|
PR OPEN TREATMENT TARSAL BONE DISLOCATION
|
Professional
|
Both
|
$1,694.00
|
|
|
Service Code
|
HCPCS 28555
|
| Min. Negotiated Rate |
$427.92 |
| Max. Negotiated Rate |
$1,269.58 |
| Rate for Payer: Aetna Commercial |
$874.77
|
| Rate for Payer: Aetna Medicare |
$652.81
|
| Rate for Payer: BCBS Complete |
$449.32
|
| Rate for Payer: BCBS MAPPO |
$652.81
|
| Rate for Payer: BCBS Trust/PPO |
$645.58
|
| Rate for Payer: BCN Commercial |
$1,269.58
|
| Rate for Payer: BCN Medicare Advantage |
$652.81
|
| Rate for Payer: Cash Price |
$1,355.20
|
| Rate for Payer: Cash Price |
$1,355.20
|
| Rate for Payer: Cofinity Commercial |
$940.05
|
| Rate for Payer: Cofinity Commercial |
$874.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$652.81
|
| Rate for Payer: Healthscope Commercial |
$783.37
|
| Rate for Payer: Healthscope Whirlpool |
$783.37
|
| Rate for Payer: Meridian Medicaid |
$449.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$685.45
|
| Rate for Payer: PACE SWMI |
$652.81
|
| Rate for Payer: PHP Medicare Advantage |
$652.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$427.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,185.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,017.72
|
| Rate for Payer: Priority Health Medicare |
$652.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,017.72
|
| Rate for Payer: UHC Medicare Advantage |
$672.39
|
|
|
PR OPEN TREATMENT TARSOMETATARSAL JOINT DISLOCATION
|
Professional
|
Both
|
$1,760.00
|
|
|
Service Code
|
HCPCS 28615
|
| Min. Negotiated Rate |
$535.48 |
| Max. Negotiated Rate |
$1,778.26 |
| Rate for Payer: Aetna Commercial |
$1,084.26
|
| Rate for Payer: Aetna Medicare |
$809.15
|
| Rate for Payer: BCBS Complete |
$562.25
|
| Rate for Payer: BCBS MAPPO |
$809.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,778.26
|
| Rate for Payer: BCN Commercial |
$1,214.37
|
| Rate for Payer: BCN Medicare Advantage |
$809.15
|
| Rate for Payer: Cash Price |
$1,408.00
|
| Rate for Payer: Cash Price |
$1,408.00
|
| Rate for Payer: Cofinity Commercial |
$1,084.26
|
| Rate for Payer: Cofinity Commercial |
$1,165.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$809.15
|
| Rate for Payer: Healthscope Commercial |
$970.98
|
| Rate for Payer: Healthscope Whirlpool |
$970.98
|
| Rate for Payer: Meridian Medicaid |
$562.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$849.61
|
| Rate for Payer: PACE SWMI |
$809.15
|
| Rate for Payer: PHP Medicare Advantage |
$809.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$535.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,232.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,268.97
|
| Rate for Payer: Priority Health Medicare |
$809.15
|
| Rate for Payer: Priority Health Narrow Network |
$1,268.97
|
| Rate for Payer: UHC Medicare Advantage |
$833.42
|
|
|
PR OPEN TREATMENT ULNAR FRACTURE PROXIMAL END
|
Professional
|
Both
|
$2,297.00
|
|
|
Service Code
|
HCPCS 24685
|
| Hospital Charge Code |
24685
|
| Min. Negotiated Rate |
$338.11 |
| Max. Negotiated Rate |
$1,607.90 |
| Rate for Payer: Aetna Commercial |
$863.46
|
| Rate for Payer: Aetna Medicare |
$644.37
|
| Rate for Payer: BCBS Complete |
$446.63
|
| Rate for Payer: BCBS MAPPO |
$644.37
|
| Rate for Payer: BCBS Trust/PPO |
$338.11
|
| Rate for Payer: BCN Commercial |
$965.63
|
| Rate for Payer: BCN Medicare Advantage |
$644.37
|
| Rate for Payer: Cash Price |
$1,837.60
|
| Rate for Payer: Cash Price |
$1,837.60
|
| Rate for Payer: Cofinity Commercial |
$863.46
|
| Rate for Payer: Cofinity Commercial |
$927.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$644.37
|
| Rate for Payer: Healthscope Commercial |
$773.24
|
| Rate for Payer: Healthscope Whirlpool |
$773.24
|
| Rate for Payer: Meridian Medicaid |
$446.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$676.59
|
| Rate for Payer: PACE SWMI |
$644.37
|
| Rate for Payer: PHP Medicare Advantage |
$644.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$425.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,607.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,009.04
|
| Rate for Payer: Priority Health Medicare |
$644.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,009.04
|
| Rate for Payer: UHC Medicare Advantage |
$663.70
|
|
|
PR OPEN TREATMENT ULNAR FRACTURE PROXIMAL END
|
Facility
|
OP
|
$2,297.00
|
|
|
Service Code
|
CPT 24685
|
| Hospital Charge Code |
24685
|
| Min. Negotiated Rate |
$1,607.90 |
| Max. Negotiated Rate |
$7,948.86 |
| Rate for Payer: Aetna Commercial |
$2,067.30
|
| Rate for Payer: Aetna Medicare |
$6,359.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: ASR ASR |
$2,228.09
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,780.86
|
| Rate for Payer: BCN Commercial |
$1,780.86
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Cash Price |
$1,837.60
|
| Rate for Payer: Cash Price |
$1,837.60
|
| Rate for Payer: Cofinity Commercial |
$2,159.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,837.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Healthscope Commercial |
$2,297.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,228.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,359.09
|
| Rate for Payer: Mclaren Commercial |
$2,067.30
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,952.45
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Commercial |
$6,995.00
|
| Rate for Payer: PHP Medicaid |
$3,478.42
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,607.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,090.27
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,630.87
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,021.36
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
PR OPEN TREATMENT ULNAR FRACTURE PROXIMAL END
|
Facility
|
IP
|
$2,297.00
|
|
|
Service Code
|
CPT 24685
|
| Hospital Charge Code |
24685
|
| Min. Negotiated Rate |
$1,607.90 |
| Max. Negotiated Rate |
$2,297.00 |
| Rate for Payer: Aetna Commercial |
$2,067.30
|
| Rate for Payer: ASR ASR |
$2,228.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,780.86
|
| Rate for Payer: BCN Commercial |
$1,780.86
|
| Rate for Payer: Cash Price |
$1,837.60
|
| Rate for Payer: Cofinity Commercial |
$2,159.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,837.60
|
| Rate for Payer: Healthscope Commercial |
$2,297.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,228.09
|
| Rate for Payer: Mclaren Commercial |
$2,067.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,952.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,607.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,021.36
|
|
|
PR OPEN TREATMENT ULNAR FRACTURE PROXIMAL END
|
Professional
|
Both
|
$2,297.00
|
|
|
Service Code
|
HCPCS 24685
|
| Min. Negotiated Rate |
$338.11 |
| Max. Negotiated Rate |
$1,607.90 |
| Rate for Payer: Aetna Commercial |
$863.46
|
| Rate for Payer: Aetna Medicare |
$644.37
|
| Rate for Payer: BCBS Complete |
$446.63
|
| Rate for Payer: BCBS MAPPO |
$644.37
|
| Rate for Payer: BCBS Trust/PPO |
$338.11
|
| Rate for Payer: BCN Commercial |
$965.63
|
| Rate for Payer: BCN Medicare Advantage |
$644.37
|
| Rate for Payer: Cash Price |
$1,837.60
|
| Rate for Payer: Cash Price |
$1,837.60
|
| Rate for Payer: Cofinity Commercial |
$927.89
|
| Rate for Payer: Cofinity Commercial |
$863.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$644.37
|
| Rate for Payer: Healthscope Commercial |
$773.24
|
| Rate for Payer: Healthscope Whirlpool |
$773.24
|
| Rate for Payer: Meridian Medicaid |
$446.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$676.59
|
| Rate for Payer: PACE SWMI |
$644.37
|
| Rate for Payer: PHP Medicare Advantage |
$644.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$425.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,607.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,009.04
|
| Rate for Payer: Priority Health Medicare |
$644.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,009.04
|
| Rate for Payer: UHC Medicare Advantage |
$663.70
|
|
|
PR OPEN TREATMENT ULNAR STYLOID FRACTURE
|
Professional
|
Both
|
$1,634.00
|
|
|
Service Code
|
HCPCS 25652
|
| Min. Negotiated Rate |
$405.98 |
| Max. Negotiated Rate |
$1,501.43 |
| Rate for Payer: Aetna Commercial |
$824.80
|
| Rate for Payer: Aetna Medicare |
$615.52
|
| Rate for Payer: BCBS Complete |
$426.28
|
| Rate for Payer: BCBS MAPPO |
$615.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,501.43
|
| Rate for Payer: BCN Commercial |
$922.13
|
| Rate for Payer: BCN Medicare Advantage |
$615.52
|
| Rate for Payer: Cash Price |
$1,307.20
|
| Rate for Payer: Cash Price |
$1,307.20
|
| Rate for Payer: Cofinity Commercial |
$886.35
|
| Rate for Payer: Cofinity Commercial |
$824.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.52
|
| Rate for Payer: Healthscope Commercial |
$738.62
|
| Rate for Payer: Healthscope Whirlpool |
$738.62
|
| Rate for Payer: Meridian Medicaid |
$426.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$646.30
|
| Rate for Payer: PACE SWMI |
$615.52
|
| Rate for Payer: PHP Medicare Advantage |
$615.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$405.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,143.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$963.59
|
| Rate for Payer: Priority Health Medicare |
$615.52
|
| Rate for Payer: Priority Health Narrow Network |
$963.59
|
| Rate for Payer: UHC Medicare Advantage |
$633.99
|
|
|
PR OPEN TREAT RIB FRACTURE W/INT FIXATION, UNILATERAL, 1-2 RIBS
|
Professional
|
Both
|
$3,282.00
|
|
|
Service Code
|
HCPCS 0245T
|
| Min. Negotiated Rate |
$1,312.80 |
| Max. Negotiated Rate |
$2,297.40 |
| Rate for Payer: BCBS Complete |
$1,312.80
|
| Rate for Payer: Cash Price |
$2,625.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,297.40
|
|
|
PR OPEN TREAT RIB FRACTURE W/INT FIXATION, UNILATERAL, 3-4 RIBS
|
Professional
|
Both
|
$3,617.00
|
|
|
Service Code
|
HCPCS 0246T
|
| Min. Negotiated Rate |
$1,446.80 |
| Max. Negotiated Rate |
$2,531.90 |
| Rate for Payer: BCBS Complete |
$1,446.80
|
| Rate for Payer: Cash Price |
$2,893.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,531.90
|
|
|
PR OPEN TREAT RIB FRACTURE W/INT FIXATION, UNILATERAL, 5-6 RIBS
|
Professional
|
Both
|
$4,000.00
|
|
|
Service Code
|
HCPCS 0247T
|
| Min. Negotiated Rate |
$1,600.00 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: BCBS Complete |
$1,600.00
|
| Rate for Payer: Cash Price |
$3,200.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,800.00
|
|
|
PR OPEN TREAT RIB FRACTURE W/INT FIXATION, UNILATERAL, 7+ RIBS
|
Professional
|
Both
|
$4,617.00
|
|
|
Service Code
|
HCPCS 0248T
|
| Min. Negotiated Rate |
$1,846.80 |
| Max. Negotiated Rate |
$3,231.90 |
| Rate for Payer: BCBS Complete |
$1,846.80
|
| Rate for Payer: Cash Price |
$3,693.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,231.90
|
|
|
PR OPEN TX ACROMIOCLAVICULAR DISLC ACUTE/CHRONIC
|
Professional
|
Both
|
$2,689.00
|
|
|
Service Code
|
HCPCS 23550
|
| Min. Negotiated Rate |
$372.11 |
| Max. Negotiated Rate |
$1,882.30 |
| Rate for Payer: Aetna Commercial |
$758.02
|
| Rate for Payer: Aetna Medicare |
$565.69
|
| Rate for Payer: BCBS Complete |
$390.72
|
| Rate for Payer: BCBS MAPPO |
$565.69
|
| Rate for Payer: BCBS Trust/PPO |
$528.83
|
| Rate for Payer: BCN Commercial |
$846.39
|
| Rate for Payer: BCN Medicare Advantage |
$565.69
|
| Rate for Payer: Cash Price |
$2,151.20
|
| Rate for Payer: Cash Price |
$2,151.20
|
| Rate for Payer: Cofinity Commercial |
$814.59
|
| Rate for Payer: Cofinity Commercial |
$758.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$565.69
|
| Rate for Payer: Healthscope Commercial |
$678.83
|
| Rate for Payer: Healthscope Whirlpool |
$678.83
|
| Rate for Payer: Meridian Medicaid |
$390.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$593.97
|
| Rate for Payer: PACE SWMI |
$565.69
|
| Rate for Payer: PHP Medicare Advantage |
$565.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$372.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,882.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$884.45
|
| Rate for Payer: Priority Health Medicare |
$565.69
|
| Rate for Payer: Priority Health Narrow Network |
$884.45
|
| Rate for Payer: UHC Medicare Advantage |
$582.66
|
|
|
PR OPEN TX ACUTE/CHRONIC ELBOW DISLOCATION
|
Professional
|
Both
|
$2,526.00
|
|
|
Service Code
|
HCPCS 24615
|
| Min. Negotiated Rate |
$462.42 |
| Max. Negotiated Rate |
$1,768.20 |
| Rate for Payer: Aetna Commercial |
$945.58
|
| Rate for Payer: Aetna Medicare |
$705.66
|
| Rate for Payer: BCBS Complete |
$485.54
|
| Rate for Payer: BCBS MAPPO |
$705.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,254.71
|
| Rate for Payer: BCN Commercial |
$1,053.10
|
| Rate for Payer: BCN Medicare Advantage |
$705.66
|
| Rate for Payer: Cash Price |
$2,020.80
|
| Rate for Payer: Cash Price |
$2,020.80
|
| Rate for Payer: Cofinity Commercial |
$945.58
|
| Rate for Payer: Cofinity Commercial |
$1,016.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.66
|
| Rate for Payer: Healthscope Commercial |
$846.79
|
| Rate for Payer: Healthscope Whirlpool |
$846.79
|
| Rate for Payer: Meridian Medicaid |
$485.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$740.94
|
| Rate for Payer: PACE SWMI |
$705.66
|
| Rate for Payer: PHP Medicare Advantage |
$705.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$462.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,768.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,100.45
|
| Rate for Payer: Priority Health Medicare |
$705.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,100.45
|
| Rate for Payer: UHC Medicare Advantage |
$726.83
|
|
|
PR OPEN TX ACUTE SHOULDER DISLOCATION
|
Professional
|
Both
|
$2,667.00
|
|
|
Service Code
|
HCPCS 23660
|
| Min. Negotiated Rate |
$367.62 |
| Max. Negotiated Rate |
$1,866.90 |
| Rate for Payer: Aetna Commercial |
$776.96
|
| Rate for Payer: Aetna Medicare |
$579.82
|
| Rate for Payer: BCBS Complete |
$399.88
|
| Rate for Payer: BCBS MAPPO |
$579.82
|
| Rate for Payer: BCBS Trust/PPO |
$367.62
|
| Rate for Payer: BCN Commercial |
$867.89
|
| Rate for Payer: BCN Medicare Advantage |
$579.82
|
| Rate for Payer: Cash Price |
$2,133.60
|
| Rate for Payer: Cash Price |
$2,133.60
|
| Rate for Payer: Cofinity Commercial |
$776.96
|
| Rate for Payer: Cofinity Commercial |
$834.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$579.82
|
| Rate for Payer: Healthscope Commercial |
$695.78
|
| Rate for Payer: Healthscope Whirlpool |
$695.78
|
| Rate for Payer: Meridian Medicaid |
$399.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$608.81
|
| Rate for Payer: PACE SWMI |
$579.82
|
| Rate for Payer: PHP Medicare Advantage |
$579.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$380.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,866.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$906.92
|
| Rate for Payer: Priority Health Medicare |
$579.82
|
| Rate for Payer: Priority Health Narrow Network |
$906.92
|
| Rate for Payer: UHC Medicare Advantage |
$597.21
|
|
|
PR OPEN TX ARTICULAR FRACTURE MCP/IP JOINT EA
|
Professional
|
Both
|
$2,480.00
|
|
|
Service Code
|
HCPCS 26746
|
| Min. Negotiated Rate |
$481.17 |
| Max. Negotiated Rate |
$1,736.00 |
| Rate for Payer: Aetna Commercial |
$980.21
|
| Rate for Payer: Aetna Medicare |
$731.50
|
| Rate for Payer: BCBS Complete |
$505.23
|
| Rate for Payer: BCBS MAPPO |
$731.50
|
| Rate for Payer: BCBS Trust/PPO |
$663.54
|
| Rate for Payer: BCN Commercial |
$1,095.13
|
| Rate for Payer: BCN Medicare Advantage |
$731.50
|
| Rate for Payer: Cash Price |
$1,984.00
|
| Rate for Payer: Cash Price |
$1,984.00
|
| Rate for Payer: Cofinity Commercial |
$980.21
|
| Rate for Payer: Cofinity Commercial |
$1,053.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$731.50
|
| Rate for Payer: Healthscope Commercial |
$877.80
|
| Rate for Payer: Healthscope Whirlpool |
$877.80
|
| Rate for Payer: Meridian Medicaid |
$505.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$768.08
|
| Rate for Payer: PACE SWMI |
$731.50
|
| Rate for Payer: PHP Medicare Advantage |
$731.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$481.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,736.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,144.36
|
| Rate for Payer: Priority Health Medicare |
$731.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,144.36
|
| Rate for Payer: UHC Medicare Advantage |
$753.44
|
|
|
PR OPEN TX CARPAL BONE FRACTURE OTH/THN SCAPHOID EA
|
Professional
|
Both
|
$1,478.00
|
|
|
Service Code
|
HCPCS 25645
|
| Min. Negotiated Rate |
$372.54 |
| Max. Negotiated Rate |
$1,263.69 |
| Rate for Payer: Aetna Commercial |
$758.12
|
| Rate for Payer: Aetna Medicare |
$565.76
|
| Rate for Payer: BCBS Complete |
$391.17
|
| Rate for Payer: BCBS MAPPO |
$565.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,263.69
|
| Rate for Payer: BCN Commercial |
$846.87
|
| Rate for Payer: BCN Medicare Advantage |
$565.76
|
| Rate for Payer: Cash Price |
$1,182.40
|
| Rate for Payer: Cash Price |
$1,182.40
|
| Rate for Payer: Cofinity Commercial |
$814.69
|
| Rate for Payer: Cofinity Commercial |
$758.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$565.76
|
| Rate for Payer: Healthscope Commercial |
$678.91
|
| Rate for Payer: Healthscope Whirlpool |
$678.91
|
| Rate for Payer: Meridian Medicaid |
$391.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$594.05
|
| Rate for Payer: PACE SWMI |
$565.76
|
| Rate for Payer: PHP Medicare Advantage |
$565.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$372.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,034.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$884.96
|
| Rate for Payer: Priority Health Medicare |
$565.76
|
| Rate for Payer: Priority Health Narrow Network |
$884.96
|
| Rate for Payer: UHC Medicare Advantage |
$582.73
|
|
|
PR OPEN TX CARPAL SCAPHOID NAVICULAR FRACTURE
|
Professional
|
Both
|
$1,984.00
|
|
|
Service Code
|
HCPCS 25628
|
| Min. Negotiated Rate |
$466.68 |
| Max. Negotiated Rate |
$1,388.80 |
| Rate for Payer: Aetna Commercial |
$950.92
|
| Rate for Payer: Aetna Medicare |
$709.64
|
| Rate for Payer: BCBS Complete |
$490.01
|
| Rate for Payer: BCBS MAPPO |
$709.64
|
| Rate for Payer: BCBS Trust/PPO |
$548.81
|
| Rate for Payer: BCN Commercial |
$1,061.41
|
| Rate for Payer: BCN Medicare Advantage |
$709.64
|
| Rate for Payer: Cash Price |
$1,587.20
|
| Rate for Payer: Cash Price |
$1,587.20
|
| Rate for Payer: Cofinity Commercial |
$1,021.88
|
| Rate for Payer: Cofinity Commercial |
$950.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$709.64
|
| Rate for Payer: Healthscope Commercial |
$851.57
|
| Rate for Payer: Healthscope Whirlpool |
$851.57
|
| Rate for Payer: Meridian Medicaid |
$490.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$745.12
|
| Rate for Payer: PACE SWMI |
$709.64
|
| Rate for Payer: PHP Medicare Advantage |
$709.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$466.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,388.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,109.13
|
| Rate for Payer: Priority Health Medicare |
$709.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,109.13
|
| Rate for Payer: UHC Medicare Advantage |
$730.93
|
|
|
PR OPEN TX CARPOMETACARPAL DISLOCATE NOT THUMB
|
Professional
|
Both
|
$2,211.00
|
|
|
Service Code
|
HCPCS 26685
|
| Min. Negotiated Rate |
$56.88 |
| Max. Negotiated Rate |
$1,547.70 |
| Rate for Payer: Aetna Commercial |
$759.42
|
| Rate for Payer: Aetna Medicare |
$566.73
|
| Rate for Payer: BCBS Complete |
$394.75
|
| Rate for Payer: BCBS MAPPO |
$566.73
|
| Rate for Payer: BCBS Trust/PPO |
$56.88
|
| Rate for Payer: BCN Commercial |
$851.77
|
| Rate for Payer: BCN Medicare Advantage |
$566.73
|
| Rate for Payer: Cash Price |
$1,768.80
|
| Rate for Payer: Cash Price |
$1,768.80
|
| Rate for Payer: Cofinity Commercial |
$816.09
|
| Rate for Payer: Cofinity Commercial |
$759.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$566.73
|
| Rate for Payer: Healthscope Commercial |
$680.08
|
| Rate for Payer: Healthscope Whirlpool |
$680.08
|
| Rate for Payer: Meridian Medicaid |
$394.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$595.07
|
| Rate for Payer: PACE SWMI |
$566.73
|
| Rate for Payer: PHP Medicare Advantage |
$566.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$375.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,547.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$890.06
|
| Rate for Payer: Priority Health Medicare |
$566.73
|
| Rate for Payer: Priority Health Narrow Network |
$890.06
|
| Rate for Payer: UHC Medicare Advantage |
$583.73
|
|
|
PR OPEN TX CARPOMETACARPAL FRACTURE DISLOCATE THUMB
|
Professional
|
Both
|
$2,831.00
|
|
|
Service Code
|
HCPCS 26665
|
| Min. Negotiated Rate |
$44.57 |
| Max. Negotiated Rate |
$1,981.70 |
| Rate for Payer: Aetna Commercial |
$826.31
|
| Rate for Payer: Aetna Medicare |
$616.65
|
| Rate for Payer: BCBS Complete |
$428.52
|
| Rate for Payer: BCBS MAPPO |
$616.65
|
| Rate for Payer: BCBS Trust/PPO |
$44.57
|
| Rate for Payer: BCN Commercial |
$926.54
|
| Rate for Payer: BCN Medicare Advantage |
$616.65
|
| Rate for Payer: Cash Price |
$2,264.80
|
| Rate for Payer: Cash Price |
$2,264.80
|
| Rate for Payer: Cofinity Commercial |
$826.31
|
| Rate for Payer: Cofinity Commercial |
$887.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$616.65
|
| Rate for Payer: Healthscope Commercial |
$739.98
|
| Rate for Payer: Healthscope Whirlpool |
$739.98
|
| Rate for Payer: Meridian Medicaid |
$428.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$647.48
|
| Rate for Payer: PACE SWMI |
$616.65
|
| Rate for Payer: PHP Medicare Advantage |
$616.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,981.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$968.19
|
| Rate for Payer: Priority Health Medicare |
$616.65
|
| Rate for Payer: Priority Health Narrow Network |
$968.19
|
| Rate for Payer: UHC Medicare Advantage |
$635.15
|
|
|
PR OPEN TX CLAVICULAR FRACTURE INTERNAL FIXATION
|
Professional
|
Both
|
$2,407.00
|
|
|
Service Code
|
HCPCS 23515
|
| Min. Negotiated Rate |
$285.26 |
| Max. Negotiated Rate |
$1,684.90 |
| Rate for Payer: Aetna Commercial |
$953.21
|
| Rate for Payer: Aetna Medicare |
$711.35
|
| Rate for Payer: BCBS Complete |
$490.47
|
| Rate for Payer: BCBS MAPPO |
$711.35
|
| Rate for Payer: BCBS Trust/PPO |
$285.26
|
| Rate for Payer: BCN Commercial |
$1,062.87
|
| Rate for Payer: BCN Medicare Advantage |
$711.35
|
| Rate for Payer: Cash Price |
$1,925.60
|
| Rate for Payer: Cash Price |
$1,925.60
|
| Rate for Payer: Cofinity Commercial |
$953.21
|
| Rate for Payer: Cofinity Commercial |
$1,024.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$711.35
|
| Rate for Payer: Healthscope Commercial |
$853.62
|
| Rate for Payer: Healthscope Whirlpool |
$853.62
|
| Rate for Payer: Meridian Medicaid |
$490.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$746.92
|
| Rate for Payer: PACE SWMI |
$711.35
|
| Rate for Payer: PHP Medicare Advantage |
$711.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,684.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,110.67
|
| Rate for Payer: Priority Health Medicare |
$711.35
|
| Rate for Payer: Priority Health Narrow Network |
$1,110.67
|
| Rate for Payer: UHC Medicare Advantage |
$732.69
|
|
|
PR OPEN TX COMP FX MALAR W/INTERNAL FX&MULT SURG
|
Professional
|
Both
|
$1,978.00
|
|
|
Service Code
|
HCPCS 21365
|
| Min. Negotiated Rate |
$180.58 |
| Max. Negotiated Rate |
$1,654.00 |
| Rate for Payer: Aetna Commercial |
$1,425.80
|
| Rate for Payer: Aetna Medicare |
$1,064.03
|
| Rate for Payer: BCBS Complete |
$724.63
|
| Rate for Payer: BCBS MAPPO |
$1,064.03
|
| Rate for Payer: BCBS Trust/PPO |
$180.58
|
| Rate for Payer: BCN Commercial |
$1,582.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,064.03
|
| Rate for Payer: Cash Price |
$1,582.40
|
| Rate for Payer: Cash Price |
$1,582.40
|
| Rate for Payer: Cofinity Commercial |
$1,532.20
|
| Rate for Payer: Cofinity Commercial |
$1,425.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,064.03
|
| Rate for Payer: Healthscope Commercial |
$1,276.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,276.84
|
| Rate for Payer: Meridian Medicaid |
$724.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,117.23
|
| Rate for Payer: PACE SWMI |
$1,064.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,064.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$690.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,384.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,654.00
|
| Rate for Payer: Priority Health Medicare |
$1,064.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,654.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,095.95
|
|
|
PR OPEN TX COMPLICATED FRONTAL SINUS FRACTURE
|
Professional
|
Both
|
$3,407.00
|
|
|
Service Code
|
HCPCS 21344
|
| Min. Negotiated Rate |
$118.87 |
| Max. Negotiated Rate |
$2,384.90 |
| Rate for Payer: Aetna Commercial |
$1,840.92
|
| Rate for Payer: Aetna Medicare |
$1,373.82
|
| Rate for Payer: BCBS Complete |
$935.75
|
| Rate for Payer: BCBS MAPPO |
$1,373.82
|
| Rate for Payer: BCBS Trust/PPO |
$118.87
|
| Rate for Payer: BCN Commercial |
$2,044.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,373.82
|
| Rate for Payer: Cash Price |
$2,725.60
|
| Rate for Payer: Cash Price |
$2,725.60
|
| Rate for Payer: Cofinity Commercial |
$1,840.92
|
| Rate for Payer: Cofinity Commercial |
$1,978.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,373.82
|
| Rate for Payer: Healthscope Commercial |
$1,648.58
|
| Rate for Payer: Healthscope Whirlpool |
$1,648.58
|
| Rate for Payer: Meridian Medicaid |
$935.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,442.51
|
| Rate for Payer: PACE SWMI |
$1,373.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,373.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$891.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,384.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,136.56
|
| Rate for Payer: Priority Health Medicare |
$1,373.82
|
| Rate for Payer: Priority Health Narrow Network |
$2,136.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,415.03
|
|
|
PR OPEN TX CRANIOFACIAL SEP COMPLICATED MLT APPR
|
Professional
|
Both
|
$2,954.00
|
|
|
Service Code
|
HCPCS 21433
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$2,644.15 |
| Rate for Payer: Aetna Commercial |
$2,283.78
|
| Rate for Payer: Aetna Medicare |
$1,704.31
|
| Rate for Payer: BCBS Complete |
$1,159.85
|
| Rate for Payer: BCBS MAPPO |
$1,704.31
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$2,530.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,704.31
|
| Rate for Payer: Cash Price |
$2,363.20
|
| Rate for Payer: Cash Price |
$2,363.20
|
| Rate for Payer: Cofinity Commercial |
$2,454.21
|
| Rate for Payer: Cofinity Commercial |
$2,283.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,704.31
|
| Rate for Payer: Healthscope Commercial |
$2,045.17
|
| Rate for Payer: Healthscope Whirlpool |
$2,045.17
|
| Rate for Payer: Meridian Medicaid |
$1,159.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,789.53
|
| Rate for Payer: PACE SWMI |
$1,704.31
|
| Rate for Payer: PHP Medicare Advantage |
$1,704.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,104.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,067.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,644.15
|
| Rate for Payer: Priority Health Medicare |
$1,704.31
|
| Rate for Payer: Priority Health Narrow Network |
$2,644.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,755.44
|
|
|
PR OPEN TX DEPRESSED FRONTAL SINUS FRACTURE
|
Professional
|
Both
|
$2,405.00
|
|
|
Service Code
|
HCPCS 21343
|
| Min. Negotiated Rate |
$106.88 |
| Max. Negotiated Rate |
$1,683.50 |
| Rate for Payer: Aetna Commercial |
$1,426.22
|
| Rate for Payer: Aetna Medicare |
$1,064.34
|
| Rate for Payer: BCBS Complete |
$732.68
|
| Rate for Payer: BCBS MAPPO |
$1,064.34
|
| Rate for Payer: BCBS Trust/PPO |
$106.88
|
| Rate for Payer: BCN Commercial |
$1,598.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,064.34
|
| Rate for Payer: Cash Price |
$1,924.00
|
| Rate for Payer: Cash Price |
$1,924.00
|
| Rate for Payer: Cofinity Commercial |
$1,532.65
|
| Rate for Payer: Cofinity Commercial |
$1,426.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,064.34
|
| Rate for Payer: Healthscope Commercial |
$1,277.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,277.21
|
| Rate for Payer: Meridian Medicaid |
$732.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,117.56
|
| Rate for Payer: PACE SWMI |
$1,064.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,064.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$697.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,683.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,670.34
|
| Rate for Payer: Priority Health Medicare |
$1,064.34
|
| Rate for Payer: Priority Health Narrow Network |
$1,670.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,096.27
|
|
|
PR OPEN TX DEPRESSED MALAR FRACTURE
|
Professional
|
Both
|
$1,017.00
|
|
|
Service Code
|
HCPCS 21360
|
| Min. Negotiated Rate |
$339.31 |
| Max. Negotiated Rate |
$6,614.63 |
| Rate for Payer: Aetna Commercial |
$689.48
|
| Rate for Payer: Aetna Medicare |
$514.54
|
| Rate for Payer: BCBS Complete |
$356.28
|
| Rate for Payer: BCBS MAPPO |
$514.54
|
| Rate for Payer: BCBS Trust/PPO |
$6,614.63
|
| Rate for Payer: BCN Commercial |
$771.14
|
| Rate for Payer: BCN Medicare Advantage |
$514.54
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cofinity Commercial |
$740.94
|
| Rate for Payer: Cofinity Commercial |
$689.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$514.54
|
| Rate for Payer: Healthscope Commercial |
$617.45
|
| Rate for Payer: Healthscope Whirlpool |
$617.45
|
| Rate for Payer: Meridian Medicaid |
$356.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$540.27
|
| Rate for Payer: PACE SWMI |
$514.54
|
| Rate for Payer: PHP Medicare Advantage |
$514.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$339.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$711.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$805.81
|
| Rate for Payer: Priority Health Medicare |
$514.54
|
| Rate for Payer: Priority Health Narrow Network |
$805.81
|
| Rate for Payer: UHC Medicare Advantage |
$529.98
|
|
