|
PR CLTX IPHAL JT DISLC W/MANJ W/O ANES
|
Professional
|
Both
|
$558.00
|
|
|
Service Code
|
HCPCS 26770
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$375.49 |
| Rate for Payer: Aetna Commercial |
$349.42
|
| Rate for Payer: Aetna Medicare |
$260.76
|
| Rate for Payer: BCBS Complete |
$223.20
|
| Rate for Payer: BCBS MAPPO |
$260.76
|
| Rate for Payer: BCN Medicare Advantage |
$260.76
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cofinity Commercial |
$375.49
|
| Rate for Payer: Cofinity Commercial |
$349.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.76
|
| Rate for Payer: Healthscope Commercial |
$312.91
|
| Rate for Payer: Healthscope Whirlpool |
$312.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.80
|
| Rate for Payer: Nomi Health Commercial |
$312.91
|
| Rate for Payer: PACE SWMI |
$260.76
|
| Rate for Payer: PHP Medicare Advantage |
$260.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$362.70
|
| Rate for Payer: Priority Health Medicare |
$260.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$260.76
|
| Rate for Payer: UHC Medicare Advantage |
$260.76
|
| Rate for Payer: UHCCP DNSP |
$260.76
|
|
|
PR CLTX MANDIBULAR/MAXILLARY ALVEOLAR RIDGE FX SPX
|
Professional
|
Both
|
$1,195.00
|
|
|
Service Code
|
HCPCS 21440
|
| Min. Negotiated Rate |
$478.00 |
| Max. Negotiated Rate |
$781.19 |
| Rate for Payer: Aetna Commercial |
$726.94
|
| Rate for Payer: Aetna Medicare |
$542.49
|
| Rate for Payer: BCBS Complete |
$478.00
|
| Rate for Payer: BCBS MAPPO |
$542.49
|
| Rate for Payer: BCN Medicare Advantage |
$542.49
|
| Rate for Payer: Cash Price |
$956.00
|
| Rate for Payer: Cash Price |
$956.00
|
| Rate for Payer: Cofinity Commercial |
$781.19
|
| Rate for Payer: Cofinity Commercial |
$726.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$542.49
|
| Rate for Payer: Healthscope Commercial |
$650.99
|
| Rate for Payer: Healthscope Whirlpool |
$650.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$569.61
|
| Rate for Payer: Nomi Health Commercial |
$650.99
|
| Rate for Payer: PACE SWMI |
$542.49
|
| Rate for Payer: PHP Medicare Advantage |
$542.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$776.75
|
| Rate for Payer: Priority Health Medicare |
$542.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$542.49
|
| Rate for Payer: UHC Medicare Advantage |
$542.49
|
| Rate for Payer: UHCCP DNSP |
$542.49
|
|
|
PR CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION
|
Professional
|
Both
|
$872.00
|
|
|
Service Code
|
HCPCS 27760
|
| Min. Negotiated Rate |
$301.17 |
| Max. Negotiated Rate |
$566.80 |
| Rate for Payer: Aetna Commercial |
$403.57
|
| Rate for Payer: Aetna Medicare |
$301.17
|
| Rate for Payer: BCBS Complete |
$348.80
|
| Rate for Payer: BCBS MAPPO |
$301.17
|
| Rate for Payer: BCN Medicare Advantage |
$301.17
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cofinity Commercial |
$433.68
|
| Rate for Payer: Cofinity Commercial |
$403.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$301.17
|
| Rate for Payer: Healthscope Commercial |
$361.40
|
| Rate for Payer: Healthscope Whirlpool |
$361.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$316.23
|
| Rate for Payer: Nomi Health Commercial |
$361.40
|
| Rate for Payer: PACE SWMI |
$301.17
|
| Rate for Payer: PHP Medicare Advantage |
$301.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.80
|
| Rate for Payer: Priority Health Medicare |
$301.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$301.17
|
| Rate for Payer: UHC Medicare Advantage |
$301.17
|
| Rate for Payer: UHCCP DNSP |
$301.17
|
|
|
PR CLTX METACARPAL FX W/MANIPULATION EACH BONE
|
Professional
|
Both
|
$715.00
|
|
|
Service Code
|
HCPCS 26605
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$464.75 |
| Rate for Payer: Aetna Commercial |
$390.07
|
| Rate for Payer: Aetna Medicare |
$291.10
|
| Rate for Payer: BCBS Complete |
$286.00
|
| Rate for Payer: BCBS MAPPO |
$291.10
|
| Rate for Payer: BCN Medicare Advantage |
$291.10
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cofinity Commercial |
$419.18
|
| Rate for Payer: Cofinity Commercial |
$390.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$291.10
|
| Rate for Payer: Healthscope Commercial |
$349.32
|
| Rate for Payer: Healthscope Whirlpool |
$349.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$305.65
|
| Rate for Payer: Nomi Health Commercial |
$349.32
|
| Rate for Payer: PACE SWMI |
$291.10
|
| Rate for Payer: PHP Medicare Advantage |
$291.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.75
|
| Rate for Payer: Priority Health Medicare |
$291.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$291.10
|
| Rate for Payer: UHC Medicare Advantage |
$291.10
|
| Rate for Payer: UHCCP DNSP |
$291.10
|
|
|
PR CLTX METACARPAL FX W/MANJ W/XTRNL FIXJ EA BONE
|
Professional
|
Both
|
$1,540.00
|
|
|
Service Code
|
HCPCS 26607
|
| Min. Negotiated Rate |
$484.75 |
| Max. Negotiated Rate |
$1,001.00 |
| Rate for Payer: Aetna Commercial |
$649.57
|
| Rate for Payer: Aetna Medicare |
$484.75
|
| Rate for Payer: BCBS Complete |
$616.00
|
| Rate for Payer: BCBS MAPPO |
$484.75
|
| Rate for Payer: BCN Medicare Advantage |
$484.75
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cofinity Commercial |
$698.04
|
| Rate for Payer: Cofinity Commercial |
$649.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$484.75
|
| Rate for Payer: Healthscope Commercial |
$581.70
|
| Rate for Payer: Healthscope Whirlpool |
$581.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$508.99
|
| Rate for Payer: Nomi Health Commercial |
$581.70
|
| Rate for Payer: PACE SWMI |
$484.75
|
| Rate for Payer: PHP Medicare Advantage |
$484.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,001.00
|
| Rate for Payer: Priority Health Medicare |
$484.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$484.75
|
| Rate for Payer: UHC Medicare Advantage |
$484.75
|
| Rate for Payer: UHCCP DNSP |
$484.75
|
|
|
PR CLTX METACARPAL FX W/O MANIPULATION EACH BONE
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 26600
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$405.14 |
| Rate for Payer: Aetna Commercial |
$377.01
|
| Rate for Payer: Aetna Medicare |
$281.35
|
| Rate for Payer: BCBS Complete |
$220.00
|
| Rate for Payer: BCBS MAPPO |
$281.35
|
| Rate for Payer: BCN Medicare Advantage |
$281.35
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cofinity Commercial |
$405.14
|
| Rate for Payer: Cofinity Commercial |
$377.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$281.35
|
| Rate for Payer: Healthscope Commercial |
$337.62
|
| Rate for Payer: Healthscope Whirlpool |
$337.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$295.42
|
| Rate for Payer: Nomi Health Commercial |
$337.62
|
| Rate for Payer: PACE SWMI |
$281.35
|
| Rate for Payer: PHP Medicare Advantage |
$281.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.50
|
| Rate for Payer: Priority Health Medicare |
$281.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$281.35
|
| Rate for Payer: UHC Medicare Advantage |
$281.35
|
| Rate for Payer: UHCCP DNSP |
$281.35
|
|
|
PR CLTX METACARPOPHALANGEAL DISLC W/MANJ W/ANES
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 26705
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$558.04 |
| Rate for Payer: Aetna Commercial |
$519.29
|
| Rate for Payer: Aetna Medicare |
$387.53
|
| Rate for Payer: BCBS Complete |
$330.00
|
| Rate for Payer: BCBS MAPPO |
$387.53
|
| Rate for Payer: BCN Medicare Advantage |
$387.53
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cofinity Commercial |
$558.04
|
| Rate for Payer: Cofinity Commercial |
$519.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$387.53
|
| Rate for Payer: Healthscope Commercial |
$465.04
|
| Rate for Payer: Healthscope Whirlpool |
$465.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$406.91
|
| Rate for Payer: Nomi Health Commercial |
$465.04
|
| Rate for Payer: PACE SWMI |
$387.53
|
| Rate for Payer: PHP Medicare Advantage |
$387.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.25
|
| Rate for Payer: Priority Health Medicare |
$387.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$387.53
|
| Rate for Payer: UHC Medicare Advantage |
$387.53
|
| Rate for Payer: UHCCP DNSP |
$387.53
|
|
|
PR CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 26700
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$446.10 |
| Rate for Payer: Aetna Commercial |
$415.12
|
| Rate for Payer: Aetna Medicare |
$309.79
|
| Rate for Payer: BCBS Complete |
$220.00
|
| Rate for Payer: BCBS MAPPO |
$309.79
|
| Rate for Payer: BCN Medicare Advantage |
$309.79
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cofinity Commercial |
$446.10
|
| Rate for Payer: Cofinity Commercial |
$415.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$309.79
|
| Rate for Payer: Healthscope Commercial |
$371.75
|
| Rate for Payer: Healthscope Whirlpool |
$371.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$325.28
|
| Rate for Payer: Nomi Health Commercial |
$371.75
|
| Rate for Payer: PACE SWMI |
$309.79
|
| Rate for Payer: PHP Medicare Advantage |
$309.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.50
|
| Rate for Payer: Priority Health Medicare |
$309.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$309.79
|
| Rate for Payer: UHC Medicare Advantage |
$309.79
|
| Rate for Payer: UHCCP DNSP |
$309.79
|
|
|
PR CLTX METAR FX W/MANJ
|
Professional
|
Both
|
$741.00
|
|
|
Service Code
|
HCPCS 28475
|
| Min. Negotiated Rate |
$222.28 |
| Max. Negotiated Rate |
$481.65 |
| Rate for Payer: Aetna Commercial |
$297.86
|
| Rate for Payer: Aetna Medicare |
$222.28
|
| Rate for Payer: BCBS Complete |
$296.40
|
| Rate for Payer: BCBS MAPPO |
$222.28
|
| Rate for Payer: BCN Medicare Advantage |
$222.28
|
| Rate for Payer: Cash Price |
$592.80
|
| Rate for Payer: Cash Price |
$592.80
|
| Rate for Payer: Cofinity Commercial |
$320.08
|
| Rate for Payer: Cofinity Commercial |
$297.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.28
|
| Rate for Payer: Healthscope Commercial |
$266.74
|
| Rate for Payer: Healthscope Whirlpool |
$266.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$233.39
|
| Rate for Payer: Nomi Health Commercial |
$266.74
|
| Rate for Payer: PACE SWMI |
$222.28
|
| Rate for Payer: PHP Medicare Advantage |
$222.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$481.65
|
| Rate for Payer: Priority Health Medicare |
$222.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$222.28
|
| Rate for Payer: UHC Medicare Advantage |
$222.28
|
| Rate for Payer: UHCCP DNSP |
$222.28
|
|
|
PR CLTX METATARSOPHLNGL JT DISLC REQ ANES
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 28635
|
| Min. Negotiated Rate |
$125.29 |
| Max. Negotiated Rate |
$205.40 |
| Rate for Payer: Aetna Commercial |
$167.89
|
| Rate for Payer: Aetna Medicare |
$125.29
|
| Rate for Payer: BCBS Complete |
$126.40
|
| Rate for Payer: BCBS MAPPO |
$125.29
|
| Rate for Payer: BCN Medicare Advantage |
$125.29
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cofinity Commercial |
$180.42
|
| Rate for Payer: Cofinity Commercial |
$167.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.29
|
| Rate for Payer: Healthscope Commercial |
$150.35
|
| Rate for Payer: Healthscope Whirlpool |
$150.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.55
|
| Rate for Payer: Nomi Health Commercial |
$150.35
|
| Rate for Payer: PACE SWMI |
$125.29
|
| Rate for Payer: PHP Medicare Advantage |
$125.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
| Rate for Payer: Priority Health Medicare |
$125.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.29
|
| Rate for Payer: UHC Medicare Advantage |
$125.29
|
| Rate for Payer: UHCCP DNSP |
$125.29
|
|
|
PR CLTX METATARSOPHLNGL JT DISLC W/O ANES
|
Professional
|
Both
|
$318.00
|
|
|
Service Code
|
HCPCS 28630
|
| Min. Negotiated Rate |
$107.52 |
| Max. Negotiated Rate |
$206.70 |
| Rate for Payer: Aetna Commercial |
$144.08
|
| Rate for Payer: Aetna Medicare |
$107.52
|
| Rate for Payer: BCBS Complete |
$127.20
|
| Rate for Payer: BCBS MAPPO |
$107.52
|
| Rate for Payer: BCN Medicare Advantage |
$107.52
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cofinity Commercial |
$154.83
|
| Rate for Payer: Cofinity Commercial |
$144.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.52
|
| Rate for Payer: Healthscope Commercial |
$129.02
|
| Rate for Payer: Healthscope Whirlpool |
$129.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.90
|
| Rate for Payer: Nomi Health Commercial |
$129.02
|
| Rate for Payer: PACE SWMI |
$107.52
|
| Rate for Payer: PHP Medicare Advantage |
$107.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.70
|
| Rate for Payer: Priority Health Medicare |
$107.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.52
|
| Rate for Payer: UHC Medicare Advantage |
$107.52
|
| Rate for Payer: UHCCP DNSP |
$107.52
|
|
|
PR CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA
|
Professional
|
Both
|
$715.00
|
|
|
Service Code
|
HCPCS 26725
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$464.75 |
| Rate for Payer: Aetna Commercial |
$401.29
|
| Rate for Payer: Aetna Medicare |
$299.47
|
| Rate for Payer: BCBS Complete |
$286.00
|
| Rate for Payer: BCBS MAPPO |
$299.47
|
| Rate for Payer: BCN Medicare Advantage |
$299.47
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cofinity Commercial |
$431.24
|
| Rate for Payer: Cofinity Commercial |
$401.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$299.47
|
| Rate for Payer: Healthscope Commercial |
$359.36
|
| Rate for Payer: Healthscope Whirlpool |
$359.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$314.44
|
| Rate for Payer: Nomi Health Commercial |
$359.36
|
| Rate for Payer: PACE SWMI |
$299.47
|
| Rate for Payer: PHP Medicare Advantage |
$299.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.75
|
| Rate for Payer: Priority Health Medicare |
$299.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$299.47
|
| Rate for Payer: UHC Medicare Advantage |
$299.47
|
| Rate for Payer: UHCCP DNSP |
$299.47
|
|
|
PR CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA
|
Professional
|
Both
|
$412.00
|
|
|
Service Code
|
HCPCS 26720
|
| Min. Negotiated Rate |
$164.80 |
| Max. Negotiated Rate |
$268.29 |
| Rate for Payer: Aetna Commercial |
$249.66
|
| Rate for Payer: Aetna Medicare |
$186.31
|
| Rate for Payer: BCBS Complete |
$164.80
|
| Rate for Payer: BCBS MAPPO |
$186.31
|
| Rate for Payer: BCN Medicare Advantage |
$186.31
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cofinity Commercial |
$268.29
|
| Rate for Payer: Cofinity Commercial |
$249.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.31
|
| Rate for Payer: Healthscope Commercial |
$223.57
|
| Rate for Payer: Healthscope Whirlpool |
$223.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$195.63
|
| Rate for Payer: Nomi Health Commercial |
$223.57
|
| Rate for Payer: PACE SWMI |
$186.31
|
| Rate for Payer: PHP Medicare Advantage |
$186.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.80
|
| Rate for Payer: Priority Health Medicare |
$186.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$186.31
|
| Rate for Payer: UHC Medicare Advantage |
$186.31
|
| Rate for Payer: UHCCP DNSP |
$186.31
|
|
|
PR CLTX POST HIP ARTHRP DISLC REQ ANES
|
Professional
|
Both
|
$1,530.00
|
|
|
Service Code
|
HCPCS 27266
|
| Min. Negotiated Rate |
$562.29 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Aetna Commercial |
$753.47
|
| Rate for Payer: Aetna Medicare |
$562.29
|
| Rate for Payer: BCBS Complete |
$612.00
|
| Rate for Payer: BCBS MAPPO |
$562.29
|
| Rate for Payer: BCN Medicare Advantage |
$562.29
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cofinity Commercial |
$809.70
|
| Rate for Payer: Cofinity Commercial |
$753.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$562.29
|
| Rate for Payer: Healthscope Commercial |
$674.75
|
| Rate for Payer: Healthscope Whirlpool |
$674.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$590.40
|
| Rate for Payer: Nomi Health Commercial |
$674.75
|
| Rate for Payer: PACE SWMI |
$562.29
|
| Rate for Payer: PHP Medicare Advantage |
$562.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.50
|
| Rate for Payer: Priority Health Medicare |
$562.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$562.29
|
| Rate for Payer: UHC Medicare Advantage |
$562.29
|
| Rate for Payer: UHCCP DNSP |
$562.29
|
|
|
PR CLTX POST HIP ARTHRP DISLC W/O ANES
|
Professional
|
Both
|
$742.00
|
|
|
Service Code
|
HCPCS 27265
|
| Min. Negotiated Rate |
$296.80 |
| Max. Negotiated Rate |
$587.20 |
| Rate for Payer: Aetna Commercial |
$546.43
|
| Rate for Payer: Aetna Medicare |
$407.78
|
| Rate for Payer: BCBS Complete |
$296.80
|
| Rate for Payer: BCBS MAPPO |
$407.78
|
| Rate for Payer: BCN Medicare Advantage |
$407.78
|
| Rate for Payer: Cash Price |
$593.60
|
| Rate for Payer: Cash Price |
$593.60
|
| Rate for Payer: Cofinity Commercial |
$587.20
|
| Rate for Payer: Cofinity Commercial |
$546.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$407.78
|
| Rate for Payer: Healthscope Commercial |
$489.34
|
| Rate for Payer: Healthscope Whirlpool |
$489.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$428.17
|
| Rate for Payer: Nomi Health Commercial |
$489.34
|
| Rate for Payer: PACE SWMI |
$407.78
|
| Rate for Payer: PHP Medicare Advantage |
$407.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.30
|
| Rate for Payer: Priority Health Medicare |
$407.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$407.78
|
| Rate for Payer: UHC Medicare Advantage |
$407.78
|
| Rate for Payer: UHCCP DNSP |
$407.78
|
|
|
PR CLTX PROX FIBULA/SHFT FX W/MANJ
|
Professional
|
Both
|
$1,212.00
|
|
|
Service Code
|
HCPCS 27781
|
| Min. Negotiated Rate |
$393.23 |
| Max. Negotiated Rate |
$787.80 |
| Rate for Payer: Aetna Commercial |
$526.93
|
| Rate for Payer: Aetna Medicare |
$393.23
|
| Rate for Payer: BCBS Complete |
$484.80
|
| Rate for Payer: BCBS MAPPO |
$393.23
|
| Rate for Payer: BCN Medicare Advantage |
$393.23
|
| Rate for Payer: Cash Price |
$969.60
|
| Rate for Payer: Cash Price |
$969.60
|
| Rate for Payer: Cofinity Commercial |
$566.25
|
| Rate for Payer: Cofinity Commercial |
$526.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.23
|
| Rate for Payer: Healthscope Commercial |
$471.88
|
| Rate for Payer: Healthscope Whirlpool |
$471.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$412.89
|
| Rate for Payer: Nomi Health Commercial |
$471.88
|
| Rate for Payer: PACE SWMI |
$393.23
|
| Rate for Payer: PHP Medicare Advantage |
$393.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.80
|
| Rate for Payer: Priority Health Medicare |
$393.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.23
|
| Rate for Payer: UHC Medicare Advantage |
$393.23
|
| Rate for Payer: UHCCP DNSP |
$393.23
|
|
|
PR CLTX PROX FIBULA/SHFT FX W/O MANJ
|
Professional
|
Both
|
$666.00
|
|
|
Service Code
|
HCPCS 27780
|
| Min. Negotiated Rate |
$266.40 |
| Max. Negotiated Rate |
$432.90 |
| Rate for Payer: Aetna Commercial |
$373.73
|
| Rate for Payer: Aetna Medicare |
$278.90
|
| Rate for Payer: BCBS Complete |
$266.40
|
| Rate for Payer: BCBS MAPPO |
$278.90
|
| Rate for Payer: BCN Medicare Advantage |
$278.90
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cofinity Commercial |
$401.62
|
| Rate for Payer: Cofinity Commercial |
$373.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$278.90
|
| Rate for Payer: Healthscope Commercial |
$334.68
|
| Rate for Payer: Healthscope Whirlpool |
$334.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$292.85
|
| Rate for Payer: Nomi Health Commercial |
$334.68
|
| Rate for Payer: PACE SWMI |
$278.90
|
| Rate for Payer: PHP Medicare Advantage |
$278.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.90
|
| Rate for Payer: Priority Health Medicare |
$278.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$278.90
|
| Rate for Payer: UHC Medicare Advantage |
$278.90
|
| Rate for Payer: UHCCP DNSP |
$278.90
|
|
|
PR CLTX PROX HUMRL FX W/MNPJ W/WO SKELETAL TRACJ
|
Professional
|
Both
|
$1,424.00
|
|
|
Service Code
|
HCPCS 23605
|
| Min. Negotiated Rate |
$416.69 |
| Max. Negotiated Rate |
$925.60 |
| Rate for Payer: Aetna Commercial |
$558.36
|
| Rate for Payer: Aetna Medicare |
$416.69
|
| Rate for Payer: BCBS Complete |
$569.60
|
| Rate for Payer: BCBS MAPPO |
$416.69
|
| Rate for Payer: BCN Medicare Advantage |
$416.69
|
| Rate for Payer: Cash Price |
$1,139.20
|
| Rate for Payer: Cash Price |
$1,139.20
|
| Rate for Payer: Cofinity Commercial |
$600.03
|
| Rate for Payer: Cofinity Commercial |
$558.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$416.69
|
| Rate for Payer: Healthscope Commercial |
$500.03
|
| Rate for Payer: Healthscope Whirlpool |
$500.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$437.52
|
| Rate for Payer: Nomi Health Commercial |
$500.03
|
| Rate for Payer: PACE SWMI |
$416.69
|
| Rate for Payer: PHP Medicare Advantage |
$416.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$925.60
|
| Rate for Payer: Priority Health Medicare |
$416.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$416.69
|
| Rate for Payer: UHC Medicare Advantage |
$416.69
|
| Rate for Payer: UHCCP DNSP |
$416.69
|
|
|
PR CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$785.00
|
|
|
Service Code
|
HCPCS 23600
|
| Min. Negotiated Rate |
$309.58 |
| Max. Negotiated Rate |
$510.25 |
| Rate for Payer: Aetna Commercial |
$414.84
|
| Rate for Payer: Aetna Medicare |
$309.58
|
| Rate for Payer: BCBS Complete |
$314.00
|
| Rate for Payer: BCBS MAPPO |
$309.58
|
| Rate for Payer: BCN Medicare Advantage |
$309.58
|
| Rate for Payer: Cash Price |
$628.00
|
| Rate for Payer: Cash Price |
$628.00
|
| Rate for Payer: Cofinity Commercial |
$445.80
|
| Rate for Payer: Cofinity Commercial |
$414.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$309.58
|
| Rate for Payer: Healthscope Commercial |
$371.50
|
| Rate for Payer: Healthscope Whirlpool |
$371.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$325.06
|
| Rate for Payer: Nomi Health Commercial |
$371.50
|
| Rate for Payer: PACE SWMI |
$309.58
|
| Rate for Payer: PHP Medicare Advantage |
$309.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.25
|
| Rate for Payer: Priority Health Medicare |
$309.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$309.58
|
| Rate for Payer: UHC Medicare Advantage |
$309.58
|
| Rate for Payer: UHCCP DNSP |
$309.58
|
|
|
PR CLTX PROX TIBFIB JT DISLC REQ ANES
|
Professional
|
Both
|
$760.00
|
|
|
Service Code
|
HCPCS 27831
|
| Min. Negotiated Rate |
$304.00 |
| Max. Negotiated Rate |
$574.59 |
| Rate for Payer: Aetna Commercial |
$534.69
|
| Rate for Payer: Aetna Medicare |
$399.02
|
| Rate for Payer: BCBS Complete |
$304.00
|
| Rate for Payer: BCBS MAPPO |
$399.02
|
| Rate for Payer: BCN Medicare Advantage |
$399.02
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cofinity Commercial |
$574.59
|
| Rate for Payer: Cofinity Commercial |
$534.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$399.02
|
| Rate for Payer: Healthscope Commercial |
$478.82
|
| Rate for Payer: Healthscope Whirlpool |
$478.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.97
|
| Rate for Payer: Nomi Health Commercial |
$478.82
|
| Rate for Payer: PACE SWMI |
$399.02
|
| Rate for Payer: PHP Medicare Advantage |
$399.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$494.00
|
| Rate for Payer: Priority Health Medicare |
$399.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$399.02
|
| Rate for Payer: UHC Medicare Advantage |
$399.02
|
| Rate for Payer: UHCCP DNSP |
$399.02
|
|
|
PR CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MNPJ
|
Professional
|
Both
|
$718.00
|
|
|
Service Code
|
HCPCS 25660
|
| Min. Negotiated Rate |
$287.20 |
| Max. Negotiated Rate |
$630.68 |
| Rate for Payer: Aetna Commercial |
$586.88
|
| Rate for Payer: Aetna Medicare |
$437.97
|
| Rate for Payer: BCBS Complete |
$287.20
|
| Rate for Payer: BCBS MAPPO |
$437.97
|
| Rate for Payer: BCN Medicare Advantage |
$437.97
|
| Rate for Payer: Cash Price |
$574.40
|
| Rate for Payer: Cash Price |
$574.40
|
| Rate for Payer: Cofinity Commercial |
$630.68
|
| Rate for Payer: Cofinity Commercial |
$586.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$437.97
|
| Rate for Payer: Healthscope Commercial |
$525.56
|
| Rate for Payer: Healthscope Whirlpool |
$525.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$459.87
|
| Rate for Payer: Nomi Health Commercial |
$525.56
|
| Rate for Payer: PACE SWMI |
$437.97
|
| Rate for Payer: PHP Medicare Advantage |
$437.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.70
|
| Rate for Payer: Priority Health Medicare |
$437.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$437.97
|
| Rate for Payer: UHC Medicare Advantage |
$437.97
|
| Rate for Payer: UHCCP DNSP |
$437.97
|
|
|
PR CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
HCPCS 24640
|
| Min. Negotiated Rate |
$74.70 |
| Max. Negotiated Rate |
$158.60 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Aetna Medicare |
$74.70
|
| Rate for Payer: BCBS Complete |
$97.60
|
| Rate for Payer: BCBS MAPPO |
$74.70
|
| Rate for Payer: BCN Medicare Advantage |
$74.70
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cofinity Commercial |
$107.57
|
| Rate for Payer: Cofinity Commercial |
$100.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.70
|
| Rate for Payer: Healthscope Commercial |
$89.64
|
| Rate for Payer: Healthscope Whirlpool |
$89.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.44
|
| Rate for Payer: Nomi Health Commercial |
$89.64
|
| Rate for Payer: PACE SWMI |
$74.70
|
| Rate for Payer: PHP Medicare Advantage |
$74.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.60
|
| Rate for Payer: Priority Health Medicare |
$74.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.70
|
| Rate for Payer: UHC Medicare Advantage |
$74.70
|
| Rate for Payer: UHCCP DNSP |
$74.70
|
|
|
PR CLTX RDL SHFT FX&CLTX DISLC DSTL RAD/ULN JT
|
Professional
|
Both
|
$1,503.00
|
|
|
Service Code
|
HCPCS 25520
|
| Min. Negotiated Rate |
$531.61 |
| Max. Negotiated Rate |
$976.95 |
| Rate for Payer: Aetna Commercial |
$712.36
|
| Rate for Payer: Aetna Medicare |
$531.61
|
| Rate for Payer: BCBS Complete |
$601.20
|
| Rate for Payer: BCBS MAPPO |
$531.61
|
| Rate for Payer: BCN Medicare Advantage |
$531.61
|
| Rate for Payer: Cash Price |
$1,202.40
|
| Rate for Payer: Cash Price |
$1,202.40
|
| Rate for Payer: Cofinity Commercial |
$765.52
|
| Rate for Payer: Cofinity Commercial |
$712.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$531.61
|
| Rate for Payer: Healthscope Commercial |
$637.93
|
| Rate for Payer: Healthscope Whirlpool |
$637.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$558.19
|
| Rate for Payer: Nomi Health Commercial |
$637.93
|
| Rate for Payer: PACE SWMI |
$531.61
|
| Rate for Payer: PHP Medicare Advantage |
$531.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$976.95
|
| Rate for Payer: Priority Health Medicare |
$531.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$531.61
|
| Rate for Payer: UHC Medicare Advantage |
$531.61
|
| Rate for Payer: UHCCP DNSP |
$531.61
|
|
|
PR CLTX SCAPULAR FX W/MNPJ W/WO SKELETAL TRACTION
|
Professional
|
Both
|
$1,031.00
|
|
|
Service Code
|
HCPCS 23575
|
| Min. Negotiated Rate |
$371.60 |
| Max. Negotiated Rate |
$670.15 |
| Rate for Payer: Aetna Commercial |
$497.94
|
| Rate for Payer: Aetna Medicare |
$371.60
|
| Rate for Payer: BCBS Complete |
$412.40
|
| Rate for Payer: BCBS MAPPO |
$371.60
|
| Rate for Payer: BCN Medicare Advantage |
$371.60
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Cofinity Commercial |
$535.10
|
| Rate for Payer: Cofinity Commercial |
$497.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.60
|
| Rate for Payer: Healthscope Commercial |
$445.92
|
| Rate for Payer: Healthscope Whirlpool |
$445.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.18
|
| Rate for Payer: Nomi Health Commercial |
$445.92
|
| Rate for Payer: PACE SWMI |
$371.60
|
| Rate for Payer: PHP Medicare Advantage |
$371.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.15
|
| Rate for Payer: Priority Health Medicare |
$371.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$371.60
|
| Rate for Payer: UHC Medicare Advantage |
$371.60
|
| Rate for Payer: UHCCP DNSP |
$371.60
|
|
|
PR CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MNPJ
|
Professional
|
Both
|
$1,373.00
|
|
|
Service Code
|
HCPCS 23665
|
| Min. Negotiated Rate |
$391.58 |
| Max. Negotiated Rate |
$892.45 |
| Rate for Payer: Aetna Commercial |
$524.72
|
| Rate for Payer: Aetna Medicare |
$391.58
|
| Rate for Payer: BCBS Complete |
$549.20
|
| Rate for Payer: BCBS MAPPO |
$391.58
|
| Rate for Payer: BCN Medicare Advantage |
$391.58
|
| Rate for Payer: Cash Price |
$1,098.40
|
| Rate for Payer: Cash Price |
$1,098.40
|
| Rate for Payer: Cofinity Commercial |
$563.88
|
| Rate for Payer: Cofinity Commercial |
$524.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.58
|
| Rate for Payer: Healthscope Commercial |
$469.90
|
| Rate for Payer: Healthscope Whirlpool |
$469.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.16
|
| Rate for Payer: Nomi Health Commercial |
$469.90
|
| Rate for Payer: PACE SWMI |
$391.58
|
| Rate for Payer: PHP Medicare Advantage |
$391.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$892.45
|
| Rate for Payer: Priority Health Medicare |
$391.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.58
|
| Rate for Payer: UHC Medicare Advantage |
$391.58
|
| Rate for Payer: UHCCP DNSP |
$391.58
|
|
