|
PR CIRCUMCISION AGE >28 DAYS
|
Facility
|
OP
|
$1,543.00
|
|
|
Service Code
|
CPT 54161
|
| Hospital Charge Code |
54161
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,002.95 |
| Max. Negotiated Rate |
$3,110.99 |
| Rate for Payer: Aetna Commercial |
$1,388.70
|
| Rate for Payer: Aetna Medicare |
$2,007.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,508.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,508.86
|
| Rate for Payer: ASR ASR |
$1,496.71
|
| Rate for Payer: ASR Commercial |
$1,496.71
|
| Rate for Payer: BCBS Complete |
$1,129.59
|
| Rate for Payer: BCBS MAPPO |
$2,007.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,263.56
|
| Rate for Payer: BCN Commercial |
$1,196.29
|
| Rate for Payer: BCN Medicare Advantage |
$2,007.09
|
| Rate for Payer: Cash Price |
$1,234.40
|
| Rate for Payer: Cash Price |
$1,234.40
|
| Rate for Payer: Cofinity Commercial |
$1,450.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,234.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,007.09
|
| Rate for Payer: Healthscope Commercial |
$1,543.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,496.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,007.09
|
| Rate for Payer: Mclaren Commercial |
$1,388.70
|
| Rate for Payer: Mclaren Medicaid |
$1,075.80
|
| Rate for Payer: Mclaren Medicare |
$2,007.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,107.44
|
| Rate for Payer: Meridian Medicaid |
$1,129.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,308.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,311.55
|
| Rate for Payer: Nomi Health Commercial |
$1,265.26
|
| Rate for Payer: PACE Medicare |
$1,906.74
|
| Rate for Payer: PACE SWMI |
$2,007.09
|
| Rate for Payer: PHP Commercial |
$2,207.80
|
| Rate for Payer: PHP Medicaid |
$1,075.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,007.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,002.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,351.98
|
| Rate for Payer: Priority Health Medicare |
$2,007.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,081.64
|
| Rate for Payer: Railroad Medicare Medicare |
$2,007.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,357.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,007.09
|
| Rate for Payer: UHC Exchange |
$3,110.99
|
| Rate for Payer: UHC Medicare Advantage |
$2,007.09
|
| Rate for Payer: UHCCP DNSP |
$2,007.09
|
| Rate for Payer: UHCCP Medicaid |
$1,075.80
|
| Rate for Payer: VA VA |
$2,007.09
|
|
|
PR CIRCUMCISION NEONATE
|
Professional
|
Both
|
$606.00
|
|
|
Service Code
|
HCPCS 54160
|
| Min. Negotiated Rate |
$93.08 |
| Max. Negotiated Rate |
$2,797.35 |
| Rate for Payer: Aetna Commercial |
$185.88
|
| Rate for Payer: Aetna Medicare |
$303.00
|
| Rate for Payer: BCBS Complete |
$97.73
|
| Rate for Payer: BCBS Trust/PPO |
$2,797.35
|
| Rate for Payer: BCN Commercial |
$321.06
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Meridian Medicaid |
$97.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$232.21
|
| Rate for Payer: Priority Health Narrow Network |
$232.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.88
|
| Rate for Payer: UHC Exchange |
$173.88
|
| Rate for Payer: UHCCP Medicaid |
$93.08
|
|
|
PR CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK
|
Professional
|
Both
|
$521.00
|
|
|
Service Code
|
HCPCS 54150
|
| Min. Negotiated Rate |
$61.13 |
| Max. Negotiated Rate |
$1,797.28 |
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: Aetna Medicare |
$260.50
|
| Rate for Payer: BCBS Complete |
$64.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,797.28
|
| Rate for Payer: BCN Commercial |
$216.98
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Meridian Medicaid |
$64.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$151.79
|
| Rate for Payer: Priority Health Narrow Network |
$151.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.57
|
| Rate for Payer: UHC Exchange |
$118.57
|
| Rate for Payer: UHCCP Medicaid |
$61.13
|
|
|
PR CISTERNAL/LATERAL C1-C2 PUNCTURE W/O INJ SPX
|
Professional
|
Both
|
$479.00
|
|
|
Service Code
|
HCPCS 61050
|
| Min. Negotiated Rate |
$51.33 |
| Max. Negotiated Rate |
$519.32 |
| Rate for Payer: Aetna Commercial |
$105.74
|
| Rate for Payer: Aetna Medicare |
$239.50
|
| Rate for Payer: BCBS Complete |
$53.90
|
| Rate for Payer: BCBS Trust/PPO |
$519.32
|
| Rate for Payer: BCN Commercial |
$115.82
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Meridian Medicaid |
$53.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.78
|
| Rate for Payer: Priority Health Narrow Network |
$134.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$122.63
|
| Rate for Payer: UHC Exchange |
$122.63
|
| Rate for Payer: UHCCP Medicaid |
$51.33
|
|
|
PR CLAVICULECTOMY PARTIAL
|
Professional
|
Both
|
$1,092.00
|
|
|
Service Code
|
HCPCS 23120
|
| Min. Negotiated Rate |
$34.34 |
| Max. Negotiated Rate |
$956.69 |
| Rate for Payer: Aetna Commercial |
$781.06
|
| Rate for Payer: Aetna Medicare |
$546.00
|
| Rate for Payer: BCBS Complete |
$405.26
|
| Rate for Payer: BCBS Trust/PPO |
$34.34
|
| Rate for Payer: BCN Commercial |
$956.69
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Meridian Medicaid |
$405.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$709.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$915.96
|
| Rate for Payer: Priority Health Narrow Network |
$915.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$654.52
|
| Rate for Payer: UHC Exchange |
$654.52
|
| Rate for Payer: UHCCP Medicaid |
$385.96
|
|
|
PR CLAVICULECTOMY TOTAL
|
Professional
|
Both
|
$1,599.00
|
|
|
Service Code
|
HCPCS 23125
|
| Min. Negotiated Rate |
$44.38 |
| Max. Negotiated Rate |
$1,100.67 |
| Rate for Payer: Aetna Commercial |
$947.74
|
| Rate for Payer: Aetna Medicare |
$799.50
|
| Rate for Payer: BCBS Complete |
$487.78
|
| Rate for Payer: BCBS Trust/PPO |
$44.38
|
| Rate for Payer: BCN Commercial |
$1,047.24
|
| Rate for Payer: Cash Price |
$1,279.20
|
| Rate for Payer: Cash Price |
$1,279.20
|
| Rate for Payer: Meridian Medicaid |
$487.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$464.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,039.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,100.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,100.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$801.34
|
| Rate for Payer: UHC Exchange |
$801.34
|
| Rate for Payer: UHCCP Medicaid |
$464.55
|
|
|
PR CLOSED RX PELVIC RING FX/SUBLUX
|
Professional
|
Both
|
$970.00
|
|
|
Service Code
|
HCPCS 27193
|
| Min. Negotiated Rate |
$388.00 |
| Max. Negotiated Rate |
$630.50 |
| Rate for Payer: Aetna Medicare |
$485.00
|
| Rate for Payer: BCBS Complete |
$388.00
|
| Rate for Payer: Cash Price |
$776.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.50
|
|
|
PR CLOSED RX PELV RING FX/SUBLUX,MANIP
|
Professional
|
Both
|
$1,941.00
|
|
|
Service Code
|
HCPCS 27194
|
| Min. Negotiated Rate |
$776.40 |
| Max. Negotiated Rate |
$1,261.65 |
| Rate for Payer: Aetna Medicare |
$970.50
|
| Rate for Payer: BCBS Complete |
$776.40
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,261.65
|
|
|
PR CLOSED RX RIB FRACTURE
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 21800
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$145.60 |
| Rate for Payer: Aetna Medicare |
$112.00
|
| Rate for Payer: BCBS Complete |
$89.60
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
|
|
PR CLOSED TREATMENT COCCYGEAL FRACTURE
|
Professional
|
Both
|
$390.00
|
|
|
Service Code
|
HCPCS 27200
|
| Min. Negotiated Rate |
$129.29 |
| Max. Negotiated Rate |
$1,904.52 |
| Rate for Payer: Aetna Commercial |
$246.94
|
| Rate for Payer: Aetna Medicare |
$195.00
|
| Rate for Payer: BCBS Complete |
$135.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,904.52
|
| Rate for Payer: BCN Commercial |
$279.53
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Meridian Medicaid |
$135.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$304.30
|
| Rate for Payer: Priority Health Narrow Network |
$304.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.02
|
| Rate for Payer: UHC Exchange |
$197.02
|
| Rate for Payer: UHCCP Medicaid |
$129.29
|
|
|
PR CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ
|
Professional
|
Both
|
$765.00
|
|
|
Service Code
|
HCPCS 27768
|
| Min. Negotiated Rate |
$298.41 |
| Max. Negotiated Rate |
$3,241.12 |
| Rate for Payer: Aetna Commercial |
$593.02
|
| Rate for Payer: Aetna Medicare |
$382.50
|
| Rate for Payer: BCBS Complete |
$313.33
|
| Rate for Payer: BCBS Trust/PPO |
$3,241.12
|
| Rate for Payer: BCN Commercial |
$667.54
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Meridian Medicaid |
$313.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$298.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$706.30
|
| Rate for Payer: Priority Health Narrow Network |
$706.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$467.27
|
| Rate for Payer: UHC Exchange |
$467.27
|
| Rate for Payer: UHCCP Medicaid |
$298.41
|
|
|
PR CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANJ
|
Professional
|
Both
|
$727.00
|
|
|
Service Code
|
HCPCS 27767
|
| Min. Negotiated Rate |
$196.81 |
| Max. Negotiated Rate |
$563.09 |
| Rate for Payer: Aetna Commercial |
$380.80
|
| Rate for Payer: Aetna Medicare |
$363.50
|
| Rate for Payer: BCBS Complete |
$206.65
|
| Rate for Payer: BCBS Trust/PPO |
$563.09
|
| Rate for Payer: BCN Commercial |
$438.35
|
| Rate for Payer: Cash Price |
$581.60
|
| Rate for Payer: Cash Price |
$581.60
|
| Rate for Payer: Meridian Medicaid |
$206.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$196.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$461.02
|
| Rate for Payer: Priority Health Narrow Network |
$461.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$294.17
|
| Rate for Payer: UHC Exchange |
$294.17
|
| Rate for Payer: UHCCP Medicaid |
$196.81
|
|
|
PR CLOSED TREATMENT SESAMOID FRACTURE
|
Professional
|
Both
|
$352.00
|
|
|
Service Code
|
HCPCS 28530
|
| Min. Negotiated Rate |
$69.23 |
| Max. Negotiated Rate |
$1,243.09 |
| Rate for Payer: Aetna Commercial |
$129.88
|
| Rate for Payer: Aetna Medicare |
$176.00
|
| Rate for Payer: BCBS Complete |
$72.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,243.09
|
| Rate for Payer: BCN Commercial |
$171.04
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Meridian Medicaid |
$72.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$160.80
|
| Rate for Payer: Priority Health Narrow Network |
$160.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.97
|
| Rate for Payer: UHC Exchange |
$112.97
|
| Rate for Payer: UHCCP Medicaid |
$69.23
|
|
|
PR CLOSED TREATMENT STERNUM FRACTURE
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 21820
|
| Min. Negotiated Rate |
$97.00 |
| Max. Negotiated Rate |
$234.59 |
| Rate for Payer: Aetna Commercial |
$191.49
|
| Rate for Payer: Aetna Medicare |
$97.00
|
| Rate for Payer: BCBS Complete |
$105.34
|
| Rate for Payer: BCBS Trust/PPO |
$99.81
|
| Rate for Payer: BCN Commercial |
$224.30
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Meridian Medicaid |
$105.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$234.59
|
| Rate for Payer: Priority Health Narrow Network |
$234.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$151.01
|
| Rate for Payer: UHC Exchange |
$151.01
|
| Rate for Payer: UHCCP Medicaid |
$100.32
|
|
|
PR CLOSED TREATMENT ULNAR STYLOID FRACTURE
|
Professional
|
Both
|
$833.00
|
|
|
Service Code
|
HCPCS 25650
|
| Min. Negotiated Rate |
$206.40 |
| Max. Negotiated Rate |
$1,117.88 |
| Rate for Payer: Aetna Commercial |
$404.75
|
| Rate for Payer: Aetna Medicare |
$416.50
|
| Rate for Payer: BCBS Complete |
$216.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,117.88
|
| Rate for Payer: BCN Commercial |
$498.94
|
| Rate for Payer: Cash Price |
$666.40
|
| Rate for Payer: Cash Price |
$666.40
|
| Rate for Payer: Meridian Medicaid |
$216.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$206.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$487.48
|
| Rate for Payer: Priority Health Narrow Network |
$487.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$318.10
|
| Rate for Payer: UHC Exchange |
$318.10
|
| Rate for Payer: UHCCP Medicaid |
$206.40
|
|
|
PR CLOSED TREAT SPINE PROCESS FX
|
Professional
|
Both
|
$423.00
|
|
|
Service Code
|
HCPCS 22305
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna Medicare |
$211.50
|
| Rate for Payer: BCBS Complete |
$169.20
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.95
|
|
|
PR CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA
|
Professional
|
Both
|
$921.00
|
|
|
Service Code
|
HCPCS 27840
|
| Min. Negotiated Rate |
$257.52 |
| Max. Negotiated Rate |
$1,414.69 |
| Rate for Payer: Aetna Commercial |
$504.89
|
| Rate for Payer: Aetna Medicare |
$460.50
|
| Rate for Payer: BCBS Complete |
$270.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,414.69
|
| Rate for Payer: BCN Commercial |
$577.62
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Meridian Medicaid |
$270.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$257.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$610.63
|
| Rate for Payer: Priority Health Narrow Network |
$610.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$402.47
|
| Rate for Payer: UHC Exchange |
$402.47
|
| Rate for Payer: UHCCP Medicaid |
$257.52
|
|
|
PR CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ
|
Professional
|
Both
|
$1,190.00
|
|
|
Service Code
|
HCPCS 27810
|
| Min. Negotiated Rate |
$284.57 |
| Max. Negotiated Rate |
$2,867.08 |
| Rate for Payer: Aetna Commercial |
$566.31
|
| Rate for Payer: Aetna Medicare |
$595.00
|
| Rate for Payer: BCBS Complete |
$298.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,867.08
|
| Rate for Payer: BCN Commercial |
$710.05
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Meridian Medicaid |
$298.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$773.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$675.27
|
| Rate for Payer: Priority Health Narrow Network |
$675.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$481.98
|
| Rate for Payer: UHC Exchange |
$481.98
|
| Rate for Payer: UHCCP Medicaid |
$284.57
|
|
|
PR CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ
|
Professional
|
Both
|
$872.00
|
|
|
Service Code
|
HCPCS 27808
|
| Min. Negotiated Rate |
$205.97 |
| Max. Negotiated Rate |
$566.80 |
| Rate for Payer: Aetna Commercial |
$403.72
|
| Rate for Payer: Aetna Medicare |
$436.00
|
| Rate for Payer: BCBS Complete |
$216.27
|
| Rate for Payer: BCBS Trust/PPO |
$556.11
|
| Rate for Payer: BCN Commercial |
$503.83
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Meridian Medicaid |
$216.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$486.98
|
| Rate for Payer: Priority Health Narrow Network |
$486.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.58
|
| Rate for Payer: UHC Exchange |
$320.58
|
| Rate for Payer: UHCCP Medicaid |
$205.97
|
|
|
PR CLOSED TX CALCANEAL FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$1,164.00
|
|
|
Service Code
|
HCPCS 28405
|
| Min. Negotiated Rate |
$270.94 |
| Max. Negotiated Rate |
$1,513.05 |
| Rate for Payer: Aetna Commercial |
$471.72
|
| Rate for Payer: Aetna Medicare |
$582.00
|
| Rate for Payer: BCBS Complete |
$284.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,513.05
|
| Rate for Payer: BCN Commercial |
$673.40
|
| Rate for Payer: Cash Price |
$931.20
|
| Rate for Payer: Cash Price |
$931.20
|
| Rate for Payer: Meridian Medicaid |
$284.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$756.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$639.13
|
| Rate for Payer: Priority Health Narrow Network |
$639.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$401.29
|
| Rate for Payer: UHC Exchange |
$401.29
|
| Rate for Payer: UHCCP Medicaid |
$270.94
|
|
|
PR CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$718.00
|
|
|
Service Code
|
HCPCS 28400
|
| Min. Negotiated Rate |
$153.57 |
| Max. Negotiated Rate |
$1,304.90 |
| Rate for Payer: Aetna Commercial |
$299.58
|
| Rate for Payer: Aetna Medicare |
$359.00
|
| Rate for Payer: BCBS Complete |
$161.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,304.90
|
| Rate for Payer: BCN Commercial |
$368.95
|
| Rate for Payer: Cash Price |
$574.40
|
| Rate for Payer: Cash Price |
$574.40
|
| Rate for Payer: Meridian Medicaid |
$161.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$153.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$363.84
|
| Rate for Payer: Priority Health Narrow Network |
$363.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.25
|
| Rate for Payer: UHC Exchange |
$246.25
|
| Rate for Payer: UHCCP Medicaid |
$153.57
|
|
|
PR CLOSED TX CARPAL SCAPHOID FRACTURE W/MNPJ
|
Professional
|
Both
|
$756.00
|
|
|
Service Code
|
HCPCS 25624
|
| Min. Negotiated Rate |
$298.63 |
| Max. Negotiated Rate |
$939.26 |
| Rate for Payer: Aetna Commercial |
$588.21
|
| Rate for Payer: Aetna Medicare |
$378.00
|
| Rate for Payer: BCBS Complete |
$313.56
|
| Rate for Payer: BCBS Trust/PPO |
$939.26
|
| Rate for Payer: BCN Commercial |
$735.95
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Meridian Medicaid |
$313.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$298.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$491.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$705.27
|
| Rate for Payer: Priority Health Narrow Network |
$705.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.42
|
| Rate for Payer: UHC Exchange |
$461.42
|
| Rate for Payer: UHCCP Medicaid |
$298.63
|
|
|
PR CLOSED TX CARPAL SCAPHOID FRACTURE W/O MNPJ
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
HCPCS 25622
|
| Min. Negotiated Rate |
$192.34 |
| Max. Negotiated Rate |
$939.26 |
| Rate for Payer: Aetna Commercial |
$373.80
|
| Rate for Payer: Aetna Medicare |
$397.00
|
| Rate for Payer: BCBS Complete |
$201.96
|
| Rate for Payer: BCBS Trust/PPO |
$939.26
|
| Rate for Payer: BCN Commercial |
$373.03
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Meridian Medicaid |
$201.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$453.90
|
| Rate for Payer: Priority Health Narrow Network |
$453.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$291.07
|
| Rate for Payer: UHC Exchange |
$291.07
|
| Rate for Payer: UHCCP Medicaid |
$192.34
|
|
|
PR CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MNPJ
|
Professional
|
Both
|
$1,031.00
|
|
|
Service Code
|
HCPCS 25675
|
| Min. Negotiated Rate |
$277.11 |
| Max. Negotiated Rate |
$1,123.17 |
| Rate for Payer: Aetna Commercial |
$536.39
|
| Rate for Payer: Aetna Medicare |
$515.50
|
| Rate for Payer: BCBS Complete |
$290.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,123.17
|
| Rate for Payer: BCN Commercial |
$685.13
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Meridian Medicaid |
$290.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$653.88
|
| Rate for Payer: Priority Health Narrow Network |
$653.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$437.74
|
| Rate for Payer: UHC Exchange |
$437.74
|
| Rate for Payer: UHCCP Medicaid |
$277.11
|
|
|
PR CLOSED TX FEMORAL FRACTURE PROX HEAD W/MANJ
|
Professional
|
Both
|
$805.00
|
|
|
Service Code
|
HCPCS 27268
|
| Min. Negotiated Rate |
$358.27 |
| Max. Negotiated Rate |
$3,411.76 |
| Rate for Payer: Aetna Commercial |
$725.37
|
| Rate for Payer: Aetna Medicare |
$402.50
|
| Rate for Payer: BCBS Complete |
$376.18
|
| Rate for Payer: BCBS Trust/PPO |
$3,411.76
|
| Rate for Payer: BCN Commercial |
$805.83
|
| Rate for Payer: Cash Price |
$644.00
|
| Rate for Payer: Cash Price |
$644.00
|
| Rate for Payer: Meridian Medicaid |
$376.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$358.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$847.76
|
| Rate for Payer: Priority Health Narrow Network |
$847.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$591.28
|
| Rate for Payer: UHC Exchange |
$591.28
|
| Rate for Payer: UHCCP Medicaid |
$358.27
|
|
