|
PR CLOSED TREATMENT STERNUM FRACTURE
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 21820
|
| Min. Negotiated Rate |
$107.78 |
| Max. Negotiated Rate |
$250.72 |
| Rate for Payer: Aetna Commercial |
$214.75
|
| Rate for Payer: Aetna Medicare |
$160.26
|
| Rate for Payer: BCBS Complete |
$113.17
|
| Rate for Payer: BCBS MAPPO |
$160.26
|
| Rate for Payer: BCN Commercial |
$234.54
|
| Rate for Payer: BCN Medicare Advantage |
$160.26
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$230.77
|
| Rate for Payer: Cofinity Commercial |
$214.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.26
|
| Rate for Payer: Healthscope Commercial |
$192.31
|
| Rate for Payer: Healthscope Whirlpool |
$192.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$168.27
|
| Rate for Payer: Meridian Medicaid |
$113.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$176.29
|
| Rate for Payer: Nomi Health Commercial |
$192.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.00
|
| Rate for Payer: PACE SWMI |
$160.26
|
| Rate for Payer: PHP Medicare Advantage |
$160.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$250.72
|
| Rate for Payer: Priority Health Medicare |
$160.26
|
| Rate for Payer: Priority Health Narrow Network |
$250.72
|
| Rate for Payer: Railroad Medicare Medicare |
$160.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$160.26
|
| Rate for Payer: UHC Exchange |
$247.13
|
| Rate for Payer: UHC Medicaid |
$107.78
|
| Rate for Payer: UHCCP DNSP |
$160.26
|
| Rate for Payer: UHCCP Medicaid |
$107.78
|
|
|
PR CLOSED TREATMENT ULNAR STYLOID FRACTURE
|
Professional
|
Both
|
$858.00
|
|
|
Service Code
|
HCPCS 25650
|
| Min. Negotiated Rate |
$207.25 |
| Max. Negotiated Rate |
$643.50 |
| Rate for Payer: Aetna Commercial |
$416.24
|
| Rate for Payer: Aetna Medicare |
$310.63
|
| Rate for Payer: BCBS Complete |
$217.61
|
| Rate for Payer: BCBS MAPPO |
$310.63
|
| Rate for Payer: BCN Commercial |
$482.54
|
| Rate for Payer: BCN Medicare Advantage |
$310.63
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cofinity Commercial |
$416.24
|
| Rate for Payer: Cofinity Commercial |
$447.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$310.63
|
| Rate for Payer: Healthscope Commercial |
$372.76
|
| Rate for Payer: Healthscope Whirlpool |
$372.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$326.16
|
| Rate for Payer: Meridian Medicaid |
$217.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$341.69
|
| Rate for Payer: Nomi Health Commercial |
$372.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$643.50
|
| Rate for Payer: PACE SWMI |
$310.63
|
| Rate for Payer: PHP Medicare Advantage |
$310.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$207.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$515.83
|
| Rate for Payer: Priority Health Medicare |
$310.63
|
| Rate for Payer: Priority Health Narrow Network |
$515.83
|
| Rate for Payer: Railroad Medicare Medicare |
$310.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$520.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$310.63
|
| Rate for Payer: UHC Exchange |
$520.29
|
| Rate for Payer: UHC Medicaid |
$207.25
|
| Rate for Payer: UHCCP DNSP |
$310.63
|
| Rate for Payer: UHCCP Medicaid |
$207.25
|
|
|
PR CLOSED TREAT SPINE PROCESS FX
|
Professional
|
Both
|
$436.00
|
|
|
Service Code
|
HCPCS 22305
|
| Min. Negotiated Rate |
$174.40 |
| Max. Negotiated Rate |
$327.00 |
| Rate for Payer: BCBS Complete |
$174.40
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.00
|
|
|
PR CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA
|
Professional
|
Both
|
$949.00
|
|
|
Service Code
|
HCPCS 27840
|
| Min. Negotiated Rate |
$288.83 |
| Max. Negotiated Rate |
$711.75 |
| Rate for Payer: Aetna Commercial |
$582.66
|
| Rate for Payer: Aetna Medicare |
$434.82
|
| Rate for Payer: BCBS Complete |
$303.27
|
| Rate for Payer: BCBS MAPPO |
$434.82
|
| Rate for Payer: BCN Commercial |
$602.06
|
| Rate for Payer: BCN Medicare Advantage |
$434.82
|
| Rate for Payer: Cash Price |
$759.20
|
| Rate for Payer: Cash Price |
$759.20
|
| Rate for Payer: Cofinity Commercial |
$626.14
|
| Rate for Payer: Cofinity Commercial |
$582.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$434.82
|
| Rate for Payer: Healthscope Commercial |
$521.78
|
| Rate for Payer: Healthscope Whirlpool |
$521.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$456.56
|
| Rate for Payer: Meridian Medicaid |
$303.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$478.30
|
| Rate for Payer: Nomi Health Commercial |
$521.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$711.75
|
| Rate for Payer: PACE SWMI |
$434.82
|
| Rate for Payer: PHP Medicare Advantage |
$434.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$643.59
|
| Rate for Payer: Priority Health Medicare |
$434.82
|
| Rate for Payer: Priority Health Narrow Network |
$643.59
|
| Rate for Payer: Railroad Medicare Medicare |
$434.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$653.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$434.82
|
| Rate for Payer: UHC Exchange |
$653.11
|
| Rate for Payer: UHC Medicaid |
$288.83
|
| Rate for Payer: UHCCP DNSP |
$434.82
|
| Rate for Payer: UHCCP Medicaid |
$288.83
|
|
|
PR CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ
|
Professional
|
Both
|
$1,226.00
|
|
|
Service Code
|
HCPCS 27810
|
| Min. Negotiated Rate |
$296.07 |
| Max. Negotiated Rate |
$919.50 |
| Rate for Payer: Aetna Commercial |
$599.52
|
| Rate for Payer: Aetna Medicare |
$447.40
|
| Rate for Payer: BCBS Complete |
$310.87
|
| Rate for Payer: BCBS MAPPO |
$447.40
|
| Rate for Payer: BCN Commercial |
$665.30
|
| Rate for Payer: BCN Medicare Advantage |
$447.40
|
| Rate for Payer: Cash Price |
$980.80
|
| Rate for Payer: Cash Price |
$980.80
|
| Rate for Payer: Cofinity Commercial |
$644.26
|
| Rate for Payer: Cofinity Commercial |
$599.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$447.40
|
| Rate for Payer: Healthscope Commercial |
$536.88
|
| Rate for Payer: Healthscope Whirlpool |
$536.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$469.77
|
| Rate for Payer: Meridian Medicaid |
$310.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$492.14
|
| Rate for Payer: Nomi Health Commercial |
$536.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$919.50
|
| Rate for Payer: PACE SWMI |
$447.40
|
| Rate for Payer: PHP Medicare Advantage |
$447.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$296.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$711.19
|
| Rate for Payer: Priority Health Medicare |
$447.40
|
| Rate for Payer: Priority Health Narrow Network |
$711.19
|
| Rate for Payer: Railroad Medicare Medicare |
$447.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$734.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$447.40
|
| Rate for Payer: UHC Exchange |
$734.82
|
| Rate for Payer: UHC Medicaid |
$296.07
|
| Rate for Payer: UHCCP DNSP |
$447.40
|
| Rate for Payer: UHCCP Medicaid |
$296.07
|
|
|
PR CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ
|
Professional
|
Both
|
$898.00
|
|
|
Service Code
|
HCPCS 27808
|
| Min. Negotiated Rate |
$204.05 |
| Max. Negotiated Rate |
$673.50 |
| Rate for Payer: Aetna Commercial |
$408.57
|
| Rate for Payer: Aetna Medicare |
$304.90
|
| Rate for Payer: BCBS Complete |
$214.25
|
| Rate for Payer: BCBS MAPPO |
$304.90
|
| Rate for Payer: BCN Commercial |
$481.54
|
| Rate for Payer: BCN Medicare Advantage |
$304.90
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cofinity Commercial |
$439.06
|
| Rate for Payer: Cofinity Commercial |
$408.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$304.90
|
| Rate for Payer: Healthscope Commercial |
$365.88
|
| Rate for Payer: Healthscope Whirlpool |
$365.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.14
|
| Rate for Payer: Meridian Medicaid |
$214.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$335.39
|
| Rate for Payer: Nomi Health Commercial |
$365.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$673.50
|
| Rate for Payer: PACE SWMI |
$304.90
|
| Rate for Payer: PHP Medicare Advantage |
$304.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$204.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$514.76
|
| Rate for Payer: Priority Health Medicare |
$304.90
|
| Rate for Payer: Priority Health Narrow Network |
$514.76
|
| Rate for Payer: Railroad Medicare Medicare |
$304.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$519.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$304.90
|
| Rate for Payer: UHC Exchange |
$519.01
|
| Rate for Payer: UHC Medicaid |
$204.05
|
| Rate for Payer: UHCCP DNSP |
$304.90
|
| Rate for Payer: UHCCP Medicaid |
$204.05
|
|
|
PR CLOSED TX CALCANEAL FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$1,199.00
|
|
|
Service Code
|
HCPCS 28405
|
| Min. Negotiated Rate |
$254.96 |
| Max. Negotiated Rate |
$899.25 |
| Rate for Payer: Aetna Commercial |
$516.80
|
| Rate for Payer: Aetna Medicare |
$385.67
|
| Rate for Payer: BCBS Complete |
$267.71
|
| Rate for Payer: BCBS MAPPO |
$385.67
|
| Rate for Payer: BCN Commercial |
$633.43
|
| Rate for Payer: BCN Medicare Advantage |
$385.67
|
| Rate for Payer: Cash Price |
$959.20
|
| Rate for Payer: Cash Price |
$959.20
|
| Rate for Payer: Cofinity Commercial |
$555.36
|
| Rate for Payer: Cofinity Commercial |
$516.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$385.67
|
| Rate for Payer: Healthscope Commercial |
$462.80
|
| Rate for Payer: Healthscope Whirlpool |
$462.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$404.95
|
| Rate for Payer: Meridian Medicaid |
$267.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$424.24
|
| Rate for Payer: Nomi Health Commercial |
$462.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$899.25
|
| Rate for Payer: PACE SWMI |
$385.67
|
| Rate for Payer: PHP Medicare Advantage |
$385.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$254.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$677.13
|
| Rate for Payer: Priority Health Medicare |
$385.67
|
| Rate for Payer: Priority Health Narrow Network |
$677.13
|
| Rate for Payer: Railroad Medicare Medicare |
$385.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$607.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$385.67
|
| Rate for Payer: UHC Exchange |
$607.85
|
| Rate for Payer: UHC Medicaid |
$254.96
|
| Rate for Payer: UHCCP DNSP |
$385.67
|
| Rate for Payer: UHCCP Medicaid |
$254.96
|
|
|
PR CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$740.00
|
|
|
Service Code
|
HCPCS 28400
|
| Min. Negotiated Rate |
$149.31 |
| Max. Negotiated Rate |
$555.00 |
| Rate for Payer: Aetna Commercial |
$298.79
|
| Rate for Payer: Aetna Medicare |
$222.98
|
| Rate for Payer: BCBS Complete |
$156.78
|
| Rate for Payer: BCBS MAPPO |
$222.98
|
| Rate for Payer: BCN Commercial |
$359.04
|
| Rate for Payer: BCN Medicare Advantage |
$222.98
|
| Rate for Payer: Cash Price |
$592.00
|
| Rate for Payer: Cash Price |
$592.00
|
| Rate for Payer: Cofinity Commercial |
$321.09
|
| Rate for Payer: Cofinity Commercial |
$298.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.98
|
| Rate for Payer: Healthscope Commercial |
$267.58
|
| Rate for Payer: Healthscope Whirlpool |
$267.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$234.13
|
| Rate for Payer: Meridian Medicaid |
$156.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$245.28
|
| Rate for Payer: Nomi Health Commercial |
$267.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$555.00
|
| Rate for Payer: PACE SWMI |
$222.98
|
| Rate for Payer: PHP Medicare Advantage |
$222.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$149.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$383.81
|
| Rate for Payer: Priority Health Medicare |
$222.98
|
| Rate for Payer: Priority Health Narrow Network |
$383.81
|
| Rate for Payer: Railroad Medicare Medicare |
$222.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$390.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$222.98
|
| Rate for Payer: UHC Exchange |
$390.63
|
| Rate for Payer: UHC Medicaid |
$149.31
|
| Rate for Payer: UHCCP DNSP |
$222.98
|
| Rate for Payer: UHCCP Medicaid |
$149.31
|
|
|
PR CLOSED TX CARPAL SCAPHOID FRACTURE W/MNPJ
|
Professional
|
Both
|
$779.00
|
|
|
Service Code
|
HCPCS 25624
|
| Min. Negotiated Rate |
$284.57 |
| Max. Negotiated Rate |
$756.06 |
| Rate for Payer: Aetna Commercial |
$573.71
|
| Rate for Payer: Aetna Medicare |
$428.14
|
| Rate for Payer: BCBS Complete |
$298.80
|
| Rate for Payer: BCBS MAPPO |
$428.14
|
| Rate for Payer: BCN Commercial |
$698.17
|
| Rate for Payer: BCN Medicare Advantage |
$428.14
|
| Rate for Payer: Cash Price |
$623.20
|
| Rate for Payer: Cash Price |
$623.20
|
| Rate for Payer: Cofinity Commercial |
$616.52
|
| Rate for Payer: Cofinity Commercial |
$573.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$428.14
|
| Rate for Payer: Healthscope Commercial |
$513.77
|
| Rate for Payer: Healthscope Whirlpool |
$513.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$449.55
|
| Rate for Payer: Meridian Medicaid |
$298.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$470.95
|
| Rate for Payer: Nomi Health Commercial |
$513.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$584.25
|
| Rate for Payer: PACE SWMI |
$428.14
|
| Rate for Payer: PHP Medicare Advantage |
$428.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$746.33
|
| Rate for Payer: Priority Health Medicare |
$428.14
|
| Rate for Payer: Priority Health Narrow Network |
$746.33
|
| Rate for Payer: Railroad Medicare Medicare |
$428.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$756.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$428.14
|
| Rate for Payer: UHC Exchange |
$756.06
|
| Rate for Payer: UHC Medicaid |
$284.57
|
| Rate for Payer: UHCCP DNSP |
$428.14
|
| Rate for Payer: UHCCP Medicaid |
$284.57
|
|
|
PR CLOSED TX CARPAL SCAPHOID FRACTURE W/O MNPJ
|
Professional
|
Both
|
$818.00
|
|
|
Service Code
|
HCPCS 25622
|
| Min. Negotiated Rate |
$188.72 |
| Max. Negotiated Rate |
$613.50 |
| Rate for Payer: Aetna Commercial |
$377.87
|
| Rate for Payer: Aetna Medicare |
$281.99
|
| Rate for Payer: BCBS Complete |
$198.16
|
| Rate for Payer: BCBS MAPPO |
$281.99
|
| Rate for Payer: BCN Commercial |
$354.61
|
| Rate for Payer: BCN Medicare Advantage |
$281.99
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cofinity Commercial |
$406.07
|
| Rate for Payer: Cofinity Commercial |
$377.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$281.99
|
| Rate for Payer: Healthscope Commercial |
$338.39
|
| Rate for Payer: Healthscope Whirlpool |
$338.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$296.09
|
| Rate for Payer: Meridian Medicaid |
$198.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$310.19
|
| Rate for Payer: Nomi Health Commercial |
$338.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$613.50
|
| Rate for Payer: PACE SWMI |
$281.99
|
| Rate for Payer: PHP Medicare Advantage |
$281.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$188.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$480.69
|
| Rate for Payer: Priority Health Medicare |
$281.99
|
| Rate for Payer: Priority Health Narrow Network |
$480.69
|
| Rate for Payer: Railroad Medicare Medicare |
$281.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$481.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$281.99
|
| Rate for Payer: UHC Exchange |
$481.32
|
| Rate for Payer: UHC Medicaid |
$188.72
|
| Rate for Payer: UHCCP DNSP |
$281.99
|
| Rate for Payer: UHCCP Medicaid |
$188.72
|
|
|
PR CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MNPJ
|
Professional
|
Both
|
$1,062.00
|
|
|
Service Code
|
HCPCS 25675
|
| Min. Negotiated Rate |
$312.05 |
| Max. Negotiated Rate |
$796.50 |
| Rate for Payer: Aetna Commercial |
$628.15
|
| Rate for Payer: Aetna Medicare |
$468.77
|
| Rate for Payer: BCBS Complete |
$327.65
|
| Rate for Payer: BCBS MAPPO |
$468.77
|
| Rate for Payer: BCN Commercial |
$647.87
|
| Rate for Payer: BCN Medicare Advantage |
$468.77
|
| Rate for Payer: Cash Price |
$849.60
|
| Rate for Payer: Cash Price |
$849.60
|
| Rate for Payer: Cofinity Commercial |
$675.03
|
| Rate for Payer: Cofinity Commercial |
$628.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$468.77
|
| Rate for Payer: Healthscope Commercial |
$562.52
|
| Rate for Payer: Healthscope Whirlpool |
$562.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$492.21
|
| Rate for Payer: Meridian Medicaid |
$327.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$515.65
|
| Rate for Payer: Nomi Health Commercial |
$562.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$796.50
|
| Rate for Payer: PACE SWMI |
$468.77
|
| Rate for Payer: PHP Medicare Advantage |
$468.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$312.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$692.56
|
| Rate for Payer: Priority Health Medicare |
$468.77
|
| Rate for Payer: Priority Health Narrow Network |
$692.56
|
| Rate for Payer: Railroad Medicare Medicare |
$468.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$694.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$468.77
|
| Rate for Payer: UHC Exchange |
$694.17
|
| Rate for Payer: UHC Medicaid |
$312.05
|
| Rate for Payer: UHCCP DNSP |
$468.77
|
| Rate for Payer: UHCCP Medicaid |
$312.05
|
|
|
PR CLOSED TX FEMORAL FRACTURE PROX HEAD W/MANJ
|
Professional
|
Both
|
$829.00
|
|
|
Service Code
|
HCPCS 27268
|
| Min. Negotiated Rate |
$329.30 |
| Max. Negotiated Rate |
$942.99 |
| Rate for Payer: Aetna Commercial |
$672.99
|
| Rate for Payer: Aetna Medicare |
$502.23
|
| Rate for Payer: BCBS Complete |
$345.76
|
| Rate for Payer: BCBS MAPPO |
$502.23
|
| Rate for Payer: BCN Commercial |
$837.60
|
| Rate for Payer: BCN Medicare Advantage |
$502.23
|
| Rate for Payer: Cash Price |
$663.20
|
| Rate for Payer: Cash Price |
$663.20
|
| Rate for Payer: Cofinity Commercial |
$723.21
|
| Rate for Payer: Cofinity Commercial |
$672.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$502.23
|
| Rate for Payer: Healthscope Commercial |
$602.68
|
| Rate for Payer: Healthscope Whirlpool |
$602.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$527.34
|
| Rate for Payer: Meridian Medicaid |
$345.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$552.45
|
| Rate for Payer: Nomi Health Commercial |
$602.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$621.75
|
| Rate for Payer: PACE SWMI |
$502.23
|
| Rate for Payer: PHP Medicare Advantage |
$502.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$329.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$895.38
|
| Rate for Payer: Priority Health Medicare |
$502.23
|
| Rate for Payer: Priority Health Narrow Network |
$895.38
|
| Rate for Payer: Railroad Medicare Medicare |
$502.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$942.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$502.23
|
| Rate for Payer: UHC Exchange |
$942.99
|
| Rate for Payer: UHC Medicaid |
$329.30
|
| Rate for Payer: UHCCP DNSP |
$502.23
|
| Rate for Payer: UHCCP Medicaid |
$329.30
|
|
|
PR CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION
|
Professional
|
Both
|
$1,320.00
|
|
|
Service Code
|
HCPCS 27500
|
| Min. Negotiated Rate |
$296.50 |
| Max. Negotiated Rate |
$990.00 |
| Rate for Payer: Aetna Commercial |
$605.39
|
| Rate for Payer: Aetna Medicare |
$451.78
|
| Rate for Payer: BCBS Complete |
$311.32
|
| Rate for Payer: BCBS MAPPO |
$451.78
|
| Rate for Payer: BCN Commercial |
$739.01
|
| Rate for Payer: BCN Medicare Advantage |
$451.78
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Cofinity Commercial |
$650.56
|
| Rate for Payer: Cofinity Commercial |
$605.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$451.78
|
| Rate for Payer: Healthscope Commercial |
$542.14
|
| Rate for Payer: Healthscope Whirlpool |
$542.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$474.37
|
| Rate for Payer: Meridian Medicaid |
$311.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$496.96
|
| Rate for Payer: Nomi Health Commercial |
$542.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$990.00
|
| Rate for Payer: PACE SWMI |
$451.78
|
| Rate for Payer: PHP Medicare Advantage |
$451.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$296.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$789.97
|
| Rate for Payer: Priority Health Medicare |
$451.78
|
| Rate for Payer: Priority Health Narrow Network |
$789.97
|
| Rate for Payer: Railroad Medicare Medicare |
$451.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$835.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$451.78
|
| Rate for Payer: UHC Exchange |
$835.97
|
| Rate for Payer: UHC Medicaid |
$296.50
|
| Rate for Payer: UHCCP DNSP |
$451.78
|
| Rate for Payer: UHCCP Medicaid |
$296.50
|
|
|
PR CLOSED TX KNEE DISLOCATION W/ANESTHESIA
|
Professional
|
Both
|
$905.00
|
|
|
Service Code
|
HCPCS 27552
|
| Min. Negotiated Rate |
$386.60 |
| Max. Negotiated Rate |
$1,094.44 |
| Rate for Payer: Aetna Commercial |
$788.98
|
| Rate for Payer: Aetna Medicare |
$588.79
|
| Rate for Payer: BCBS Complete |
$405.93
|
| Rate for Payer: BCBS MAPPO |
$588.79
|
| Rate for Payer: BCN Commercial |
$975.05
|
| Rate for Payer: BCN Medicare Advantage |
$588.79
|
| Rate for Payer: Cash Price |
$724.00
|
| Rate for Payer: Cash Price |
$724.00
|
| Rate for Payer: Cofinity Commercial |
$847.86
|
| Rate for Payer: Cofinity Commercial |
$788.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$588.79
|
| Rate for Payer: Healthscope Commercial |
$706.55
|
| Rate for Payer: Healthscope Whirlpool |
$706.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$618.23
|
| Rate for Payer: Meridian Medicaid |
$405.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$647.67
|
| Rate for Payer: Nomi Health Commercial |
$706.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$678.75
|
| Rate for Payer: PACE SWMI |
$588.79
|
| Rate for Payer: PHP Medicare Advantage |
$588.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$386.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,042.29
|
| Rate for Payer: Priority Health Medicare |
$588.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,042.29
|
| Rate for Payer: Railroad Medicare Medicare |
$588.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,094.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$588.79
|
| Rate for Payer: UHC Exchange |
$1,094.44
|
| Rate for Payer: UHC Medicaid |
$386.60
|
| Rate for Payer: UHCCP DNSP |
$588.79
|
| Rate for Payer: UHCCP Medicaid |
$386.60
|
|
|
PR CLOSED TX KNEE DISLOCATION W/O ANESTHESIA
|
Professional
|
Both
|
$870.00
|
|
|
Service Code
|
HCPCS 27550
|
| Min. Negotiated Rate |
$333.56 |
| Max. Negotiated Rate |
$840.26 |
| Rate for Payer: Aetna Commercial |
$675.48
|
| Rate for Payer: Aetna Medicare |
$504.09
|
| Rate for Payer: BCBS Complete |
$350.24
|
| Rate for Payer: BCBS MAPPO |
$504.09
|
| Rate for Payer: BCN Commercial |
$729.05
|
| Rate for Payer: BCN Medicare Advantage |
$504.09
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cofinity Commercial |
$725.89
|
| Rate for Payer: Cofinity Commercial |
$675.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$504.09
|
| Rate for Payer: Healthscope Commercial |
$604.91
|
| Rate for Payer: Healthscope Whirlpool |
$604.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$529.29
|
| Rate for Payer: Meridian Medicaid |
$350.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$554.50
|
| Rate for Payer: Nomi Health Commercial |
$604.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$652.50
|
| Rate for Payer: PACE SWMI |
$504.09
|
| Rate for Payer: PHP Medicare Advantage |
$504.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$333.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$779.32
|
| Rate for Payer: Priority Health Medicare |
$504.09
|
| Rate for Payer: Priority Health Narrow Network |
$779.32
|
| Rate for Payer: Railroad Medicare Medicare |
$504.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$840.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$504.09
|
| Rate for Payer: UHC Exchange |
$840.26
|
| Rate for Payer: UHC Medicaid |
$333.56
|
| Rate for Payer: UHCCP DNSP |
$504.09
|
| Rate for Payer: UHCCP Medicaid |
$333.56
|
|
|
PR CLOSED TX LUNATE DISLOCATION W/MANIPULATION
|
Professional
|
Both
|
$867.00
|
|
|
Service Code
|
HCPCS 25690
|
| Min. Negotiated Rate |
$307.57 |
| Max. Negotiated Rate |
$840.96 |
| Rate for Payer: Aetna Commercial |
$623.39
|
| Rate for Payer: Aetna Medicare |
$465.22
|
| Rate for Payer: BCBS Complete |
$322.95
|
| Rate for Payer: BCBS MAPPO |
$465.22
|
| Rate for Payer: BCN Commercial |
$763.90
|
| Rate for Payer: BCN Medicare Advantage |
$465.22
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cofinity Commercial |
$669.92
|
| Rate for Payer: Cofinity Commercial |
$623.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$465.22
|
| Rate for Payer: Healthscope Commercial |
$558.26
|
| Rate for Payer: Healthscope Whirlpool |
$558.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$488.48
|
| Rate for Payer: Meridian Medicaid |
$322.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$511.74
|
| Rate for Payer: Nomi Health Commercial |
$558.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$650.25
|
| Rate for Payer: PACE SWMI |
$465.22
|
| Rate for Payer: PHP Medicare Advantage |
$465.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$307.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$816.60
|
| Rate for Payer: Priority Health Medicare |
$465.22
|
| Rate for Payer: Priority Health Narrow Network |
$816.60
|
| Rate for Payer: Railroad Medicare Medicare |
$465.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$840.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$465.22
|
| Rate for Payer: UHC Exchange |
$840.96
|
| Rate for Payer: UHC Medicaid |
$307.57
|
| Rate for Payer: UHCCP DNSP |
$465.22
|
| Rate for Payer: UHCCP Medicaid |
$307.57
|
|
|
PR CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$1,243.00
|
|
|
Service Code
|
HCPCS 21451
|
| Min. Negotiated Rate |
$387.87 |
| Max. Negotiated Rate |
$1,069.23 |
| Rate for Payer: Aetna Commercial |
$771.57
|
| Rate for Payer: Aetna Medicare |
$575.80
|
| Rate for Payer: BCBS Complete |
$407.26
|
| Rate for Payer: BCBS MAPPO |
$575.80
|
| Rate for Payer: BCN Commercial |
$960.10
|
| Rate for Payer: BCN Medicare Advantage |
$575.80
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cofinity Commercial |
$829.15
|
| Rate for Payer: Cofinity Commercial |
$771.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$575.80
|
| Rate for Payer: Healthscope Commercial |
$690.96
|
| Rate for Payer: Healthscope Whirlpool |
$690.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$604.59
|
| Rate for Payer: Meridian Medicaid |
$407.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$633.38
|
| Rate for Payer: Nomi Health Commercial |
$690.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$932.25
|
| Rate for Payer: PACE SWMI |
$575.80
|
| Rate for Payer: PHP Medicare Advantage |
$575.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$387.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,026.33
|
| Rate for Payer: Priority Health Medicare |
$575.80
|
| Rate for Payer: Priority Health Narrow Network |
$1,026.33
|
| Rate for Payer: Railroad Medicare Medicare |
$575.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,069.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$575.80
|
| Rate for Payer: UHC Exchange |
$1,069.23
|
| Rate for Payer: UHC Medicaid |
$387.87
|
| Rate for Payer: UHCCP DNSP |
$575.80
|
| Rate for Payer: UHCCP Medicaid |
$387.87
|
|
|
PR CLOSED TX MANDIBULAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$1,205.00
|
|
|
Service Code
|
HCPCS 21450
|
| Min. Negotiated Rate |
$293.30 |
| Max. Negotiated Rate |
$903.75 |
| Rate for Payer: Aetna Commercial |
$580.74
|
| Rate for Payer: Aetna Medicare |
$433.39
|
| Rate for Payer: BCBS Complete |
$307.96
|
| Rate for Payer: BCBS MAPPO |
$433.39
|
| Rate for Payer: BCN Commercial |
$719.59
|
| Rate for Payer: BCN Medicare Advantage |
$433.39
|
| Rate for Payer: Cash Price |
$964.00
|
| Rate for Payer: Cash Price |
$964.00
|
| Rate for Payer: Cofinity Commercial |
$624.08
|
| Rate for Payer: Cofinity Commercial |
$580.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$433.39
|
| Rate for Payer: Healthscope Commercial |
$520.07
|
| Rate for Payer: Healthscope Whirlpool |
$520.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$455.06
|
| Rate for Payer: Meridian Medicaid |
$307.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$476.73
|
| Rate for Payer: Nomi Health Commercial |
$520.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$903.75
|
| Rate for Payer: PACE SWMI |
$433.39
|
| Rate for Payer: PHP Medicare Advantage |
$433.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$293.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$769.22
|
| Rate for Payer: Priority Health Medicare |
$433.39
|
| Rate for Payer: Priority Health Narrow Network |
$769.22
|
| Rate for Payer: Railroad Medicare Medicare |
$433.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$791.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$433.39
|
| Rate for Payer: UHC Exchange |
$791.44
|
| Rate for Payer: UHC Medicaid |
$293.30
|
| Rate for Payer: UHCCP DNSP |
$433.39
|
| Rate for Payer: UHCCP Medicaid |
$293.30
|
|
|
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 |
$1,125.72
|
| Rate for Payer: Aetna Medicare |
$840.09
|
| Rate for Payer: BCBS Complete |
$597.15
|
| Rate for Payer: BCBS MAPPO |
$840.09
|
| Rate for Payer: BCN Commercial |
$1,373.43
|
| Rate for Payer: BCN Medicare Advantage |
$840.09
|
| Rate for Payer: Cash Price |
$1,166.40
|
| Rate for Payer: Cash Price |
$1,166.40
|
| Rate for Payer: Cofinity Commercial |
$1,209.73
|
| Rate for Payer: Cofinity Commercial |
$1,125.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$840.09
|
| Rate for Payer: Healthscope Commercial |
$1,008.11
|
| Rate for Payer: Healthscope Whirlpool |
$1,008.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$882.09
|
| Rate for Payer: Meridian Medicaid |
$597.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$924.10
|
| Rate for Payer: Nomi Health Commercial |
$1,008.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,093.50
|
| Rate for Payer: PACE SWMI |
$840.09
|
| Rate for Payer: PHP Medicare Advantage |
$840.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$568.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,468.17
|
| Rate for Payer: Priority Health Medicare |
$840.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,468.17
|
| Rate for Payer: Railroad Medicare Medicare |
$840.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,448.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$840.09
|
| Rate for Payer: UHC Exchange |
$1,448.58
|
| Rate for Payer: UHC Medicaid |
$568.71
|
| Rate for Payer: UHCCP DNSP |
$840.09
|
| 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 |
$289.77
|
| Rate for Payer: Aetna Medicare |
$216.25
|
| Rate for Payer: BCBS Complete |
$150.30
|
| Rate for Payer: BCBS MAPPO |
$216.25
|
| Rate for Payer: BCN Commercial |
$355.56
|
| Rate for Payer: BCN Medicare Advantage |
$216.25
|
| Rate for Payer: Cash Price |
$610.40
|
| Rate for Payer: Cash Price |
$610.40
|
| Rate for Payer: Cofinity Commercial |
$311.40
|
| Rate for Payer: Cofinity Commercial |
$289.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.25
|
| Rate for Payer: Healthscope Commercial |
$259.50
|
| Rate for Payer: Healthscope Whirlpool |
$259.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$227.06
|
| Rate for Payer: Meridian Medicaid |
$150.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$237.88
|
| Rate for Payer: Nomi Health Commercial |
$259.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$572.25
|
| Rate for Payer: PACE SWMI |
$216.25
|
| Rate for Payer: PHP Medicare Advantage |
$216.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$380.08
|
| Rate for Payer: Priority Health Medicare |
$216.25
|
| Rate for Payer: Priority Health Narrow Network |
$380.08
|
| Rate for Payer: Railroad Medicare Medicare |
$216.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$392.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$216.25
|
| Rate for Payer: UHC Exchange |
$392.65
|
| Rate for Payer: UHC Medicaid |
$143.14
|
| Rate for Payer: UHCCP DNSP |
$216.25
|
| 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 |
$736.49
|
| Rate for Payer: Aetna Medicare |
$549.62
|
| Rate for Payer: BCBS Complete |
$380.20
|
| Rate for Payer: BCBS MAPPO |
$549.62
|
| Rate for Payer: BCN Commercial |
$909.32
|
| Rate for Payer: BCN Medicare Advantage |
$549.62
|
| Rate for Payer: Cash Price |
$1,351.20
|
| Rate for Payer: Cash Price |
$1,351.20
|
| Rate for Payer: Cofinity Commercial |
$791.45
|
| Rate for Payer: Cofinity Commercial |
$736.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$549.62
|
| Rate for Payer: Healthscope Commercial |
$659.54
|
| Rate for Payer: Healthscope Whirlpool |
$659.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$577.10
|
| Rate for Payer: Meridian Medicaid |
$380.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$604.58
|
| Rate for Payer: Nomi Health Commercial |
$659.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,266.75
|
| Rate for Payer: PACE SWMI |
$549.62
|
| Rate for Payer: PHP Medicare Advantage |
$549.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$972.04
|
| Rate for Payer: Priority Health Medicare |
$549.62
|
| Rate for Payer: Priority Health Narrow Network |
$972.04
|
| Rate for Payer: Railroad Medicare Medicare |
$549.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$964.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$549.62
|
| Rate for Payer: UHC Exchange |
$964.62
|
| Rate for Payer: UHC Medicaid |
$362.10
|
| Rate for Payer: UHCCP DNSP |
$549.62
|
| 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 |
$70.99
|
| Rate for Payer: Aetna Medicare |
$52.98
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS MAPPO |
$52.98
|
| Rate for Payer: BCN Commercial |
$90.13
|
| Rate for Payer: BCN Medicare Advantage |
$52.98
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cofinity Commercial |
$76.29
|
| Rate for Payer: Cofinity Commercial |
$70.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.98
|
| Rate for Payer: Healthscope Commercial |
$63.58
|
| Rate for Payer: Healthscope Whirlpool |
$63.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.63
|
| Rate for Payer: Meridian Medicaid |
$36.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$58.28
|
| Rate for Payer: Nomi Health Commercial |
$63.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$348.75
|
| Rate for Payer: PACE SWMI |
$52.98
|
| Rate for Payer: PHP Medicare Advantage |
$52.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$96.36
|
| Rate for Payer: Priority Health Medicare |
$52.98
|
| Rate for Payer: Priority Health Narrow Network |
$96.36
|
| Rate for Payer: Railroad Medicare Medicare |
$52.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$258.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$52.98
|
| Rate for Payer: UHC Exchange |
$258.89
|
| Rate for Payer: UHC Medicaid |
$34.29
|
| Rate for Payer: UHCCP DNSP |
$52.98
|
| 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 |
$108.38
|
| Rate for Payer: Aetna Medicare |
$80.88
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS MAPPO |
$80.88
|
| Rate for Payer: BCN Commercial |
$142.42
|
| Rate for Payer: BCN Medicare Advantage |
$80.88
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: Cofinity Commercial |
$116.47
|
| Rate for Payer: Cofinity Commercial |
$108.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.88
|
| Rate for Payer: Healthscope Commercial |
$97.06
|
| Rate for Payer: Healthscope Whirlpool |
$97.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.92
|
| Rate for Payer: Meridian Medicaid |
$54.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$88.97
|
| Rate for Payer: Nomi Health Commercial |
$97.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$320.25
|
| Rate for Payer: PACE SWMI |
$80.88
|
| Rate for Payer: PHP Medicare Advantage |
$80.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$152.24
|
| Rate for Payer: Priority Health Medicare |
$80.88
|
| Rate for Payer: Priority Health Narrow Network |
$152.24
|
| Rate for Payer: Railroad Medicare Medicare |
$80.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$230.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$80.88
|
| Rate for Payer: UHC Exchange |
$230.95
|
| Rate for Payer: UHC Medicaid |
$52.19
|
| Rate for Payer: UHCCP DNSP |
$80.88
|
| 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 |
$362.60
|
| Rate for Payer: Aetna Medicare |
$270.60
|
| Rate for Payer: BCBS Complete |
$188.76
|
| Rate for Payer: BCBS MAPPO |
$270.60
|
| Rate for Payer: BCN Commercial |
$459.64
|
| Rate for Payer: BCN Medicare Advantage |
$270.60
|
| Rate for Payer: Cash Price |
$542.40
|
| Rate for Payer: Cash Price |
$542.40
|
| Rate for Payer: Cofinity Commercial |
$389.66
|
| Rate for Payer: Cofinity Commercial |
$362.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$270.60
|
| Rate for Payer: Healthscope Commercial |
$324.72
|
| Rate for Payer: Healthscope Whirlpool |
$324.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$284.13
|
| Rate for Payer: Meridian Medicaid |
$188.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$297.66
|
| Rate for Payer: Nomi Health Commercial |
$324.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$508.50
|
| Rate for Payer: PACE SWMI |
$270.60
|
| Rate for Payer: PHP Medicare Advantage |
$270.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$491.34
|
| Rate for Payer: Priority Health Medicare |
$270.60
|
| Rate for Payer: Priority Health Narrow Network |
$491.34
|
| Rate for Payer: Railroad Medicare Medicare |
$270.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$503.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$270.60
|
| Rate for Payer: UHC Exchange |
$503.90
|
| Rate for Payer: UHC Medicaid |
$179.77
|
| Rate for Payer: UHCCP DNSP |
$270.60
|
| 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 |
$657.71
|
| Rate for Payer: Aetna Medicare |
$490.83
|
| Rate for Payer: BCBS Complete |
$343.97
|
| Rate for Payer: BCBS MAPPO |
$490.83
|
| Rate for Payer: BCN Commercial |
$825.16
|
| Rate for Payer: BCN Medicare Advantage |
$490.83
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Cofinity Commercial |
$706.80
|
| Rate for Payer: Cofinity Commercial |
$657.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.83
|
| Rate for Payer: Healthscope Commercial |
$589.00
|
| Rate for Payer: Healthscope Whirlpool |
$589.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$515.37
|
| Rate for Payer: Meridian Medicaid |
$343.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$539.91
|
| Rate for Payer: Nomi Health Commercial |
$589.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,026.00
|
| Rate for Payer: PACE SWMI |
$490.83
|
| Rate for Payer: PHP Medicare Advantage |
$490.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$327.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$882.06
|
| Rate for Payer: Priority Health Medicare |
$490.83
|
| Rate for Payer: Priority Health Narrow Network |
$882.06
|
| Rate for Payer: Railroad Medicare Medicare |
$490.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$963.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$490.83
|
| Rate for Payer: UHC Exchange |
$963.93
|
| Rate for Payer: UHC Medicaid |
$327.59
|
| Rate for Payer: UHCCP DNSP |
$490.83
|
| Rate for Payer: UHCCP Medicaid |
$327.59
|
|
