer: Meridian Medicaid |
$320.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$480.86
|
| Rate for Payer: PACE SWMI |
$457.96
|
| Rate for Payer: PHP Medicare Advantage |
$457.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$871.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$720.53
|
| Rate for Payer: Priority Health Medicare |
$457.96
|
| Rate for Payer: Priority Health Narrow Network |
$720.53
|
| Rate for Payer: UHC Medicare Advantage |
$471.70
|
|
|
PR CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$442.00
|
|
|
Service Code
|
HCPCS 25500
|
| Min. Negotiated Rate |
$172.74 |
| Max. Negotiated Rate |
$1,850.63 |
| Rate for Payer: Aetna Commercial |
$342.64
|
| Rate for Payer: Aetna Medicare |
$255.70
|
| Rate for Payer: BCBS Complete |
$181.38
|
| Rate for Payer: BCBS MAPPO |
$255.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,850.63
|
| Rate for Payer: BCN Commercial |
$429.06
|
| Rate for Payer: BCN Medicare Advantage |
$255.70
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cofinity Commercial |
$368.21
|
| Rate for Payer: Cofinity Commercial |
$342.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$255.70
|
| Rate for Payer: Healthscope Commercial |
$306.84
|
| Rate for Payer: Healthscope Whirlpool |
$306.84
|
| Rate for Payer: Meridian Medicaid |
$181.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$268.48
|
| Rate for Payer: PACE SWMI |
$255.70
|
| Rate for Payer: PHP Medicare Advantage |
$255.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$405.45
|
| Rate for Payer: Priority Health Medicare |
$255.70
|
| Rate for Payer: Priority Health Narrow Network |
$405.45
|
| Rate for Payer: UHC Medicare Advantage |
$263.37
|
|
|
PR CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 25565
|
| Min. Negotiated Rate |
$306.93 |
| Max. Negotiated Rate |
$2,806.33 |
| Rate for Payer: Aetna Commercial |
$622.79
|
| Rate for Payer: Aetna Medicare |
$464.77
|
| Rate for Payer: BCBS Complete |
$322.28
|
| Rate for Payer: BCBS MAPPO |
$464.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,806.33
|
| Rate for Payer: BCN Commercial |
$780.42
|
| Rate for Payer: BCN Medicare Advantage |
$464.77
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cofinity Commercial |
$669.27
|
| Rate for Payer: Cofinity Commercial |
$622.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$464.77
|
| Rate for Payer: Healthscope Commercial |
$557.72
|
| Rate for Payer: Healthscope Whirlpool |
$557.72
|
| Rate for Payer: Meridian Medicaid |
$322.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$488.01
|
| Rate for Payer: PACE SWMI |
$464.77
|
| Rate for Payer: PHP Medicare Advantage |
$464.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$306.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$980.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$728.70
|
| Rate for Payer: Priority Health Medicare |
$464.77
|
| Rate for Payer: Priority Health Narrow Network |
$728.70
|
| Rate for Payer: UHC Medicare Advantage |
$478.71
|
|
|
PR CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 25560
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$1,599.69 |
| Rate for Payer: Aetna Commercial |
$344.74
|
| Rate for Payer: Aetna Medicare |
$257.27
|
| Rate for Payer: BCBS Complete |
$182.28
|
| Rate for Payer: BCBS MAPPO |
$257.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,599.69
|
| Rate for Payer: BCN Commercial |
$351.82
|
| Rate for Payer: BCN Medicare Advantage |
$257.27
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cofinity Commercial |
$344.74
|
| Rate for Payer: Cofinity Commercial |
$370.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.27
|
| Rate for Payer: Healthscope Commercial |
$308.72
|
| Rate for Payer: Healthscope Whirlpool |
$308.72
|
| Rate for Payer: Meridian Medicaid |
$182.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$270.13
|
| Rate for Payer: PACE SWMI |
$257.27
|
| Rate for Payer: PHP Medicare Advantage |
$257.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$408.01
|
| Rate for Payer: Priority Health Medicare |
$257.27
|
| Rate for Payer: Priority Health Narrow Network |
$408.01
|
| Rate for Payer: UHC Medicare Advantage |
$264.99
|
|
|
PR CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$602.00
|
|
|
Service Code
|
HCPCS 23570
|
| Min. Negotiated Rate |
$162.31 |
| Max. Negotiated Rate |
$553.66 |
| Rate for Payer: Aetna Commercial |
$321.44
|
| Rate for Payer: Aetna Medicare |
$239.88
|
| Rate for Payer: BCBS Complete |
$170.43
|
| Rate for Payer: BCBS MAPPO |
$239.88
|
| Rate for Payer: BCBS Trust/PPO |
$553.66
|
| Rate for Payer: BCN Commercial |
$353.31
|
| Rate for Payer: BCN Medicare Advantage |
$239.88
|
| Rate for Payer: Cash Price |
$481.60
|
| Rate for Payer: Cash Price |
$481.60
|
| Rate for Payer: Cofinity Commercial |
$345.43
|
| Rate for Payer: Cofinity Commercial |
$321.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$239.88
|
| Rate for Payer: Healthscope Commercial |
$287.86
|
| Rate for Payer: Healthscope Whirlpool |
$287.86
|
| Rate for Payer: Meridian Medicaid |
$170.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$251.87
|
| Rate for Payer: PACE SWMI |
$239.88
|
| Rate for Payer: PHP Medicare Advantage |
$239.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$421.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$380.95
|
| Rate for Payer: Priority Health Medicare |
$239.88
|
| Rate for Payer: Priority Health Narrow Network |
$380.95
|
| Rate for Payer: UHC Medicare Advantage |
$247.08
|
|
|
PR CLOSED TX STERNOCLAVICULAR DISLC W/MANIPULATION
|
Professional
|
Both
|
$768.00
|
|
|
Service Code
|
HCPCS 23525
|
| Min. Negotiated Rate |
$241.33 |
| Max. Negotiated Rate |
$595.21 |
| Rate for Payer: Aetna Commercial |
$481.77
|
| Rate for Payer: Aetna Medicare |
$359.53
|
| Rate for Payer: BCBS Complete |
$253.40
|
| Rate for Payer: BCBS MAPPO |
$359.53
|
| Rate for Payer: BCBS Trust/PPO |
$399.45
|
| Rate for Payer: BCN Commercial |
$595.21
|
| Rate for Payer: BCN Medicare Advantage |
$359.53
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cofinity Commercial |
$481.77
|
| Rate for Payer: Cofinity Commercial |
$517.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$359.53
|
| Rate for Payer: Healthscope Commercial |
$431.44
|
| Rate for Payer: Healthscope Whirlpool |
$431.44
|
| Rate for Payer: Meridian Medicaid |
$253.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$377.51
|
| Rate for Payer: PACE SWMI |
$359.53
|
| Rate for Payer: PHP Medicare Advantage |
$359.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$241.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$537.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$568.86
|
| Rate for Payer: Priority Health Medicare |
$359.53
|
| Rate for Payer: Priority Health Narrow Network |
$568.86
|
| Rate for Payer: UHC Medicare Advantage |
$370.32
|
|
|
PR CLOSED TX TALOTARSAL JOINT DISLC W/O ANES
|
Professional
|
Both
|
$351.00
|
|
|
Service Code
|
HCPCS 28570
|
| Min. Negotiated Rate |
$131.42 |
| Max. Negotiated Rate |
$1,383.62 |
| Rate for Payer: Aetna Commercial |
$258.77
|
| Rate for Payer: Aetna Medicare |
$193.11
|
| Rate for Payer: BCBS Complete |
$137.99
|
| Rate for Payer: BCBS MAPPO |
$193.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,383.62
|
| Rate for Payer: BCN Commercial |
$351.85
|
| Rate for Payer: BCN Medicare Advantage |
$193.11
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cofinity Commercial |
$278.08
|
| Rate for Payer: Cofinity Commercial |
$258.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.11
|
| Rate for Payer: Healthscope Commercial |
$231.73
|
| Rate for Payer: Healthscope Whirlpool |
$231.73
|
| Rate for Payer: Meridian Medicaid |
$137.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$202.77
|
| Rate for Payer: PACE SWMI |
$193.11
|
| Rate for Payer: PHP Medicare Advantage |
$193.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$307.41
|
| Rate for Payer: Priority Health Medicare |
$193.11
|
| Rate for Payer: Priority Health Narrow Network |
$307.41
|
| Rate for Payer: UHC Medicare Advantage |
$198.90
|
|
|
PR CLOSED TX TALOTARSAL JOINT DISLOCATION W/ANES
|
Professional
|
Both
|
$792.00
|
|
|
Service Code
|
HCPCS 28575
|
| Min. Negotiated Rate |
$224.50 |
| Max. Negotiated Rate |
$804.60 |
| Rate for Payer: Aetna Commercial |
$448.40
|
| Rate for Payer: Aetna Medicare |
$334.63
|
| Rate for Payer: BCBS Complete |
$235.72
|
| Rate for Payer: BCBS MAPPO |
$334.63
|
| Rate for Payer: BCBS Trust/PPO |
$804.60
|
| Rate for Payer: BCN Commercial |
$565.40
|
| Rate for Payer: BCN Medicare Advantage |
$334.63
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cofinity Commercial |
$481.87
|
| Rate for Payer: Cofinity Commercial |
$448.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$334.63
|
| Rate for Payer: Healthscope Commercial |
$401.56
|
| Rate for Payer: Healthscope Whirlpool |
$401.56
|
| Rate for Payer: Meridian Medicaid |
$235.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$351.36
|
| Rate for Payer: PACE SWMI |
$334.63
|
| Rate for Payer: PHP Medicare Advantage |
$334.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$224.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$554.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$529.54
|
| Rate for Payer: Priority Health Medicare |
$334.63
|
| Rate for Payer: Priority Health Narrow Network |
$529.54
|
| Rate for Payer: UHC Medicare Advantage |
$344.67
|
|
|
PR CLOSED TX TALUS FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$792.00
|
|
|
Service Code
|
HCPCS 28435
|
| Min. Negotiated Rate |
$217.26 |
| Max. Negotiated Rate |
$1,149.05 |
| Rate for Payer: Aetna Commercial |
$434.62
|
| Rate for Payer: Aetna Medicare |
$324.34
|
| Rate for Payer: BCBS Complete |
$228.12
|
| Rate for Payer: BCBS MAPPO |
$324.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,149.05
|
| Rate for Payer: BCN Commercial |
$553.67
|
| Rate for Payer: BCN Medicare Advantage |
$324.34
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cofinity Commercial |
$434.62
|
| Rate for Payer: Cofinity Commercial |
$467.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.34
|
| Rate for Payer: Healthscope Commercial |
$389.21
|
| Rate for Payer: Healthscope Whirlpool |
$389.21
|
| Rate for Payer: Meridian Medicaid |
$228.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$340.56
|
| Rate for Payer: PACE SWMI |
$324.34
|
| Rate for Payer: PHP Medicare Advantage |
$324.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$217.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$554.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$512.18
|
| Rate for Payer: Priority Health Medicare |
$324.34
|
| Rate for Payer: Priority Health Narrow Network |
$512.18
|
| Rate for Payer: UHC Medicare Advantage |
$334.07
|
|
|
PR CLOSED TX TALUS FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 28430
|
| Min. Negotiated Rate |
$139.52 |
| Max. Negotiated Rate |
$540.45 |
| Rate for Payer: Aetna Commercial |
$277.58
|
| Rate for Payer: Aetna Medicare |
$207.15
|
| Rate for Payer: BCBS Complete |
$146.50
|
| Rate for Payer: BCBS MAPPO |
$207.15
|
| Rate for Payer: BCBS Trust/PPO |
$540.45
|
| Rate for Payer: BCN Commercial |
$358.20
|
| Rate for Payer: BCN Medicare Advantage |
$207.15
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cofinity Commercial |
$298.30
|
| Rate for Payer: Cofinity Commercial |
$277.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$207.15
|
| Rate for Payer: Healthscope Commercial |
$248.58
|
| Rate for Payer: Healthscope Whirlpool |
$248.58
|
| Rate for Payer: Meridian Medicaid |
$146.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$217.51
|
| Rate for Payer: PACE SWMI |
$207.15
|
| Rate for Payer: PHP Medicare Advantage |
$207.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$462.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$328.34
|
| Rate for Payer: Priority Health Medicare |
$207.15
|
| Rate for Payer: Priority Health Narrow Network |
$328.34
|
| Rate for Payer: UHC Medicare Advantage |
$213.36
|
|
|
PR CLOSED TX TARSOMETATARSAL DISLOCATION W/ANES
|
Professional
|
Both
|
$792.00
|
|
|
Service Code
|
HCPCS 28605
|
| Min. Negotiated Rate |
$202.35 |
| Max. Negotiated Rate |
$2,031.31 |
| Rate for Payer: Aetna Commercial |
$401.57
|
| Rate for Payer: Aetna Medicare |
$299.68
|
| Rate for Payer: BCBS Complete |
$212.47
|
| Rate for Payer: BCBS MAPPO |
$299.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,031.31
|
| Rate for Payer: BCN Commercial |
$511.16
|
| Rate for Payer: BCN Medicare Advantage |
$299.68
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cofinity Commercial |
$431.54
|
| Rate for Payer: Cofinity Commercial |
$401.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$299.68
|
| Rate for Payer: Healthscope Commercial |
$359.62
|
| Rate for Payer: Healthscope Whirlpool |
$359.62
|
| Rate for Payer: Meridian Medicaid |
$212.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$314.66
|
| Rate for Payer: PACE SWMI |
$299.68
|
| Rate for Payer: PHP Medicare Advantage |
$299.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$554.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$475.93
|
| Rate for Payer: Priority Health Medicare |
$299.68
|
| Rate for Payer: Priority Health Narrow Network |
$475.93
|
| Rate for Payer: UHC Medicare Advantage |
$308.67
|
|
|
PR CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 28600
|
| Min. Negotiated Rate |
$105.44 |
| Max. Negotiated Rate |
$1,628.75 |
| Rate for Payer: Aetna Commercial |
$243.84
|
| Rate for Payer: Aetna Medicare |
$181.97
|
| Rate for Payer: BCBS Complete |
$110.71
|
| Rate for Payer: BCBS MAPPO |
$181.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,628.75
|
| Rate for Payer: BCN Commercial |
$324.48
|
| Rate for Payer: BCN Medicare Advantage |
$181.97
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cofinity Commercial |
$262.04
|
| Rate for Payer: Cofinity Commercial |
$243.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$181.97
|
| Rate for Payer: Healthscope Commercial |
$218.36
|
| Rate for Payer: Healthscope Whirlpool |
$218.36
|
| Rate for Payer: Meridian Medicaid |
$110.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$191.07
|
| Rate for Payer: PACE SWMI |
$181.97
|
| Rate for Payer: PHP Medicare Advantage |
$181.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$288.51
|
| Rate for Payer: Priority Health Medicare |
$181.97
|
| Rate for Payer: Priority Health Narrow Network |
$288.51
|
| Rate for Payer: UHC Medicare Advantage |
$187.43
|
|
|
PR CLOSED TX TEMPOROMANDIBULAR DISLC COMP 1ST/SBSQ
|
Professional
|
Both
|
$1,067.00
|
|
|
Service Code
|
HCPCS 21485
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$1,428.40 |
| Rate for Payer: Aetna Commercial |
$1,009.82
|
| Rate for Payer: Aetna Medicare |
$753.60
|
| Rate for Payer: BCBS Complete |
$524.91
|
| Rate for Payer: BCBS MAPPO |
$753.60
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$1,428.40
|
| Rate for Payer: BCN Medicare Advantage |
$753.60
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Cofinity Commercial |
$1,009.82
|
| Rate for Payer: Cofinity Commercial |
$1,085.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$753.60
|
| Rate for Payer: Healthscope Commercial |
$904.32
|
| Rate for Payer: Healthscope Whirlpool |
$904.32
|
| Rate for Payer: Meridian Medicaid |
$524.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$791.28
|
| Rate for Payer: PACE SWMI |
$753.60
|
| Rate for Payer: PHP Medicare Advantage |
$753.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$499.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$746.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,218.41
|
| Rate for Payer: Priority Health Medicare |
$753.60
|
| Rate for Payer: Priority Health Narrow Network |
$1,218.41
|
| Rate for Payer: UHC Medicare Advantage |
$776.21
|
|
|
PR CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
HCPCS 21480
|
| Min. Negotiated Rate |
$19.81 |
| Max. Negotiated Rate |
$3,350.93 |
| Rate for Payer: Aetna Commercial |
$41.83
|
| Rate for Payer: Aetna Medicare |
$31.22
|
| Rate for Payer: BCBS Complete |
$20.80
|
| Rate for Payer: BCBS MAPPO |
$31.22
|
| Rate for Payer: BCBS Trust/PPO |
$3,350.93
|
| Rate for Payer: BCN Commercial |
$209.15
|
| Rate for Payer: BCN Medicare Advantage |
$31.22
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cofinity Commercial |
$44.96
|
| Rate for Payer: Cofinity Commercial |
$41.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.22
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Healthscope Whirlpool |
$37.46
|
| Rate for Payer: Meridian Medicaid |
$20.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.78
|
| Rate for Payer: PACE SWMI |
$31.22
|
| Rate for Payer: PHP Medicare Advantage |
$31.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.50
|
| Rate for Payer: Priority Health Medicare |
$31.22
|
| Rate for Payer: Priority Health Narrow Network |
$47.50
|
| Rate for Payer: UHC Medicare Advantage |
$32.16
|
|
|
PR CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ
|
Professional
|
Both
|
$1,230.00
|
|
|
Service Code
|
HCPCS 24675
|
| Min. Negotiated Rate |
$276.26 |
| Max. Negotiated Rate |
$1,365.66 |
| Rate for Payer: Aetna Commercial |
$555.56
|
| Rate for Payer: Aetna Medicare |
$414.60
|
| Rate for Payer: BCBS Complete |
$290.07
|
| Rate for Payer: BCBS MAPPO |
$414.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,365.66
|
| Rate for Payer: BCN Commercial |
$690.01
|
| Rate for Payer: BCN Medicare Advantage |
$414.60
|
| Rate for Payer: Cash Price |
$984.00
|
| Rate for Payer: Cash Price |
$984.00
|
| Rate for Payer: Cofinity Commercial |
$597.02
|
| Rate for Payer: Cofinity Commercial |
$555.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$414.60
|
| Rate for Payer: Healthscope Commercial |
$497.52
|
| Rate for Payer: Healthscope Whirlpool |
$497.52
|
| Rate for Payer: Meridian Medicaid |
$290.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$435.33
|
| Rate for Payer: PACE SWMI |
$414.60
|
| Rate for Payer: PHP Medicare Advantage |
$414.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$276.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$861.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$652.61
|
| Rate for Payer: Priority Health Medicare |
$414.60
|
| Rate for Payer: Priority Health Narrow Network |
$652.61
|
| Rate for Payer: UHC Medicare Advantage |
$427.04
|
|
|
PR CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ
|
Professional
|
Both
|
$781.00
|
|
|
Service Code
|
HCPCS 24670
|
| Min. Negotiated Rate |
$178.92 |
| Max. Negotiated Rate |
$1,283.24 |
| Rate for Payer: Aetna Commercial |
$356.53
|
| Rate for Payer: Aetna Medicare |
$266.07
|
| Rate for Payer: BCBS Complete |
$187.87
|
| Rate for Payer: BCBS MAPPO |
$266.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,283.24
|
| Rate for Payer: BCN Commercial |
$441.27
|
| Rate for Payer: BCN Medicare Advantage |
$266.07
|
| Rate for Payer: Cash Price |
$624.80
|
| Rate for Payer: Cash Price |
$624.80
|
| Rate for Payer: Cofinity Commercial |
$356.53
|
| Rate for Payer: Cofinity Commercial |
$383.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$266.07
|
| Rate for Payer: Healthscope Commercial |
$319.28
|
| Rate for Payer: Healthscope Whirlpool |
$319.28
|
| Rate for Payer: Meridian Medicaid |
$187.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$279.37
|
| Rate for Payer: PACE SWMI |
$266.07
|
| Rate for Payer: PHP Medicare Advantage |
$266.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$178.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$421.80
|
| Rate for Payer: Priority Health Medicare |
$266.07
|
| Rate for Payer: Priority Health Narrow Network |
$421.80
|
| Rate for Payer: UHC Medicare Advantage |
$274.05
|
|
|
PR CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$1,167.00
|
|
|
Service Code
|
HCPCS 25535
|
| Min. Negotiated Rate |
$302.46 |
| Max. Negotiated Rate |
$1,028.60 |
| Rate for Payer: Aetna Commercial |
$608.04
|
| Rate for Payer: Aetna Medicare |
$453.76
|
| Rate for Payer: BCBS Complete |
$317.58
|
| Rate for Payer: BCBS MAPPO |
$453.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,028.60
|
| Rate for Payer: BCN Commercial |
$741.32
|
| Rate for Payer: BCN Medicare Advantage |
$453.76
|
| Rate for Payer: Cash Price |
$933.60
|
| Rate for Payer: Cash Price |
$933.60
|
| Rate for Payer: Cofinity Commercial |
$653.41
|
| Rate for Payer: Cofinity Commercial |
$608.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$453.76
|
| Rate for Payer: Healthscope Commercial |
$544.51
|
| Rate for Payer: Healthscope Whirlpool |
$544.51
|
| Rate for Payer: Meridian Medicaid |
$317.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$476.45
|
| Rate for Payer: PACE SWMI |
$453.76
|
| Rate for Payer: PHP Medicare Advantage |
$453.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$302.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$816.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$714.40
|
| Rate for Payer: Priority Health Medicare |
$453.76
|
| Rate for Payer: Priority Health Narrow Network |
$714.40
|
| Rate for Payer: UHC Medicare Advantage |
$467.37
|
|
|
PR CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$642.00
|
|
|
Service Code
|
HCPCS 25530
|
| Min. Negotiated Rate |
$162.95 |
| Max. Negotiated Rate |
$1,133.73 |
| Rate for Payer: Aetna Commercial |
$322.12
|
| Rate for Payer: Aetna Medicare |
$240.39
|
| Rate for Payer: BCBS Complete |
$171.10
|
| Rate for Payer: BCBS MAPPO |
$240.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,133.73
|
| Rate for Payer: BCN Commercial |
$398.76
|
| Rate for Payer: BCN Medicare Advantage |
$240.39
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cofinity Commercial |
$346.16
|
| Rate for Payer: Cofinity Commercial |
$322.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$240.39
|
| Rate for Payer: Healthscope Commercial |
$288.47
|
| Rate for Payer: Healthscope Whirlpool |
$288.47
|
| Rate for Payer: Meridian Medicaid |
$171.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$252.41
|
| Rate for Payer: PACE SWMI |
$240.39
|
| Rate for Payer: PHP Medicare Advantage |
$240.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$382.48
|
| Rate for Payer: Priority Health Medicare |
$240.39
|
| Rate for Payer: Priority Health Narrow Network |
$382.48
|
| Rate for Payer: UHC Medicare Advantage |
$247.60
|
|
|
PR CLOSE MEDIAN STERNOTOMY SEP W/WO DEBRIDEMENT SPX
|
Professional
|
Both
|
$2,053.00
|
|
|
Service Code
|
HCPCS 21750
|
| Min. Negotiated Rate |
$430.05 |
| Max. Negotiated Rate |
$1,437.10 |
| Rate for Payer: Aetna Commercial |
$897.00
|
| Rate for Payer: Aetna Medicare |
$669.40
|
| Rate for Payer: BCBS Complete |
$451.55
|
| Rate for Payer: BCBS MAPPO |
$669.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,388.14
|
| Rate for Payer: BCN Commercial |
$981.75
|
| Rate for Payer: BCN Medicare Advantage |
$669.40
|
| Rate for Payer: Cash Price |
$1,642.40
|
| Rate for Payer: Cash Price |
$1,642.40
|
| Rate for Payer: Cofinity Commercial |
$963.94
|
| Rate for Payer: Cofinity Commercial |
$897.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$669.40
|
| Rate for Payer: Healthscope Commercial |
$803.28
|
| Rate for Payer: Healthscope Whirlpool |
$803.28
|
| Rate for Payer: Meridian Medicaid |
$451.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$702.87
|
| Rate for Payer: PACE SWMI |
$669.40
|
| Rate for Payer: PHP Medicare Advantage |
$669.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$430.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,437.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,025.89
|
| Rate for Payer: Priority Health Medicare |
$669.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,025.89
|
| Rate for Payer: UHC Medicare Advantage |
$689.48
|
|
|
PR CLOSURE CYSTOSTOMY SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,392.00
|
|
|
Service Code
|
HCPCS 51880
|
| Min. Negotiated Rate |
$298.20 |
| Max. Negotiated Rate |
$1,691.09 |
| Rate for Payer: Aetna Commercial |
$608.17
|
| Rate for Payer: Aetna Medicare |
$453.86
|
| Rate for Payer: BCBS Complete |
$313.11
|
| Rate for Payer: BCBS MAPPO |
$453.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,691.09
|
| Rate for Payer: BCN Commercial |
$671.93
|
| Rate for Payer: BCN Medicare Advantage |
$453.86
|
| Rate for Payer: Cash Price |
$1,113.60
|
| Rate for Payer: Cash Price |
$1,113.60
|
| Rate for Payer: Cofinity Commercial |
$653.56
|
| Rate for Payer: Cofinity Commercial |
$608.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$453.86
|
| Rate for Payer: Healthscope Commercial |
$544.63
|
| Rate for Payer: Healthscope Whirlpool |
$544.63
|
| Rate for Payer: Meridian Medicaid |
$313.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$476.55
|
| Rate for Payer: PACE SWMI |
$453.86
|
| Rate for Payer: PHP Medicare Advantage |
$453.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$298.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$974.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$742.99
|
| Rate for Payer: Priority Health Medicare |
$453.86
|
| Rate for Payer: Priority Health Narrow Network |
$742.99
|
| Rate for Payer: UHC Medicare Advantage |
$467.48
|
|
