|
PR CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$1,270.00
|
|
|
Service Code
|
HCPCS 25505
|
| Min. Negotiated Rate |
$450.02 |
| Max. Negotiated Rate |
$825.50 |
| Rate for Payer: Aetna Commercial |
$603.03
|
| Rate for Payer: Aetna Medicare |
$450.02
|
| Rate for Payer: BCBS Complete |
$508.00
|
| Rate for Payer: BCBS MAPPO |
$450.02
|
| Rate for Payer: BCN Medicare Advantage |
$450.02
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cofinity Commercial |
$648.03
|
| Rate for Payer: Cofinity Commercial |
$603.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$450.02
|
| Rate for Payer: Healthscope Commercial |
$540.02
|
| Rate for Payer: Healthscope Whirlpool |
$540.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$472.52
|
| Rate for Payer: Nomi Health Commercial |
$540.02
|
| Rate for Payer: PACE SWMI |
$450.02
|
| Rate for Payer: PHP Medicare Advantage |
$450.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$825.50
|
| Rate for Payer: Priority Health Medicare |
$450.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$450.02
|
| Rate for Payer: UHC Medicare Advantage |
$450.02
|
| Rate for Payer: UHCCP DNSP |
$450.02
|
|
|
PR CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$451.00
|
|
|
Service Code
|
HCPCS 25500
|
| Min. Negotiated Rate |
$180.40 |
| Max. Negotiated Rate |
$365.69 |
| Rate for Payer: Aetna Commercial |
$340.29
|
| Rate for Payer: Aetna Medicare |
$253.95
|
| Rate for Payer: BCBS Complete |
$180.40
|
| Rate for Payer: BCBS MAPPO |
$253.95
|
| Rate for Payer: BCN Medicare Advantage |
$253.95
|
| Rate for Payer: Cash Price |
$360.80
|
| Rate for Payer: Cash Price |
$360.80
|
| Rate for Payer: Cofinity Commercial |
$365.69
|
| Rate for Payer: Cofinity Commercial |
$340.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$253.95
|
| Rate for Payer: Healthscope Commercial |
$304.74
|
| Rate for Payer: Healthscope Whirlpool |
$304.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$266.65
|
| Rate for Payer: Nomi Health Commercial |
$304.74
|
| Rate for Payer: PACE SWMI |
$253.95
|
| Rate for Payer: PHP Medicare Advantage |
$253.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.15
|
| Rate for Payer: Priority Health Medicare |
$253.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$253.95
|
| Rate for Payer: UHC Medicare Advantage |
$253.95
|
| Rate for Payer: UHCCP DNSP |
$253.95
|
|
|
PR CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MNPJ
|
Professional
|
Both
|
$1,428.00
|
|
|
Service Code
|
HCPCS 25565
|
| Min. Negotiated Rate |
$453.45 |
| Max. Negotiated Rate |
$928.20 |
| Rate for Payer: Aetna Commercial |
$607.62
|
| Rate for Payer: Aetna Medicare |
$453.45
|
| Rate for Payer: BCBS Complete |
$571.20
|
| Rate for Payer: BCBS MAPPO |
$453.45
|
| Rate for Payer: BCN Medicare Advantage |
$453.45
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cofinity Commercial |
$652.97
|
| Rate for Payer: Cofinity Commercial |
$607.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$453.45
|
| Rate for Payer: Healthscope Commercial |
$544.14
|
| Rate for Payer: Healthscope Whirlpool |
$544.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$476.12
|
| Rate for Payer: Nomi Health Commercial |
$544.14
|
| Rate for Payer: PACE SWMI |
$453.45
|
| Rate for Payer: PHP Medicare Advantage |
$453.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.20
|
| Rate for Payer: Priority Health Medicare |
$453.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$453.45
|
| Rate for Payer: UHC Medicare Advantage |
$453.45
|
| Rate for Payer: UHCCP DNSP |
$453.45
|
|
|
PR CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MNPJ
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 25560
|
| Min. Negotiated Rate |
$255.18 |
| Max. Negotiated Rate |
$464.10 |
| Rate for Payer: Aetna Commercial |
$341.94
|
| Rate for Payer: Aetna Medicare |
$255.18
|
| Rate for Payer: BCBS Complete |
$285.60
|
| Rate for Payer: BCBS MAPPO |
$255.18
|
| Rate for Payer: BCN Medicare Advantage |
$255.18
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$367.46
|
| Rate for Payer: Cofinity Commercial |
$341.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$255.18
|
| Rate for Payer: Healthscope Commercial |
$306.22
|
| Rate for Payer: Healthscope Whirlpool |
$306.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$267.94
|
| Rate for Payer: Nomi Health Commercial |
$306.22
|
| Rate for Payer: PACE SWMI |
$255.18
|
| Rate for Payer: PHP Medicare Advantage |
$255.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health Medicare |
$255.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$255.18
|
| Rate for Payer: UHC Medicare Advantage |
$255.18
|
| Rate for Payer: UHCCP DNSP |
$255.18
|
|
|
PR CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$614.00
|
|
|
Service Code
|
HCPCS 23570
|
| Min. Negotiated Rate |
$239.03 |
| Max. Negotiated Rate |
$399.10 |
| Rate for Payer: Aetna Commercial |
$320.30
|
| Rate for Payer: Aetna Medicare |
$239.03
|
| Rate for Payer: BCBS Complete |
$245.60
|
| Rate for Payer: BCBS MAPPO |
$239.03
|
| Rate for Payer: BCN Medicare Advantage |
$239.03
|
| Rate for Payer: Cash Price |
$491.20
|
| Rate for Payer: Cash Price |
$491.20
|
| Rate for Payer: Cofinity Commercial |
$344.20
|
| Rate for Payer: Cofinity Commercial |
$320.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$239.03
|
| Rate for Payer: Healthscope Commercial |
$286.84
|
| Rate for Payer: Healthscope Whirlpool |
$286.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.98
|
| Rate for Payer: Nomi Health Commercial |
$286.84
|
| Rate for Payer: PACE SWMI |
$239.03
|
| Rate for Payer: PHP Medicare Advantage |
$239.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.10
|
| Rate for Payer: Priority Health Medicare |
$239.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$239.03
|
| Rate for Payer: UHC Medicare Advantage |
$239.03
|
| Rate for Payer: UHCCP DNSP |
$239.03
|
|
|
PR CLOSED TX STERNOCLAVICULAR DISLC W/MANIPULATION
|
Professional
|
Both
|
$783.00
|
|
|
Service Code
|
HCPCS 23525
|
| Min. Negotiated Rate |
$313.20 |
| Max. Negotiated Rate |
$512.48 |
| Rate for Payer: Aetna Commercial |
$476.89
|
| Rate for Payer: Aetna Medicare |
$355.89
|
| Rate for Payer: BCBS Complete |
$313.20
|
| Rate for Payer: BCBS MAPPO |
$355.89
|
| Rate for Payer: BCN Medicare Advantage |
$355.89
|
| Rate for Payer: Cash Price |
$626.40
|
| Rate for Payer: Cash Price |
$626.40
|
| Rate for Payer: Cofinity Commercial |
$512.48
|
| Rate for Payer: Cofinity Commercial |
$476.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$355.89
|
| Rate for Payer: Healthscope Commercial |
$427.07
|
| Rate for Payer: Healthscope Whirlpool |
$427.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$373.68
|
| Rate for Payer: Nomi Health Commercial |
$427.07
|
| Rate for Payer: PACE SWMI |
$355.89
|
| Rate for Payer: PHP Medicare Advantage |
$355.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$508.95
|
| Rate for Payer: Priority Health Medicare |
$355.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$355.89
|
| Rate for Payer: UHC Medicare Advantage |
$355.89
|
| Rate for Payer: UHCCP DNSP |
$355.89
|
|
|
PR CLOSED TX TALOTARSAL JOINT DISLC W/O ANES
|
Professional
|
Both
|
$358.00
|
|
|
Service Code
|
HCPCS 28570
|
| Min. Negotiated Rate |
$143.20 |
| Max. Negotiated Rate |
$277.99 |
| Rate for Payer: Aetna Commercial |
$258.69
|
| Rate for Payer: Aetna Medicare |
$193.05
|
| Rate for Payer: BCBS Complete |
$143.20
|
| Rate for Payer: BCBS MAPPO |
$193.05
|
| Rate for Payer: BCN Medicare Advantage |
$193.05
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Cofinity Commercial |
$277.99
|
| Rate for Payer: Cofinity Commercial |
$258.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.05
|
| Rate for Payer: Healthscope Commercial |
$231.66
|
| Rate for Payer: Healthscope Whirlpool |
$231.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$202.70
|
| Rate for Payer: Nomi Health Commercial |
$231.66
|
| Rate for Payer: PACE SWMI |
$193.05
|
| Rate for Payer: PHP Medicare Advantage |
$193.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.70
|
| Rate for Payer: Priority Health Medicare |
$193.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.05
|
| Rate for Payer: UHC Medicare Advantage |
$193.05
|
| Rate for Payer: UHCCP DNSP |
$193.05
|
|
|
PR CLOSED TX TALOTARSAL JOINT DISLOCATION W/ANES
|
Professional
|
Both
|
$808.00
|
|
|
Service Code
|
HCPCS 28575
|
| Min. Negotiated Rate |
$323.20 |
| Max. Negotiated Rate |
$525.20 |
| Rate for Payer: Aetna Commercial |
$442.84
|
| Rate for Payer: Aetna Medicare |
$330.48
|
| Rate for Payer: BCBS Complete |
$323.20
|
| Rate for Payer: BCBS MAPPO |
$330.48
|
| Rate for Payer: BCN Medicare Advantage |
$330.48
|
| Rate for Payer: Cash Price |
$646.40
|
| Rate for Payer: Cash Price |
$646.40
|
| Rate for Payer: Cofinity Commercial |
$475.89
|
| Rate for Payer: Cofinity Commercial |
$442.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$330.48
|
| Rate for Payer: Healthscope Commercial |
$396.58
|
| Rate for Payer: Healthscope Whirlpool |
$396.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$347.00
|
| Rate for Payer: Nomi Health Commercial |
$396.58
|
| Rate for Payer: PACE SWMI |
$330.48
|
| Rate for Payer: PHP Medicare Advantage |
$330.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.20
|
| Rate for Payer: Priority Health Medicare |
$330.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$330.48
|
| Rate for Payer: UHC Medicare Advantage |
$330.48
|
| Rate for Payer: UHCCP DNSP |
$330.48
|
|
|
PR CLOSED TX TALUS FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$808.00
|
|
|
Service Code
|
HCPCS 28435
|
| Min. Negotiated Rate |
$320.40 |
| Max. Negotiated Rate |
$525.20 |
| Rate for Payer: Aetna Commercial |
$429.34
|
| Rate for Payer: Aetna Medicare |
$320.40
|
| Rate for Payer: BCBS Complete |
$323.20
|
| Rate for Payer: BCBS MAPPO |
$320.40
|
| Rate for Payer: BCN Medicare Advantage |
$320.40
|
| Rate for Payer: Cash Price |
$646.40
|
| Rate for Payer: Cash Price |
$646.40
|
| Rate for Payer: Cofinity Commercial |
$461.38
|
| Rate for Payer: Cofinity Commercial |
$429.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$320.40
|
| Rate for Payer: Healthscope Commercial |
$384.48
|
| Rate for Payer: Healthscope Whirlpool |
$384.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$336.42
|
| Rate for Payer: Nomi Health Commercial |
$384.48
|
| Rate for Payer: PACE SWMI |
$320.40
|
| Rate for Payer: PHP Medicare Advantage |
$320.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.20
|
| Rate for Payer: Priority Health Medicare |
$320.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$320.40
|
| Rate for Payer: UHC Medicare Advantage |
$320.40
|
| Rate for Payer: UHCCP DNSP |
$320.40
|
|
|
PR CLOSED TX TALUS FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$673.00
|
|
|
Service Code
|
HCPCS 28430
|
| Min. Negotiated Rate |
$204.52 |
| Max. Negotiated Rate |
$437.45 |
| Rate for Payer: Aetna Commercial |
$274.06
|
| Rate for Payer: Aetna Medicare |
$204.52
|
| Rate for Payer: BCBS Complete |
$269.20
|
| Rate for Payer: BCBS MAPPO |
$204.52
|
| Rate for Payer: BCN Medicare Advantage |
$204.52
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Cofinity Commercial |
$294.51
|
| Rate for Payer: Cofinity Commercial |
$274.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.52
|
| Rate for Payer: Healthscope Commercial |
$245.42
|
| Rate for Payer: Healthscope Whirlpool |
$245.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$214.75
|
| Rate for Payer: Nomi Health Commercial |
$245.42
|
| Rate for Payer: PACE SWMI |
$204.52
|
| Rate for Payer: PHP Medicare Advantage |
$204.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.45
|
| Rate for Payer: Priority Health Medicare |
$204.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$204.52
|
| Rate for Payer: UHC Medicare Advantage |
$204.52
|
| Rate for Payer: UHCCP DNSP |
$204.52
|
|
|
PR CLOSED TX TARSOMETATARSAL DISLOCATION W/ANES
|
Professional
|
Both
|
$808.00
|
|
|
Service Code
|
HCPCS 28605
|
| Min. Negotiated Rate |
$297.47 |
| Max. Negotiated Rate |
$525.20 |
| Rate for Payer: Aetna Commercial |
$398.61
|
| Rate for Payer: Aetna Medicare |
$297.47
|
| Rate for Payer: BCBS Complete |
$323.20
|
| Rate for Payer: BCBS MAPPO |
$297.47
|
| Rate for Payer: BCN Medicare Advantage |
$297.47
|
| Rate for Payer: Cash Price |
$646.40
|
| Rate for Payer: Cash Price |
$646.40
|
| Rate for Payer: Cofinity Commercial |
$428.36
|
| Rate for Payer: Cofinity Commercial |
$398.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$297.47
|
| Rate for Payer: Healthscope Commercial |
$356.96
|
| Rate for Payer: Healthscope Whirlpool |
$356.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$312.34
|
| Rate for Payer: Nomi Health Commercial |
$356.96
|
| Rate for Payer: PACE SWMI |
$297.47
|
| Rate for Payer: PHP Medicare Advantage |
$297.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.20
|
| Rate for Payer: Priority Health Medicare |
$297.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$297.47
|
| Rate for Payer: UHC Medicare Advantage |
$297.47
|
| Rate for Payer: UHCCP DNSP |
$297.47
|
|
|
PR CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES
|
Professional
|
Both
|
$377.00
|
|
|
Service Code
|
HCPCS 28600
|
| Min. Negotiated Rate |
$150.80 |
| Max. Negotiated Rate |
$259.47 |
| Rate for Payer: Aetna Commercial |
$241.45
|
| Rate for Payer: Aetna Medicare |
$180.19
|
| Rate for Payer: BCBS Complete |
$150.80
|
| Rate for Payer: BCBS MAPPO |
$180.19
|
| Rate for Payer: BCN Medicare Advantage |
$180.19
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cofinity Commercial |
$259.47
|
| Rate for Payer: Cofinity Commercial |
$241.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.19
|
| Rate for Payer: Healthscope Commercial |
$216.23
|
| Rate for Payer: Healthscope Whirlpool |
$216.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$189.20
|
| Rate for Payer: Nomi Health Commercial |
$216.23
|
| Rate for Payer: PACE SWMI |
$180.19
|
| Rate for Payer: PHP Medicare Advantage |
$180.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.05
|
| Rate for Payer: Priority Health Medicare |
$180.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$180.19
|
| Rate for Payer: UHC Medicare Advantage |
$180.19
|
| Rate for Payer: UHCCP DNSP |
$180.19
|
|
|
PR CLOSED TX TEMPOROMANDIBULAR DISLC COMP 1ST/SBSQ
|
Professional
|
Both
|
$1,088.00
|
|
|
Service Code
|
HCPCS 21485
|
| Min. Negotiated Rate |
$435.20 |
| Max. Negotiated Rate |
$1,007.78 |
| Rate for Payer: Aetna Commercial |
$937.80
|
| Rate for Payer: Aetna Medicare |
$699.85
|
| Rate for Payer: BCBS Complete |
$435.20
|
| Rate for Payer: BCBS MAPPO |
$699.85
|
| Rate for Payer: BCN Medicare Advantage |
$699.85
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Cofinity Commercial |
$937.80
|
| Rate for Payer: Cofinity Commercial |
$1,007.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$699.85
|
| Rate for Payer: Healthscope Commercial |
$839.82
|
| Rate for Payer: Healthscope Whirlpool |
$839.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$734.84
|
| Rate for Payer: Nomi Health Commercial |
$839.82
|
| Rate for Payer: PACE SWMI |
$699.85
|
| Rate for Payer: PHP Medicare Advantage |
$699.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.20
|
| Rate for Payer: Priority Health Medicare |
$699.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$699.85
|
| Rate for Payer: UHC Medicare Advantage |
$699.85
|
| Rate for Payer: UHCCP DNSP |
$699.85
|
|
|
PR CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 21480
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$92.30 |
| Rate for Payer: Aetna Commercial |
$41.34
|
| Rate for Payer: Aetna Medicare |
$30.85
|
| Rate for Payer: BCBS Complete |
$56.80
|
| Rate for Payer: BCBS MAPPO |
$30.85
|
| Rate for Payer: BCN Medicare Advantage |
$30.85
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cofinity Commercial |
$44.42
|
| Rate for Payer: Cofinity Commercial |
$41.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.85
|
| Rate for Payer: Healthscope Commercial |
$37.02
|
| Rate for Payer: Healthscope Whirlpool |
$37.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.39
|
| Rate for Payer: Nomi Health Commercial |
$37.02
|
| Rate for Payer: PACE SWMI |
$30.85
|
| Rate for Payer: PHP Medicare Advantage |
$30.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.30
|
| Rate for Payer: Priority Health Medicare |
$30.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.85
|
| Rate for Payer: UHC Medicare Advantage |
$30.85
|
| Rate for Payer: UHCCP DNSP |
$30.85
|
|
|
PR CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ
|
Professional
|
Both
|
$1,255.00
|
|
|
Service Code
|
HCPCS 24675
|
| Min. Negotiated Rate |
$406.99 |
| Max. Negotiated Rate |
$815.75 |
| Rate for Payer: Aetna Commercial |
$545.37
|
| Rate for Payer: Aetna Medicare |
$406.99
|
| Rate for Payer: BCBS Complete |
$502.00
|
| Rate for Payer: BCBS MAPPO |
$406.99
|
| Rate for Payer: BCN Medicare Advantage |
$406.99
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Cofinity Commercial |
$586.07
|
| Rate for Payer: Cofinity Commercial |
$545.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$406.99
|
| Rate for Payer: Healthscope Commercial |
$488.39
|
| Rate for Payer: Healthscope Whirlpool |
$488.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$427.34
|
| Rate for Payer: Nomi Health Commercial |
$488.39
|
| Rate for Payer: PACE SWMI |
$406.99
|
| Rate for Payer: PHP Medicare Advantage |
$406.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$815.75
|
| Rate for Payer: Priority Health Medicare |
$406.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$406.99
|
| Rate for Payer: UHC Medicare Advantage |
$406.99
|
| Rate for Payer: UHCCP DNSP |
$406.99
|
|
|
PR CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ
|
Professional
|
Both
|
$797.00
|
|
|
Service Code
|
HCPCS 24670
|
| Min. Negotiated Rate |
$262.71 |
| Max. Negotiated Rate |
$518.05 |
| Rate for Payer: Aetna Commercial |
$352.03
|
| Rate for Payer: Aetna Medicare |
$262.71
|
| Rate for Payer: BCBS Complete |
$318.80
|
| Rate for Payer: BCBS MAPPO |
$262.71
|
| Rate for Payer: BCN Medicare Advantage |
$262.71
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Cofinity Commercial |
$378.30
|
| Rate for Payer: Cofinity Commercial |
$352.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$262.71
|
| Rate for Payer: Healthscope Commercial |
$315.25
|
| Rate for Payer: Healthscope Whirlpool |
$315.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$275.85
|
| Rate for Payer: Nomi Health Commercial |
$315.25
|
| Rate for Payer: PACE SWMI |
$262.71
|
| Rate for Payer: PHP Medicare Advantage |
$262.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$518.05
|
| Rate for Payer: Priority Health Medicare |
$262.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$262.71
|
| Rate for Payer: UHC Medicare Advantage |
$262.71
|
| Rate for Payer: UHCCP DNSP |
$262.71
|
|
|
PR CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$1,190.00
|
|
|
Service Code
|
HCPCS 25535
|
| Min. Negotiated Rate |
$445.34 |
| Max. Negotiated Rate |
$773.50 |
| Rate for Payer: Aetna Commercial |
$596.76
|
| Rate for Payer: Aetna Medicare |
$445.34
|
| Rate for Payer: BCBS Complete |
$476.00
|
| Rate for Payer: BCBS MAPPO |
$445.34
|
| Rate for Payer: BCN Medicare Advantage |
$445.34
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Cofinity Commercial |
$641.29
|
| Rate for Payer: Cofinity Commercial |
$596.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$445.34
|
| Rate for Payer: Healthscope Commercial |
$534.41
|
| Rate for Payer: Healthscope Whirlpool |
$534.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$467.61
|
| Rate for Payer: Nomi Health Commercial |
$534.41
|
| Rate for Payer: PACE SWMI |
$445.34
|
| Rate for Payer: PHP Medicare Advantage |
$445.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$773.50
|
| Rate for Payer: Priority Health Medicare |
$445.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$445.34
|
| Rate for Payer: UHC Medicare Advantage |
$445.34
|
| Rate for Payer: UHCCP DNSP |
$445.34
|
|
|
PR CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$655.00
|
|
|
Service Code
|
HCPCS 25530
|
| Min. Negotiated Rate |
$239.44 |
| Max. Negotiated Rate |
$425.75 |
| Rate for Payer: Aetna Commercial |
$320.85
|
| Rate for Payer: Aetna Medicare |
$239.44
|
| Rate for Payer: BCBS Complete |
$262.00
|
| Rate for Payer: BCBS MAPPO |
$239.44
|
| Rate for Payer: BCN Medicare Advantage |
$239.44
|
| Rate for Payer: Cash Price |
$524.00
|
| Rate for Payer: Cash Price |
$524.00
|
| Rate for Payer: Cofinity Commercial |
$344.79
|
| Rate for Payer: Cofinity Commercial |
$320.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$239.44
|
| Rate for Payer: Healthscope Commercial |
$287.33
|
| Rate for Payer: Healthscope Whirlpool |
$287.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$251.41
|
| Rate for Payer: Nomi Health Commercial |
$287.33
|
| Rate for Payer: PACE SWMI |
$239.44
|
| Rate for Payer: PHP Medicare Advantage |
$239.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.75
|
| Rate for Payer: Priority Health Medicare |
$239.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$239.44
|
| Rate for Payer: UHC Medicare Advantage |
$239.44
|
| Rate for Payer: UHCCP DNSP |
$239.44
|
|
|
PR CLOSE MEDIAN STERNOTOMY SEP W/WO DEBRIDEMENT SPX
|
Professional
|
Both
|
$2,094.00
|
|
|
Service Code
|
HCPCS 21750
|
| Min. Negotiated Rate |
$653.72 |
| Max. Negotiated Rate |
$1,361.10 |
| Rate for Payer: Aetna Commercial |
$875.98
|
| Rate for Payer: Aetna Medicare |
$653.72
|
| Rate for Payer: BCBS Complete |
$837.60
|
| Rate for Payer: BCBS MAPPO |
$653.72
|
| Rate for Payer: BCN Medicare Advantage |
$653.72
|
| Rate for Payer: Cash Price |
$1,675.20
|
| Rate for Payer: Cash Price |
$1,675.20
|
| Rate for Payer: Cofinity Commercial |
$941.36
|
| Rate for Payer: Cofinity Commercial |
$875.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$653.72
|
| Rate for Payer: Healthscope Commercial |
$784.46
|
| Rate for Payer: Healthscope Whirlpool |
$784.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$686.41
|
| Rate for Payer: Nomi Health Commercial |
$784.46
|
| Rate for Payer: PACE SWMI |
$653.72
|
| Rate for Payer: PHP Medicare Advantage |
$653.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,361.10
|
| Rate for Payer: Priority Health Medicare |
$653.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$653.72
|
| Rate for Payer: UHC Medicare Advantage |
$653.72
|
| Rate for Payer: UHCCP DNSP |
$653.72
|
|
|
PR CLOSURE CYSTOSTOMY SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,420.00
|
|
|
Service Code
|
HCPCS 51880
|
| Min. Negotiated Rate |
$444.82 |
| Max. Negotiated Rate |
$923.00 |
| Rate for Payer: Aetna Commercial |
$596.06
|
| Rate for Payer: Aetna Medicare |
$444.82
|
| Rate for Payer: BCBS Complete |
$568.00
|
| Rate for Payer: BCBS MAPPO |
$444.82
|
| Rate for Payer: BCN Medicare Advantage |
$444.82
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cofinity Commercial |
$640.54
|
| Rate for Payer: Cofinity Commercial |
$596.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$444.82
|
| Rate for Payer: Healthscope Commercial |
$533.78
|
| Rate for Payer: Healthscope Whirlpool |
$533.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$467.06
|
| Rate for Payer: Nomi Health Commercial |
$533.78
|
| Rate for Payer: PACE SWMI |
$444.82
|
| Rate for Payer: PHP Medicare Advantage |
$444.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.00
|
| Rate for Payer: Priority Health Medicare |
$444.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$444.82
|
| Rate for Payer: UHC Medicare Advantage |
$444.82
|
| Rate for Payer: UHCCP DNSP |
$444.82
|
|
|
PR CLOSURE ENTEROSTOMY LG/SMALL INTESTINE
|
Professional
|
Both
|
$2,261.00
|
|
|
Service Code
|
HCPCS 44620
|
| Min. Negotiated Rate |
$832.71 |
| Max. Negotiated Rate |
$1,469.65 |
| Rate for Payer: Aetna Commercial |
$1,115.83
|
| Rate for Payer: Aetna Medicare |
$832.71
|
| Rate for Payer: BCBS Complete |
$904.40
|
| Rate for Payer: BCBS MAPPO |
$832.71
|
| Rate for Payer: BCN Medicare Advantage |
$832.71
|
| Rate for Payer: Cash Price |
$1,808.80
|
| Rate for Payer: Cash Price |
$1,808.80
|
| Rate for Payer: Cofinity Commercial |
$1,199.10
|
| Rate for Payer: Cofinity Commercial |
$1,115.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$832.71
|
| Rate for Payer: Healthscope Commercial |
$999.25
|
| Rate for Payer: Healthscope Whirlpool |
$999.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$874.35
|
| Rate for Payer: Nomi Health Commercial |
$999.25
|
| Rate for Payer: PACE SWMI |
$832.71
|
| Rate for Payer: PHP Medicare Advantage |
$832.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,469.65
|
| Rate for Payer: Priority Health Medicare |
$832.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$832.71
|
| Rate for Payer: UHC Medicare Advantage |
$832.71
|
| Rate for Payer: UHCCP DNSP |
$832.71
|
|
|
PR CLOSURE GASTROCOLIC FISTULA
|
Professional
|
Both
|
$3,893.00
|
|
|
Service Code
|
HCPCS 43880
|
| Min. Negotiated Rate |
$1,557.20 |
| Max. Negotiated Rate |
$2,530.45 |
| Rate for Payer: Aetna Commercial |
$2,095.77
|
| Rate for Payer: Aetna Medicare |
$1,564.01
|
| Rate for Payer: BCBS Complete |
$1,557.20
|
| Rate for Payer: BCBS MAPPO |
$1,564.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,564.01
|
| Rate for Payer: Cash Price |
$3,114.40
|
| Rate for Payer: Cash Price |
$3,114.40
|
| Rate for Payer: Cofinity Commercial |
$2,252.17
|
| Rate for Payer: Cofinity Commercial |
$2,095.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,564.01
|
| Rate for Payer: Healthscope Commercial |
$1,876.81
|
| Rate for Payer: Healthscope Whirlpool |
$1,876.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,642.21
|
| Rate for Payer: Nomi Health Commercial |
$1,876.81
|
| Rate for Payer: PACE SWMI |
$1,564.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,564.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,530.45
|
| Rate for Payer: Priority Health Medicare |
$1,564.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,564.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,564.01
|
| Rate for Payer: UHCCP DNSP |
$1,564.01
|
|
|
PR CLOSURE GASTROSTOMY SURG
|
Professional
|
Both
|
$1,955.00
|
|
|
Service Code
|
HCPCS 43870
|
| Min. Negotiated Rate |
$687.43 |
| Max. Negotiated Rate |
$1,270.75 |
| Rate for Payer: Aetna Commercial |
$921.16
|
| Rate for Payer: Aetna Medicare |
$687.43
|
| Rate for Payer: BCBS Complete |
$782.00
|
| Rate for Payer: BCBS MAPPO |
$687.43
|
| Rate for Payer: BCN Medicare Advantage |
$687.43
|
| Rate for Payer: Cash Price |
$1,564.00
|
| Rate for Payer: Cash Price |
$1,564.00
|
| Rate for Payer: Cofinity Commercial |
$989.90
|
| Rate for Payer: Cofinity Commercial |
$921.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$687.43
|
| Rate for Payer: Healthscope Commercial |
$824.92
|
| Rate for Payer: Healthscope Whirlpool |
$824.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$721.80
|
| Rate for Payer: Nomi Health Commercial |
$824.92
|
| Rate for Payer: PACE SWMI |
$687.43
|
| Rate for Payer: PHP Medicare Advantage |
$687.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,270.75
|
| Rate for Payer: Priority Health Medicare |
$687.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$687.43
|
| Rate for Payer: UHC Medicare Advantage |
$687.43
|
| Rate for Payer: UHCCP DNSP |
$687.43
|
|
|
PR CLOSURE INTESTINAL CUTANEOUS FISTULA
|
Professional
|
Both
|
$2,546.00
|
|
|
Service Code
|
HCPCS 44640
|
| Min. Negotiated Rate |
$1,018.40 |
| Max. Negotiated Rate |
$1,940.73 |
| Rate for Payer: Aetna Commercial |
$1,805.96
|
| Rate for Payer: Aetna Medicare |
$1,347.73
|
| Rate for Payer: BCBS Complete |
$1,018.40
|
| Rate for Payer: BCBS MAPPO |
$1,347.73
|
| Rate for Payer: BCN Medicare Advantage |
$1,347.73
|
| Rate for Payer: Cash Price |
$2,036.80
|
| Rate for Payer: Cash Price |
$2,036.80
|
| Rate for Payer: Cofinity Commercial |
$1,940.73
|
| Rate for Payer: Cofinity Commercial |
$1,805.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,347.73
|
| Rate for Payer: Healthscope Commercial |
$1,617.28
|
| Rate for Payer: Healthscope Whirlpool |
$1,617.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,415.12
|
| Rate for Payer: Nomi Health Commercial |
$1,617.28
|
| Rate for Payer: PACE SWMI |
$1,347.73
|
| Rate for Payer: PHP Medicare Advantage |
$1,347.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,654.90
|
| Rate for Payer: Priority Health Medicare |
$1,347.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,347.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,347.73
|
| Rate for Payer: UHCCP DNSP |
$1,347.73
|
|
|
PR CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/<
|
Professional
|
Both
|
$537.00
|
|
|
Service Code
|
HCPCS 40830
|
| Min. Negotiated Rate |
$138.15 |
| Max. Negotiated Rate |
$349.05 |
| Rate for Payer: Aetna Commercial |
$185.12
|
| Rate for Payer: Aetna Medicare |
$138.15
|
| Rate for Payer: BCBS Complete |
$214.80
|
| Rate for Payer: BCBS MAPPO |
$138.15
|
| Rate for Payer: BCN Medicare Advantage |
$138.15
|
| Rate for Payer: Cash Price |
$429.60
|
| Rate for Payer: Cash Price |
$429.60
|
| Rate for Payer: Cofinity Commercial |
$198.94
|
| Rate for Payer: Cofinity Commercial |
$185.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.15
|
| Rate for Payer: Healthscope Commercial |
$165.78
|
| Rate for Payer: Healthscope Whirlpool |
$165.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.06
|
| Rate for Payer: Nomi Health Commercial |
$165.78
|
| Rate for Payer: PACE SWMI |
$138.15
|
| Rate for Payer: PHP Medicare Advantage |
$138.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.05
|
| Rate for Payer: Priority Health Medicare |
$138.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.15
|
| Rate for Payer: UHC Medicare Advantage |
$138.15
|
| Rate for Payer: UHCCP DNSP |
$138.15
|
|
