|
PR CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION
|
Professional
|
Both
|
$1,282.00
|
|
|
Service Code
|
HCPCS 27500
|
| Min. Negotiated Rate |
$316.09 |
| Max. Negotiated Rate |
$2,223.09 |
| Rate for Payer: Aetna Commercial |
$641.93
|
| Rate for Payer: Aetna Medicare |
$641.00
|
| Rate for Payer: BCBS Complete |
$331.89
|
| Rate for Payer: BCBS Trust/PPO |
$2,223.09
|
| Rate for Payer: BCN Commercial |
$778.46
|
| Rate for Payer: Cash Price |
$1,025.60
|
| Rate for Payer: Cash Price |
$1,025.60
|
| Rate for Payer: Meridian Medicaid |
$331.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$316.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$833.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$750.06
|
| Rate for Payer: Priority Health Narrow Network |
$750.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$537.70
|
| Rate for Payer: UHC Exchange |
$537.70
|
| Rate for Payer: UHCCP Medicaid |
$316.09
|
|
|
PR CLOSED TX KNEE DISLOCATION W/ANESTHESIA
|
Professional
|
Both
|
$879.00
|
|
|
Service Code
|
HCPCS 27552
|
| Min. Negotiated Rate |
$417.05 |
| Max. Negotiated Rate |
$1,159.09 |
| Rate for Payer: Aetna Commercial |
$844.11
|
| Rate for Payer: Aetna Medicare |
$439.50
|
| Rate for Payer: BCBS Complete |
$437.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,159.09
|
| Rate for Payer: BCN Commercial |
$936.30
|
| Rate for Payer: Cash Price |
$703.20
|
| Rate for Payer: Cash Price |
$703.20
|
| Rate for Payer: Meridian Medicaid |
$437.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$417.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$571.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$987.70
|
| Rate for Payer: Priority Health Narrow Network |
$987.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$705.82
|
| Rate for Payer: UHC Exchange |
$705.82
|
| Rate for Payer: UHCCP Medicaid |
$417.05
|
|
|
PR CLOSED TX KNEE DISLOCATION W/O ANESTHESIA
|
Professional
|
Both
|
$845.00
|
|
|
Service Code
|
HCPCS 27550
|
| Min. Negotiated Rate |
$311.83 |
| Max. Negotiated Rate |
$768.20 |
| Rate for Payer: Aetna Commercial |
$647.69
|
| Rate for Payer: Aetna Medicare |
$422.50
|
| Rate for Payer: BCBS Complete |
$327.42
|
| Rate for Payer: BCBS Trust/PPO |
$710.04
|
| Rate for Payer: BCN Commercial |
$768.20
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Meridian Medicaid |
$327.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$311.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$549.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.35
|
| Rate for Payer: Priority Health Narrow Network |
$738.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$514.12
|
| Rate for Payer: UHC Exchange |
$514.12
|
| Rate for Payer: UHCCP Medicaid |
$311.83
|
|
|
PR CLOSED TX LUNATE DISLOCATION W/MANIPULATION
|
Professional
|
Both
|
$842.00
|
|
|
Service Code
|
HCPCS 25690
|
| Min. Negotiated Rate |
$326.74 |
| Max. Negotiated Rate |
$2,554.86 |
| Rate for Payer: Aetna Commercial |
$651.62
|
| Rate for Payer: Aetna Medicare |
$421.00
|
| Rate for Payer: BCBS Complete |
$343.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,554.86
|
| Rate for Payer: BCN Commercial |
$732.53
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Meridian Medicaid |
$343.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$326.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$547.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$774.49
|
| Rate for Payer: Priority Health Narrow Network |
$774.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$524.48
|
| Rate for Payer: UHC Exchange |
$524.48
|
| Rate for Payer: UHCCP Medicaid |
$326.74
|
|
|
PR CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$1,207.00
|
|
|
Service Code
|
HCPCS 21451
|
| Min. Negotiated Rate |
$410.66 |
| Max. Negotiated Rate |
$8,162.77 |
| Rate for Payer: Aetna Commercial |
$849.59
|
| Rate for Payer: Aetna Medicare |
$603.50
|
| Rate for Payer: BCBS Complete |
$431.19
|
| Rate for Payer: BCBS Trust/PPO |
$8,162.77
|
| Rate for Payer: BCN Commercial |
$1,130.31
|
| Rate for Payer: Cash Price |
$965.60
|
| Rate for Payer: Cash Price |
$965.60
|
| Rate for Payer: Meridian Medicaid |
$431.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$410.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$784.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$978.04
|
| Rate for Payer: Priority Health Narrow Network |
$978.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$688.72
|
| Rate for Payer: UHC Exchange |
$688.72
|
| Rate for Payer: UHCCP Medicaid |
$410.66
|
|
|
PR CLOSED TX MANDIBULAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 21450
|
| Min. Negotiated Rate |
$307.79 |
| Max. Negotiated Rate |
$10,328.77 |
| Rate for Payer: Aetna Commercial |
$634.10
|
| Rate for Payer: Aetna Medicare |
$585.00
|
| Rate for Payer: BCBS Complete |
$323.18
|
| Rate for Payer: BCBS Trust/PPO |
$10,328.77
|
| Rate for Payer: BCN Commercial |
$869.84
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Meridian Medicaid |
$323.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$307.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$760.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$733.78
|
| Rate for Payer: Priority Health Narrow Network |
$733.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$520.03
|
| Rate for Payer: UHC Exchange |
$520.03
|
| Rate for Payer: UHCCP Medicaid |
$307.79
|
|
|
PR CLOSED TX MANDIBULAR FX W/INTERDENTAL FIXATION
|
Professional
|
Both
|
$1,416.00
|
|
|
Service Code
|
HCPCS 21453
|
| Min. Negotiated Rate |
$587.45 |
| Max. Negotiated Rate |
$8,162.77 |
| Rate for Payer: Aetna Commercial |
$1,208.80
|
| Rate for Payer: Aetna Medicare |
$708.00
|
| Rate for Payer: BCBS Complete |
$616.82
|
| Rate for Payer: BCBS Trust/PPO |
$8,162.77
|
| Rate for Payer: BCN Commercial |
$1,610.19
|
| Rate for Payer: Cash Price |
$1,132.80
|
| Rate for Payer: Cash Price |
$1,132.80
|
| Rate for Payer: Meridian Medicaid |
$616.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$587.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$920.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,421.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,421.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$838.51
|
| Rate for Payer: UHC Exchange |
$838.51
|
| Rate for Payer: UHCCP Medicaid |
$587.45
|
|
|
PR CLOSED TX METATARSAL FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$539.00
|
|
|
Service Code
|
HCPCS 28470
|
| Min. Negotiated Rate |
$136.96 |
| Max. Negotiated Rate |
$915.02 |
| Rate for Payer: Aetna Commercial |
$268.17
|
| Rate for Payer: Aetna Medicare |
$269.50
|
| Rate for Payer: BCBS Complete |
$143.81
|
| Rate for Payer: BCBS Trust/PPO |
$915.02
|
| Rate for Payer: BCN Commercial |
$260.33
|
| Rate for Payer: Cash Price |
$431.20
|
| Rate for Payer: Cash Price |
$431.20
|
| Rate for Payer: Meridian Medicaid |
$143.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$136.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$324.65
|
| Rate for Payer: Priority Health Narrow Network |
$324.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.74
|
| Rate for Payer: UHC Exchange |
$207.74
|
| Rate for Payer: UHCCP Medicaid |
$136.96
|
|
|
PR CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ
|
Professional
|
Both
|
$1,640.00
|
|
|
Service Code
|
HCPCS 24620
|
| Min. Negotiated Rate |
$388.94 |
| Max. Negotiated Rate |
$1,066.00 |
| Rate for Payer: Aetna Commercial |
$749.39
|
| Rate for Payer: Aetna Medicare |
$820.00
|
| Rate for Payer: BCBS Complete |
$408.39
|
| Rate for Payer: BCBS Trust/PPO |
$793.51
|
| Rate for Payer: BCN Commercial |
$872.29
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Meridian Medicaid |
$408.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$388.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,066.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$920.53
|
| Rate for Payer: Priority Health Narrow Network |
$920.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$621.50
|
| Rate for Payer: UHC Exchange |
$621.50
|
| Rate for Payer: UHCCP Medicaid |
$388.94
|
|
|
PR CLOSED TX NASAL BONE FX W/MNPJ W/O STABILIZATION
|
Professional
|
Both
|
$451.00
|
|
|
Service Code
|
HCPCS 21315
|
| Min. Negotiated Rate |
$38.55 |
| Max. Negotiated Rate |
$2,948.86 |
| Rate for Payer: Aetna Commercial |
$201.65
|
| Rate for Payer: Aetna Medicare |
$225.50
|
| Rate for Payer: BCBS Complete |
$40.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,948.86
|
| Rate for Payer: BCN Commercial |
$222.83
|
| Rate for Payer: Cash Price |
$360.80
|
| Rate for Payer: Cash Price |
$360.80
|
| Rate for Payer: Meridian Medicaid |
$40.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.08
|
| Rate for Payer: Priority Health Narrow Network |
$91.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.64
|
| Rate for Payer: UHC Exchange |
$170.64
|
| Rate for Payer: UHCCP Medicaid |
$38.55
|
|
|
PR CLOSED TX NASAL BONE FX W/MNPJ W/STABILIZATION
|
Professional
|
Both
|
$415.00
|
|
|
Service Code
|
HCPCS 21320
|
| Min. Negotiated Rate |
$60.92 |
| Max. Negotiated Rate |
$320.57 |
| Rate for Payer: Aetna Commercial |
$176.51
|
| Rate for Payer: Aetna Medicare |
$207.50
|
| Rate for Payer: BCBS Complete |
$63.97
|
| Rate for Payer: BCBS Trust/PPO |
$140.42
|
| Rate for Payer: BCN Commercial |
$320.57
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Meridian Medicaid |
$63.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$145.03
|
| Rate for Payer: Priority Health Narrow Network |
$145.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$157.04
|
| Rate for Payer: UHC Exchange |
$157.04
|
| Rate for Payer: UHCCP Medicaid |
$60.92
|
|
|
PR CLOSED TX NASAL SEPTAL FRACT W/WO STABILIZATION
|
Professional
|
Both
|
$658.00
|
|
|
Service Code
|
HCPCS 21337
|
| Min. Negotiated Rate |
$57.48 |
| Max. Negotiated Rate |
$616.71 |
| Rate for Payer: Aetna Commercial |
$388.27
|
| Rate for Payer: Aetna Medicare |
$329.00
|
| Rate for Payer: BCBS Complete |
$206.43
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$616.71
|
| Rate for Payer: Cash Price |
$526.40
|
| Rate for Payer: Cash Price |
$526.40
|
| Rate for Payer: Meridian Medicaid |
$206.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$196.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$465.10
|
| Rate for Payer: Priority Health Narrow Network |
$465.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$329.11
|
| Rate for Payer: UHC Exchange |
$329.11
|
| Rate for Payer: UHCCP Medicaid |
$196.60
|
|
|
PR CLOSED TX PALATAL/MAXILLARY FX W/FIXATION/SPLINT
|
Professional
|
Both
|
$1,328.00
|
|
|
Service Code
|
HCPCS 21421
|
| Min. Negotiated Rate |
$352.94 |
| Max. Negotiated Rate |
$3,350.93 |
| Rate for Payer: Aetna Commercial |
$736.23
|
| Rate for Payer: Aetna Medicare |
$664.00
|
| Rate for Payer: BCBS Complete |
$370.59
|
| Rate for Payer: BCBS Trust/PPO |
$3,350.93
|
| Rate for Payer: BCN Commercial |
$943.64
|
| Rate for Payer: Cash Price |
$1,062.40
|
| Rate for Payer: Cash Price |
$1,062.40
|
| Rate for Payer: Meridian Medicaid |
$370.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$352.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$863.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$831.99
|
| Rate for Payer: Priority Health Narrow Network |
$831.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$712.01
|
| Rate for Payer: UHC Exchange |
$712.01
|
| Rate for Payer: UHCCP Medicaid |
$352.94
|
|
|
PR CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA
|
Professional
|
Both
|
$614.00
|
|
|
Service Code
|
HCPCS 27560
|
| Min. Negotiated Rate |
$228.12 |
| Max. Negotiated Rate |
$2,121.65 |
| Rate for Payer: Aetna Commercial |
$457.80
|
| Rate for Payer: Aetna Medicare |
$307.00
|
| Rate for Payer: BCBS Complete |
$239.53
|
| Rate for Payer: BCBS Trust/PPO |
$2,121.65
|
| Rate for Payer: BCN Commercial |
$561.98
|
| Rate for Payer: Cash Price |
$491.20
|
| Rate for Payer: Cash Price |
$491.20
|
| Rate for Payer: Meridian Medicaid |
$239.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$228.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.43
|
| Rate for Payer: Priority Health Narrow Network |
$541.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$374.93
|
| Rate for Payer: UHC Exchange |
$374.93
|
| Rate for Payer: UHCCP Medicaid |
$228.12
|
|
|
PR CLOSED TX PATELLAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$651.00
|
|
|
Service Code
|
HCPCS 27520
|
| Min. Negotiated Rate |
$49.13 |
| Max. Negotiated Rate |
$490.14 |
| Rate for Payer: Aetna Commercial |
$396.99
|
| Rate for Payer: Aetna Medicare |
$325.50
|
| Rate for Payer: BCBS Complete |
$213.14
|
| Rate for Payer: BCBS Trust/PPO |
$49.13
|
| Rate for Payer: BCN Commercial |
$490.14
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Meridian Medicaid |
$213.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$479.35
|
| Rate for Payer: Priority Health Narrow Network |
$479.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$313.88
|
| Rate for Payer: UHC Exchange |
$313.88
|
| Rate for Payer: UHCCP Medicaid |
$202.99
|
|
|
PR CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION
|
Professional
|
Both
|
$961.00
|
|
|
Service Code
|
HCPCS 24655
|
| Min. Negotiated Rate |
$270.94 |
| Max. Negotiated Rate |
$979.47 |
| Rate for Payer: Aetna Commercial |
$532.95
|
| Rate for Payer: Aetna Medicare |
$480.50
|
| Rate for Payer: BCBS Complete |
$284.49
|
| Rate for Payer: BCBS Trust/PPO |
$979.47
|
| Rate for Payer: BCN Commercial |
$671.93
|
| Rate for Payer: Cash Price |
$768.80
|
| Rate for Payer: Cash Price |
$768.80
|
| Rate for Payer: Meridian Medicaid |
$284.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$624.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$644.22
|
| Rate for Payer: Priority Health Narrow Network |
$644.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$436.80
|
| Rate for Payer: UHC Exchange |
$436.80
|
| Rate for Payer: UHCCP Medicaid |
$270.94
|
|
|
PR CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION
|
Professional
|
Both
|
$645.00
|
|
|
Service Code
|
HCPCS 24650
|
| Min. Negotiated Rate |
$167.63 |
| Max. Negotiated Rate |
$1,113.13 |
| Rate for Payer: Aetna Commercial |
$323.50
|
| Rate for Payer: Aetna Medicare |
$322.50
|
| Rate for Payer: BCBS Complete |
$176.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,113.13
|
| Rate for Payer: BCN Commercial |
$320.02
|
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Meridian Medicaid |
$176.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$167.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$393.87
|
| Rate for Payer: Priority Health Narrow Network |
$393.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.73
|
| Rate for Payer: UHC Exchange |
$250.73
|
| Rate for Payer: UHCCP Medicaid |
$167.63
|
|
|
PR CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$1,270.00
|
|
|
Service Code
|
HCPCS 25505
|
| Min. Negotiated Rate |
$307.15 |
| Max. Negotiated Rate |
$1,458.11 |
| Rate for Payer: Aetna Commercial |
$609.77
|
| Rate for Payer: Aetna Medicare |
$635.00
|
| Rate for Payer: BCBS Complete |
$322.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,458.11
|
| Rate for Payer: BCN Commercial |
$760.38
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Meridian Medicaid |
$322.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$307.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$825.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$729.20
|
| Rate for Payer: Priority Health Narrow Network |
$729.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$508.27
|
| Rate for Payer: UHC Exchange |
$508.27
|
| Rate for Payer: UHCCP Medicaid |
$307.15
|
|
|
PR CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$451.00
|
|
|
Service Code
|
HCPCS 25500
|
| Min. Negotiated Rate |
$175.09 |
| Max. Negotiated Rate |
$1,850.63 |
| Rate for Payer: Aetna Commercial |
$339.01
|
| Rate for Payer: Aetna Medicare |
$225.50
|
| Rate for Payer: BCBS Complete |
$183.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,850.63
|
| Rate for Payer: BCN Commercial |
$429.06
|
| Rate for Payer: Cash Price |
$360.80
|
| Rate for Payer: Cash Price |
$360.80
|
| Rate for Payer: Meridian Medicaid |
$183.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$412.68
|
| Rate for Payer: Priority Health Narrow Network |
$412.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$259.84
|
| Rate for Payer: UHC Exchange |
$259.84
|
| Rate for Payer: UHCCP Medicaid |
$175.09
|
|
|
PR CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MNPJ
|
Professional
|
Both
|
$1,428.00
|
|
|
Service Code
|
HCPCS 25565
|
| Min. Negotiated Rate |
$308.42 |
| Max. Negotiated Rate |
$2,806.33 |
| Rate for Payer: Aetna Commercial |
$619.55
|
| Rate for Payer: Aetna Medicare |
$714.00
|
| Rate for Payer: BCBS Complete |
$323.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,806.33
|
| Rate for Payer: BCN Commercial |
$780.42
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Meridian Medicaid |
$323.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$308.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$733.26
|
| Rate for Payer: Priority Health Narrow Network |
$733.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$527.10
|
| Rate for Payer: UHC Exchange |
$527.10
|
| Rate for Payer: UHCCP Medicaid |
$308.42
|
|
|
PR CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MNPJ
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 25560
|
| Min. Negotiated Rate |
$175.94 |
| Max. Negotiated Rate |
$1,599.69 |
| Rate for Payer: Aetna Commercial |
$340.68
|
| Rate for Payer: Aetna Medicare |
$357.00
|
| Rate for Payer: BCBS Complete |
$184.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,599.69
|
| Rate for Payer: BCN Commercial |
$351.82
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Meridian Medicaid |
$184.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$414.72
|
| Rate for Payer: Priority Health Narrow Network |
$414.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$259.92
|
| Rate for Payer: UHC Exchange |
$259.92
|
| Rate for Payer: UHCCP Medicaid |
$175.94
|
|
|
PR CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$614.00
|
|
|
Service Code
|
HCPCS 23570
|
| Min. Negotiated Rate |
$164.86 |
| Max. Negotiated Rate |
$553.66 |
| Rate for Payer: Aetna Commercial |
$319.45
|
| Rate for Payer: Aetna Medicare |
$307.00
|
| Rate for Payer: BCBS Complete |
$173.10
|
| Rate for Payer: BCBS Trust/PPO |
$553.66
|
| Rate for Payer: BCN Commercial |
$353.31
|
| Rate for Payer: Cash Price |
$491.20
|
| Rate for Payer: Cash Price |
$491.20
|
| Rate for Payer: Meridian Medicaid |
$173.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$387.75
|
| Rate for Payer: Priority Health Narrow Network |
$387.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.71
|
| Rate for Payer: UHC Exchange |
$251.71
|
| Rate for Payer: UHCCP Medicaid |
$164.86
|
|
|
PR CLOSED TX STERNOCLAVICULAR DISLC W/MANIPULATION
|
Professional
|
Both
|
$783.00
|
|
|
Service Code
|
HCPCS 23525
|
| Min. Negotiated Rate |
$244.52 |
| Max. Negotiated Rate |
$595.21 |
| Rate for Payer: Aetna Commercial |
$478.72
|
| Rate for Payer: Aetna Medicare |
$391.50
|
| Rate for Payer: BCBS Complete |
$256.75
|
| Rate for Payer: BCBS Trust/PPO |
$399.45
|
| Rate for Payer: BCN Commercial |
$595.21
|
| Rate for Payer: Cash Price |
$626.40
|
| Rate for Payer: Cash Price |
$626.40
|
| Rate for Payer: Meridian Medicaid |
$256.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$244.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$508.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$576.54
|
| Rate for Payer: Priority Health Narrow Network |
$576.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$362.99
|
| Rate for Payer: UHC Exchange |
$362.99
|
| Rate for Payer: UHCCP Medicaid |
$244.52
|
|
|
PR CLOSED TX TALOTARSAL JOINT DISLC W/O ANES
|
Professional
|
Both
|
$358.00
|
|
|
Service Code
|
HCPCS 28570
|
| Min. Negotiated Rate |
$133.55 |
| Max. Negotiated Rate |
$1,383.62 |
| Rate for Payer: Aetna Commercial |
$255.65
|
| Rate for Payer: Aetna Medicare |
$179.00
|
| Rate for Payer: BCBS Complete |
$140.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,383.62
|
| Rate for Payer: BCN Commercial |
$351.85
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Meridian Medicaid |
$140.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$133.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$313.96
|
| Rate for Payer: Priority Health Narrow Network |
$313.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.92
|
| Rate for Payer: UHC Exchange |
$163.92
|
| Rate for Payer: UHCCP Medicaid |
$133.55
|
|
|
PR CLOSED TX TALOTARSAL JOINT DISLOCATION W/ANES
|
Professional
|
Both
|
$808.00
|
|
|
Service Code
|
HCPCS 28575
|
| Min. Negotiated Rate |
$227.27 |
| Max. Negotiated Rate |
$804.60 |
| Rate for Payer: Aetna Commercial |
$445.15
|
| Rate for Payer: Aetna Medicare |
$404.00
|
| Rate for Payer: BCBS Complete |
$238.63
|
| Rate for Payer: BCBS Trust/PPO |
$804.60
|
| Rate for Payer: BCN Commercial |
$565.40
|
| Rate for Payer: Cash Price |
$646.40
|
| Rate for Payer: Cash Price |
$646.40
|
| Rate for Payer: Meridian Medicaid |
$238.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$227.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$536.34
|
| Rate for Payer: Priority Health Narrow Network |
$536.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$348.65
|
| Rate for Payer: UHC Exchange |
$348.65
|
| Rate for Payer: UHCCP Medicaid |
$227.27
|
|
