|
PR CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ
|
Professional
|
Both
|
$1,190.00
|
|
|
Service Code
|
HCPCS 27810
|
| Min. Negotiated Rate |
$418.07 |
| Max. Negotiated Rate |
$773.50 |
| Rate for Payer: Aetna Commercial |
$560.21
|
| Rate for Payer: Aetna Medicare |
$418.07
|
| Rate for Payer: BCBS Complete |
$476.00
|
| Rate for Payer: BCBS MAPPO |
$418.07
|
| Rate for Payer: BCN Medicare Advantage |
$418.07
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Cofinity Commercial |
$602.02
|
| Rate for Payer: Cofinity Commercial |
$560.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$418.07
|
| Rate for Payer: Healthscope Commercial |
$501.68
|
| Rate for Payer: Healthscope Whirlpool |
$501.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$438.97
|
| Rate for Payer: Nomi Health Commercial |
$501.68
|
| Rate for Payer: PACE SWMI |
$418.07
|
| Rate for Payer: PHP Medicare Advantage |
$418.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$773.50
|
| Rate for Payer: Priority Health Medicare |
$418.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$418.07
|
| Rate for Payer: UHC Medicare Advantage |
$418.07
|
| Rate for Payer: UHCCP DNSP |
$418.07
|
|
|
PR CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ
|
Professional
|
Both
|
$872.00
|
|
|
Service Code
|
HCPCS 27808
|
| Min. Negotiated Rate |
$298.59 |
| Max. Negotiated Rate |
$566.80 |
| Rate for Payer: Aetna Commercial |
$400.11
|
| Rate for Payer: Aetna Medicare |
$298.59
|
| Rate for Payer: BCBS Complete |
$348.80
|
| Rate for Payer: BCBS MAPPO |
$298.59
|
| Rate for Payer: BCN Medicare Advantage |
$298.59
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cofinity Commercial |
$429.97
|
| Rate for Payer: Cofinity Commercial |
$400.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.59
|
| Rate for Payer: Healthscope Commercial |
$358.31
|
| Rate for Payer: Healthscope Whirlpool |
$358.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$313.52
|
| Rate for Payer: Nomi Health Commercial |
$358.31
|
| Rate for Payer: PACE SWMI |
$298.59
|
| Rate for Payer: PHP Medicare Advantage |
$298.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.80
|
| Rate for Payer: Priority Health Medicare |
$298.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$298.59
|
| Rate for Payer: UHC Medicare Advantage |
$298.59
|
| Rate for Payer: UHCCP DNSP |
$298.59
|
|
|
PR CLOSED TX CALCANEAL FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$1,164.00
|
|
|
Service Code
|
HCPCS 28405
|
| Min. Negotiated Rate |
$396.78 |
| Max. Negotiated Rate |
$756.60 |
| Rate for Payer: Aetna Commercial |
$531.69
|
| Rate for Payer: Aetna Medicare |
$396.78
|
| Rate for Payer: BCBS Complete |
$465.60
|
| Rate for Payer: BCBS MAPPO |
$396.78
|
| Rate for Payer: BCN Medicare Advantage |
$396.78
|
| Rate for Payer: Cash Price |
$931.20
|
| Rate for Payer: Cash Price |
$931.20
|
| Rate for Payer: Cofinity Commercial |
$571.36
|
| Rate for Payer: Cofinity Commercial |
$531.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$396.78
|
| Rate for Payer: Healthscope Commercial |
$476.14
|
| Rate for Payer: Healthscope Whirlpool |
$476.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$416.62
|
| Rate for Payer: Nomi Health Commercial |
$476.14
|
| Rate for Payer: PACE SWMI |
$396.78
|
| Rate for Payer: PHP Medicare Advantage |
$396.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$756.60
|
| Rate for Payer: Priority Health Medicare |
$396.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$396.78
|
| Rate for Payer: UHC Medicare Advantage |
$396.78
|
| Rate for Payer: UHCCP DNSP |
$396.78
|
|
|
PR CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$718.00
|
|
|
Service Code
|
HCPCS 28400
|
| Min. Negotiated Rate |
$222.16 |
| Max. Negotiated Rate |
$466.70 |
| Rate for Payer: Aetna Commercial |
$297.69
|
| Rate for Payer: Aetna Medicare |
$222.16
|
| Rate for Payer: BCBS Complete |
$287.20
|
| Rate for Payer: BCBS MAPPO |
$222.16
|
| Rate for Payer: BCN Medicare Advantage |
$222.16
|
| Rate for Payer: Cash Price |
$574.40
|
| Rate for Payer: Cash Price |
$574.40
|
| Rate for Payer: Cofinity Commercial |
$319.91
|
| Rate for Payer: Cofinity Commercial |
$297.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.16
|
| Rate for Payer: Healthscope Commercial |
$266.59
|
| Rate for Payer: Healthscope Whirlpool |
$266.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$233.27
|
| Rate for Payer: Nomi Health Commercial |
$266.59
|
| Rate for Payer: PACE SWMI |
$222.16
|
| Rate for Payer: PHP Medicare Advantage |
$222.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.70
|
| Rate for Payer: Priority Health Medicare |
$222.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$222.16
|
| Rate for Payer: UHC Medicare Advantage |
$222.16
|
| Rate for Payer: UHCCP DNSP |
$222.16
|
|
|
PR CLOSED TX CARPAL SCAPHOID FRACTURE W/MNPJ
|
Professional
|
Both
|
$756.00
|
|
|
Service Code
|
HCPCS 25624
|
| Min. Negotiated Rate |
$302.40 |
| Max. Negotiated Rate |
$626.64 |
| Rate for Payer: Aetna Commercial |
$583.13
|
| Rate for Payer: Aetna Medicare |
$435.17
|
| Rate for Payer: BCBS Complete |
$302.40
|
| Rate for Payer: BCBS MAPPO |
$435.17
|
| Rate for Payer: BCN Medicare Advantage |
$435.17
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cofinity Commercial |
$626.64
|
| Rate for Payer: Cofinity Commercial |
$583.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$435.17
|
| Rate for Payer: Healthscope Commercial |
$522.20
|
| Rate for Payer: Healthscope Whirlpool |
$522.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$456.93
|
| Rate for Payer: Nomi Health Commercial |
$522.20
|
| Rate for Payer: PACE SWMI |
$435.17
|
| Rate for Payer: PHP Medicare Advantage |
$435.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$491.40
|
| Rate for Payer: Priority Health Medicare |
$435.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$435.17
|
| Rate for Payer: UHC Medicare Advantage |
$435.17
|
| Rate for Payer: UHCCP DNSP |
$435.17
|
|
|
PR CLOSED TX CARPAL SCAPHOID FRACTURE W/O MNPJ
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
HCPCS 25622
|
| Min. Negotiated Rate |
$278.62 |
| Max. Negotiated Rate |
$516.10 |
| Rate for Payer: Aetna Commercial |
$373.35
|
| Rate for Payer: Aetna Medicare |
$278.62
|
| Rate for Payer: BCBS Complete |
$317.60
|
| Rate for Payer: BCBS MAPPO |
$278.62
|
| Rate for Payer: BCN Medicare Advantage |
$278.62
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Cofinity Commercial |
$401.21
|
| Rate for Payer: Cofinity Commercial |
$373.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$278.62
|
| Rate for Payer: Healthscope Commercial |
$334.34
|
| Rate for Payer: Healthscope Whirlpool |
$334.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$292.55
|
| Rate for Payer: Nomi Health Commercial |
$334.34
|
| Rate for Payer: PACE SWMI |
$278.62
|
| Rate for Payer: PHP Medicare Advantage |
$278.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.10
|
| Rate for Payer: Priority Health Medicare |
$278.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$278.62
|
| Rate for Payer: UHC Medicare Advantage |
$278.62
|
| Rate for Payer: UHCCP DNSP |
$278.62
|
|
|
PR CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MNPJ
|
Professional
|
Both
|
$1,031.00
|
|
|
Service Code
|
HCPCS 25675
|
| Min. Negotiated Rate |
$406.10 |
| Max. Negotiated Rate |
$670.15 |
| Rate for Payer: Aetna Commercial |
$544.17
|
| Rate for Payer: Aetna Medicare |
$406.10
|
| Rate for Payer: BCBS Complete |
$412.40
|
| Rate for Payer: BCBS MAPPO |
$406.10
|
| Rate for Payer: BCN Medicare Advantage |
$406.10
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Cofinity Commercial |
$584.78
|
| Rate for Payer: Cofinity Commercial |
$544.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$406.10
|
| Rate for Payer: Healthscope Commercial |
$487.32
|
| Rate for Payer: Healthscope Whirlpool |
$487.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$426.40
|
| Rate for Payer: Nomi Health Commercial |
$487.32
|
| Rate for Payer: PACE SWMI |
$406.10
|
| Rate for Payer: PHP Medicare Advantage |
$406.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.15
|
| Rate for Payer: Priority Health Medicare |
$406.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$406.10
|
| Rate for Payer: UHC Medicare Advantage |
$406.10
|
| Rate for Payer: UHCCP DNSP |
$406.10
|
|
|
PR CLOSED TX FEMORAL FRACTURE PROX HEAD W/MANJ
|
Professional
|
Both
|
$805.00
|
|
|
Service Code
|
HCPCS 27268
|
| Min. Negotiated Rate |
$322.00 |
| Max. Negotiated Rate |
$761.18 |
| Rate for Payer: Aetna Commercial |
$708.32
|
| Rate for Payer: Aetna Medicare |
$528.60
|
| Rate for Payer: BCBS Complete |
$322.00
|
| Rate for Payer: BCBS MAPPO |
$528.60
|
| Rate for Payer: BCN Medicare Advantage |
$528.60
|
| Rate for Payer: Cash Price |
$644.00
|
| Rate for Payer: Cash Price |
$644.00
|
| Rate for Payer: Cofinity Commercial |
$761.18
|
| Rate for Payer: Cofinity Commercial |
$708.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$528.60
|
| Rate for Payer: Healthscope Commercial |
$634.32
|
| Rate for Payer: Healthscope Whirlpool |
$634.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$555.03
|
| Rate for Payer: Nomi Health Commercial |
$634.32
|
| Rate for Payer: PACE SWMI |
$528.60
|
| Rate for Payer: PHP Medicare Advantage |
$528.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.25
|
| Rate for Payer: Priority Health Medicare |
$528.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$528.60
|
| Rate for Payer: UHC Medicare Advantage |
$528.60
|
| Rate for Payer: UHCCP DNSP |
$528.60
|
|
|
PR CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION
|
Professional
|
Both
|
$1,282.00
|
|
|
Service Code
|
HCPCS 27500
|
| Min. Negotiated Rate |
$466.20 |
| Max. Negotiated Rate |
$833.30 |
| Rate for Payer: Aetna Commercial |
$624.71
|
| Rate for Payer: Aetna Medicare |
$466.20
|
| Rate for Payer: BCBS Complete |
$512.80
|
| Rate for Payer: BCBS MAPPO |
$466.20
|
| Rate for Payer: BCN Medicare Advantage |
$466.20
|
| Rate for Payer: Cash Price |
$1,025.60
|
| Rate for Payer: Cash Price |
$1,025.60
|
| Rate for Payer: Cofinity Commercial |
$671.33
|
| Rate for Payer: Cofinity Commercial |
$624.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$466.20
|
| Rate for Payer: Healthscope Commercial |
$559.44
|
| Rate for Payer: Healthscope Whirlpool |
$559.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$489.51
|
| Rate for Payer: Nomi Health Commercial |
$559.44
|
| Rate for Payer: PACE SWMI |
$466.20
|
| Rate for Payer: PHP Medicare Advantage |
$466.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$833.30
|
| Rate for Payer: Priority Health Medicare |
$466.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$466.20
|
| Rate for Payer: UHC Medicare Advantage |
$466.20
|
| Rate for Payer: UHCCP DNSP |
$466.20
|
|
|
PR CLOSED TX KNEE DISLOCATION W/ANESTHESIA
|
Professional
|
Both
|
$879.00
|
|
|
Service Code
|
HCPCS 27552
|
| Min. Negotiated Rate |
$351.60 |
| Max. Negotiated Rate |
$884.89 |
| Rate for Payer: Aetna Commercial |
$823.44
|
| Rate for Payer: Aetna Medicare |
$614.51
|
| Rate for Payer: BCBS Complete |
$351.60
|
| Rate for Payer: BCBS MAPPO |
$614.51
|
| Rate for Payer: BCN Medicare Advantage |
$614.51
|
| Rate for Payer: Cash Price |
$703.20
|
| Rate for Payer: Cash Price |
$703.20
|
| Rate for Payer: Cofinity Commercial |
$884.89
|
| Rate for Payer: Cofinity Commercial |
$823.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$614.51
|
| Rate for Payer: Healthscope Commercial |
$737.41
|
| Rate for Payer: Healthscope Whirlpool |
$737.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$645.24
|
| Rate for Payer: Nomi Health Commercial |
$737.41
|
| Rate for Payer: PACE SWMI |
$614.51
|
| Rate for Payer: PHP Medicare Advantage |
$614.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$571.35
|
| Rate for Payer: Priority Health Medicare |
$614.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$614.51
|
| Rate for Payer: UHC Medicare Advantage |
$614.51
|
| Rate for Payer: UHCCP DNSP |
$614.51
|
|
|
PR CLOSED TX KNEE DISLOCATION W/O ANESTHESIA
|
Professional
|
Both
|
$845.00
|
|
|
Service Code
|
HCPCS 27550
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$661.03 |
| Rate for Payer: Aetna Commercial |
$615.13
|
| Rate for Payer: Aetna Medicare |
$459.05
|
| Rate for Payer: BCBS Complete |
$338.00
|
| Rate for Payer: BCBS MAPPO |
$459.05
|
| Rate for Payer: BCN Medicare Advantage |
$459.05
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Cofinity Commercial |
$661.03
|
| Rate for Payer: Cofinity Commercial |
$615.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$459.05
|
| Rate for Payer: Healthscope Commercial |
$550.86
|
| Rate for Payer: Healthscope Whirlpool |
$550.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$482.00
|
| Rate for Payer: Nomi Health Commercial |
$550.86
|
| Rate for Payer: PACE SWMI |
$459.05
|
| Rate for Payer: PHP Medicare Advantage |
$459.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$549.25
|
| Rate for Payer: Priority Health Medicare |
$459.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$459.05
|
| Rate for Payer: UHC Medicare Advantage |
$459.05
|
| Rate for Payer: UHCCP DNSP |
$459.05
|
|
|
PR CLOSED TX LUNATE DISLOCATION W/MANIPULATION
|
Professional
|
Both
|
$842.00
|
|
|
Service Code
|
HCPCS 25690
|
| Min. Negotiated Rate |
$336.80 |
| Max. Negotiated Rate |
$688.80 |
| Rate for Payer: Aetna Commercial |
$640.96
|
| Rate for Payer: Aetna Medicare |
$478.33
|
| Rate for Payer: BCBS Complete |
$336.80
|
| Rate for Payer: BCBS MAPPO |
$478.33
|
| Rate for Payer: BCN Medicare Advantage |
$478.33
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cofinity Commercial |
$688.80
|
| Rate for Payer: Cofinity Commercial |
$640.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$478.33
|
| Rate for Payer: Healthscope Commercial |
$574.00
|
| Rate for Payer: Healthscope Whirlpool |
$574.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$502.25
|
| Rate for Payer: Nomi Health Commercial |
$574.00
|
| Rate for Payer: PACE SWMI |
$478.33
|
| Rate for Payer: PHP Medicare Advantage |
$478.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$547.30
|
| Rate for Payer: Priority Health Medicare |
$478.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$478.33
|
| Rate for Payer: UHC Medicare Advantage |
$478.33
|
| Rate for Payer: UHCCP DNSP |
$478.33
|
|
|
PR CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$1,207.00
|
|
|
Service Code
|
HCPCS 21451
|
| Min. Negotiated Rate |
$482.80 |
| Max. Negotiated Rate |
$848.13 |
| Rate for Payer: Aetna Commercial |
$789.23
|
| Rate for Payer: Aetna Medicare |
$588.98
|
| Rate for Payer: BCBS Complete |
$482.80
|
| Rate for Payer: BCBS MAPPO |
$588.98
|
| Rate for Payer: BCN Medicare Advantage |
$588.98
|
| Rate for Payer: Cash Price |
$965.60
|
| Rate for Payer: Cash Price |
$965.60
|
| Rate for Payer: Cofinity Commercial |
$848.13
|
| Rate for Payer: Cofinity Commercial |
$789.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$588.98
|
| Rate for Payer: Healthscope Commercial |
$706.78
|
| Rate for Payer: Healthscope Whirlpool |
$706.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$618.43
|
| Rate for Payer: Nomi Health Commercial |
$706.78
|
| Rate for Payer: PACE SWMI |
$588.98
|
| Rate for Payer: PHP Medicare Advantage |
$588.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$784.55
|
| Rate for Payer: Priority Health Medicare |
$588.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$588.98
|
| Rate for Payer: UHC Medicare Advantage |
$588.98
|
| Rate for Payer: UHCCP DNSP |
$588.98
|
|
|
PR CLOSED TX MANDIBULAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 21450
|
| Min. Negotiated Rate |
$439.54 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Aetna Commercial |
$588.98
|
| Rate for Payer: Aetna Medicare |
$439.54
|
| Rate for Payer: BCBS Complete |
$468.00
|
| Rate for Payer: BCBS MAPPO |
$439.54
|
| Rate for Payer: BCN Medicare Advantage |
$439.54
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cofinity Commercial |
$632.94
|
| Rate for Payer: Cofinity Commercial |
$588.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$439.54
|
| Rate for Payer: Healthscope Commercial |
$527.45
|
| Rate for Payer: Healthscope Whirlpool |
$527.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$461.52
|
| Rate for Payer: Nomi Health Commercial |
$527.45
|
| Rate for Payer: PACE SWMI |
$439.54
|
| Rate for Payer: PHP Medicare Advantage |
$439.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$760.50
|
| Rate for Payer: Priority Health Medicare |
$439.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$439.54
|
| Rate for Payer: UHC Medicare Advantage |
$439.54
|
| Rate for Payer: UHCCP DNSP |
$439.54
|
|
|
PR CLOSED TX MANDIBULAR FX W/INTERDENTAL FIXATION
|
Professional
|
Both
|
$1,416.00
|
|
|
Service Code
|
HCPCS 21453
|
| Min. Negotiated Rate |
$566.40 |
| Max. Negotiated Rate |
$1,208.58 |
| Rate for Payer: Aetna Commercial |
$1,124.65
|
| Rate for Payer: Aetna Medicare |
$839.29
|
| Rate for Payer: BCBS Complete |
$566.40
|
| Rate for Payer: BCBS MAPPO |
$839.29
|
| Rate for Payer: BCN Medicare Advantage |
$839.29
|
| Rate for Payer: Cash Price |
$1,132.80
|
| Rate for Payer: Cash Price |
$1,132.80
|
| Rate for Payer: Cofinity Commercial |
$1,208.58
|
| Rate for Payer: Cofinity Commercial |
$1,124.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$839.29
|
| Rate for Payer: Healthscope Commercial |
$1,007.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,007.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$881.25
|
| Rate for Payer: Nomi Health Commercial |
$1,007.15
|
| Rate for Payer: PACE SWMI |
$839.29
|
| Rate for Payer: PHP Medicare Advantage |
$839.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$920.40
|
| Rate for Payer: Priority Health Medicare |
$839.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$839.29
|
| Rate for Payer: UHC Medicare Advantage |
$839.29
|
| Rate for Payer: UHCCP DNSP |
$839.29
|
|
|
PR CLOSED TX METATARSAL FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$539.00
|
|
|
Service Code
|
HCPCS 28470
|
| Min. Negotiated Rate |
$197.69 |
| Max. Negotiated Rate |
$350.35 |
| Rate for Payer: Aetna Commercial |
$264.90
|
| Rate for Payer: Aetna Medicare |
$197.69
|
| Rate for Payer: BCBS Complete |
$215.60
|
| Rate for Payer: BCBS MAPPO |
$197.69
|
| Rate for Payer: BCN Medicare Advantage |
$197.69
|
| Rate for Payer: Cash Price |
$431.20
|
| Rate for Payer: Cash Price |
$431.20
|
| Rate for Payer: Cofinity Commercial |
$284.67
|
| Rate for Payer: Cofinity Commercial |
$264.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.69
|
| Rate for Payer: Healthscope Commercial |
$237.23
|
| Rate for Payer: Healthscope Whirlpool |
$237.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$207.57
|
| Rate for Payer: Nomi Health Commercial |
$237.23
|
| Rate for Payer: PACE SWMI |
$197.69
|
| Rate for Payer: PHP Medicare Advantage |
$197.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.35
|
| Rate for Payer: Priority Health Medicare |
$197.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.69
|
| Rate for Payer: UHC Medicare Advantage |
$197.69
|
| Rate for Payer: UHCCP DNSP |
$197.69
|
|
|
PR CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ
|
Professional
|
Both
|
$1,640.00
|
|
|
Service Code
|
HCPCS 24620
|
| Min. Negotiated Rate |
$571.32 |
| Max. Negotiated Rate |
$1,066.00 |
| Rate for Payer: Aetna Commercial |
$765.57
|
| Rate for Payer: Aetna Medicare |
$571.32
|
| Rate for Payer: BCBS Complete |
$656.00
|
| Rate for Payer: BCBS MAPPO |
$571.32
|
| Rate for Payer: BCN Medicare Advantage |
$571.32
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Cofinity Commercial |
$822.70
|
| Rate for Payer: Cofinity Commercial |
$765.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$571.32
|
| Rate for Payer: Healthscope Commercial |
$685.58
|
| Rate for Payer: Healthscope Whirlpool |
$685.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$599.89
|
| Rate for Payer: Nomi Health Commercial |
$685.58
|
| Rate for Payer: PACE SWMI |
$571.32
|
| Rate for Payer: PHP Medicare Advantage |
$571.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,066.00
|
| Rate for Payer: Priority Health Medicare |
$571.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$571.32
|
| Rate for Payer: UHC Medicare Advantage |
$571.32
|
| Rate for Payer: UHCCP DNSP |
$571.32
|
|
|
PR CLOSED TX NASAL BONE FX W/MNPJ W/O STABILIZATION
|
Professional
|
Both
|
$451.00
|
|
|
Service Code
|
HCPCS 21315
|
| Min. Negotiated Rate |
$57.46 |
| Max. Negotiated Rate |
$293.15 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Aetna Medicare |
$57.46
|
| Rate for Payer: BCBS Complete |
$180.40
|
| Rate for Payer: BCBS MAPPO |
$57.46
|
| Rate for Payer: BCN Medicare Advantage |
$57.46
|
| Rate for Payer: Cash Price |
$360.80
|
| Rate for Payer: Cash Price |
$360.80
|
| Rate for Payer: Cofinity Commercial |
$82.74
|
| Rate for Payer: Cofinity Commercial |
$77.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.46
|
| Rate for Payer: Healthscope Commercial |
$68.95
|
| Rate for Payer: Healthscope Whirlpool |
$68.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.33
|
| Rate for Payer: Nomi Health Commercial |
$68.95
|
| Rate for Payer: PACE SWMI |
$57.46
|
| Rate for Payer: PHP Medicare Advantage |
$57.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.15
|
| Rate for Payer: Priority Health Medicare |
$57.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.46
|
| Rate for Payer: UHC Medicare Advantage |
$57.46
|
| Rate for Payer: UHCCP DNSP |
$57.46
|
|
|
PR CLOSED TX NASAL BONE FX W/MNPJ W/STABILIZATION
|
Professional
|
Both
|
$415.00
|
|
|
Service Code
|
HCPCS 21320
|
| Min. Negotiated Rate |
$90.80 |
| Max. Negotiated Rate |
$269.75 |
| Rate for Payer: Aetna Commercial |
$121.67
|
| Rate for Payer: Aetna Medicare |
$90.80
|
| Rate for Payer: BCBS Complete |
$166.00
|
| Rate for Payer: BCBS MAPPO |
$90.80
|
| Rate for Payer: BCN Medicare Advantage |
$90.80
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Cofinity Commercial |
$130.75
|
| Rate for Payer: Cofinity Commercial |
$121.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.80
|
| Rate for Payer: Healthscope Commercial |
$108.96
|
| Rate for Payer: Healthscope Whirlpool |
$108.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.34
|
| Rate for Payer: Nomi Health Commercial |
$108.96
|
| Rate for Payer: PACE SWMI |
$90.80
|
| Rate for Payer: PHP Medicare Advantage |
$90.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.75
|
| Rate for Payer: Priority Health Medicare |
$90.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.80
|
| Rate for Payer: UHC Medicare Advantage |
$90.80
|
| Rate for Payer: UHCCP DNSP |
$90.80
|
|
|
PR CLOSED TX NASAL SEPTAL FRACT W/WO STABILIZATION
|
Professional
|
Both
|
$658.00
|
|
|
Service Code
|
HCPCS 21337
|
| Min. Negotiated Rate |
$263.20 |
| Max. Negotiated Rate |
$427.70 |
| Rate for Payer: Aetna Commercial |
$383.44
|
| Rate for Payer: Aetna Medicare |
$286.15
|
| Rate for Payer: BCBS Complete |
$263.20
|
| Rate for Payer: BCBS MAPPO |
$286.15
|
| Rate for Payer: BCN Medicare Advantage |
$286.15
|
| Rate for Payer: Cash Price |
$526.40
|
| Rate for Payer: Cash Price |
$526.40
|
| Rate for Payer: Cofinity Commercial |
$412.06
|
| Rate for Payer: Cofinity Commercial |
$383.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$286.15
|
| Rate for Payer: Healthscope Commercial |
$343.38
|
| Rate for Payer: Healthscope Whirlpool |
$343.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$300.46
|
| Rate for Payer: Nomi Health Commercial |
$343.38
|
| Rate for Payer: PACE SWMI |
$286.15
|
| Rate for Payer: PHP Medicare Advantage |
$286.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.70
|
| Rate for Payer: Priority Health Medicare |
$286.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$286.15
|
| Rate for Payer: UHC Medicare Advantage |
$286.15
|
| Rate for Payer: UHCCP DNSP |
$286.15
|
|
|
PR CLOSED TX PALATAL/MAXILLARY FX W/FIXATION/SPLINT
|
Professional
|
Both
|
$1,328.00
|
|
|
Service Code
|
HCPCS 21421
|
| Min. Negotiated Rate |
$510.61 |
| Max. Negotiated Rate |
$863.20 |
| Rate for Payer: Aetna Commercial |
$684.22
|
| Rate for Payer: Aetna Medicare |
$510.61
|
| Rate for Payer: BCBS Complete |
$531.20
|
| Rate for Payer: BCBS MAPPO |
$510.61
|
| Rate for Payer: BCN Medicare Advantage |
$510.61
|
| Rate for Payer: Cash Price |
$1,062.40
|
| Rate for Payer: Cash Price |
$1,062.40
|
| Rate for Payer: Cofinity Commercial |
$735.28
|
| Rate for Payer: Cofinity Commercial |
$684.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$510.61
|
| Rate for Payer: Healthscope Commercial |
$612.73
|
| Rate for Payer: Healthscope Whirlpool |
$612.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$536.14
|
| Rate for Payer: Nomi Health Commercial |
$612.73
|
| Rate for Payer: PACE SWMI |
$510.61
|
| Rate for Payer: PHP Medicare Advantage |
$510.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$863.20
|
| Rate for Payer: Priority Health Medicare |
$510.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$510.61
|
| Rate for Payer: UHC Medicare Advantage |
$510.61
|
| Rate for Payer: UHCCP DNSP |
$510.61
|
|
|
PR CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA
|
Professional
|
Both
|
$614.00
|
|
|
Service Code
|
HCPCS 27560
|
| Min. Negotiated Rate |
$245.60 |
| Max. Negotiated Rate |
$481.00 |
| Rate for Payer: Aetna Commercial |
$447.60
|
| Rate for Payer: Aetna Medicare |
$334.03
|
| Rate for Payer: BCBS Complete |
$245.60
|
| Rate for Payer: BCBS MAPPO |
$334.03
|
| Rate for Payer: BCN Medicare Advantage |
$334.03
|
| Rate for Payer: Cash Price |
$491.20
|
| Rate for Payer: Cash Price |
$491.20
|
| Rate for Payer: Cofinity Commercial |
$481.00
|
| Rate for Payer: Cofinity Commercial |
$447.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$334.03
|
| Rate for Payer: Healthscope Commercial |
$400.84
|
| Rate for Payer: Healthscope Whirlpool |
$400.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$350.73
|
| Rate for Payer: Nomi Health Commercial |
$400.84
|
| Rate for Payer: PACE SWMI |
$334.03
|
| Rate for Payer: PHP Medicare Advantage |
$334.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.10
|
| Rate for Payer: Priority Health Medicare |
$334.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$334.03
|
| Rate for Payer: UHC Medicare Advantage |
$334.03
|
| Rate for Payer: UHCCP DNSP |
$334.03
|
|
|
PR CLOSED TX PATELLAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$651.00
|
|
|
Service Code
|
HCPCS 27520
|
| Min. Negotiated Rate |
$260.40 |
| Max. Negotiated Rate |
$424.31 |
| Rate for Payer: Aetna Commercial |
$394.84
|
| Rate for Payer: Aetna Medicare |
$294.66
|
| Rate for Payer: BCBS Complete |
$260.40
|
| Rate for Payer: BCBS MAPPO |
$294.66
|
| Rate for Payer: BCN Medicare Advantage |
$294.66
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cofinity Commercial |
$424.31
|
| Rate for Payer: Cofinity Commercial |
$394.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$294.66
|
| Rate for Payer: Healthscope Commercial |
$353.59
|
| Rate for Payer: Healthscope Whirlpool |
$353.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$309.39
|
| Rate for Payer: Nomi Health Commercial |
$353.59
|
| Rate for Payer: PACE SWMI |
$294.66
|
| Rate for Payer: PHP Medicare Advantage |
$294.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.15
|
| Rate for Payer: Priority Health Medicare |
$294.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$294.66
|
| Rate for Payer: UHC Medicare Advantage |
$294.66
|
| Rate for Payer: UHCCP DNSP |
$294.66
|
|
|
PR CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION
|
Professional
|
Both
|
$961.00
|
|
|
Service Code
|
HCPCS 24655
|
| Min. Negotiated Rate |
$384.40 |
| Max. Negotiated Rate |
$624.65 |
| Rate for Payer: Aetna Commercial |
$530.55
|
| Rate for Payer: Aetna Medicare |
$395.93
|
| Rate for Payer: BCBS Complete |
$384.40
|
| Rate for Payer: BCBS MAPPO |
$395.93
|
| Rate for Payer: BCN Medicare Advantage |
$395.93
|
| Rate for Payer: Cash Price |
$768.80
|
| Rate for Payer: Cash Price |
$768.80
|
| Rate for Payer: Cofinity Commercial |
$570.14
|
| Rate for Payer: Cofinity Commercial |
$530.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$395.93
|
| Rate for Payer: Healthscope Commercial |
$475.12
|
| Rate for Payer: Healthscope Whirlpool |
$475.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$415.73
|
| Rate for Payer: Nomi Health Commercial |
$475.12
|
| Rate for Payer: PACE SWMI |
$395.93
|
| Rate for Payer: PHP Medicare Advantage |
$395.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$624.65
|
| Rate for Payer: Priority Health Medicare |
$395.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$395.93
|
| Rate for Payer: UHC Medicare Advantage |
$395.93
|
| Rate for Payer: UHCCP DNSP |
$395.93
|
|
|
PR CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION
|
Professional
|
Both
|
$645.00
|
|
|
Service Code
|
HCPCS 24650
|
| Min. Negotiated Rate |
$242.63 |
| Max. Negotiated Rate |
$419.25 |
| Rate for Payer: Aetna Commercial |
$325.12
|
| Rate for Payer: Aetna Medicare |
$242.63
|
| Rate for Payer: BCBS Complete |
$258.00
|
| Rate for Payer: BCBS MAPPO |
$242.63
|
| Rate for Payer: BCN Medicare Advantage |
$242.63
|
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Cofinity Commercial |
$349.39
|
| Rate for Payer: Cofinity Commercial |
$325.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$242.63
|
| Rate for Payer: Healthscope Commercial |
$291.16
|
| Rate for Payer: Healthscope Whirlpool |
$291.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$254.76
|
| Rate for Payer: Nomi Health Commercial |
$291.16
|
| Rate for Payer: PACE SWMI |
$242.63
|
| Rate for Payer: PHP Medicare Advantage |
$242.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.25
|
| Rate for Payer: Priority Health Medicare |
$242.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$242.63
|
| Rate for Payer: UHC Medicare Advantage |
$242.63
|
| Rate for Payer: UHCCP DNSP |
$242.63
|
|
