|
PR OPEN TX ILIAC SPINE UNI/BIL
|
Professional
|
Both
|
$2,634.00
|
|
|
Service Code
|
HCPCS G0412
|
| Min. Negotiated Rate |
$699.08 |
| Max. Negotiated Rate |
$1,712.10 |
| Rate for Payer: Aetna Commercial |
$936.77
|
| Rate for Payer: Aetna Medicare |
$699.08
|
| Rate for Payer: BCBS Complete |
$1,053.60
|
| Rate for Payer: BCBS MAPPO |
$699.08
|
| Rate for Payer: BCN Medicare Advantage |
$699.08
|
| Rate for Payer: Cash Price |
$2,107.20
|
| Rate for Payer: Cash Price |
$2,107.20
|
| Rate for Payer: Cofinity Commercial |
$936.77
|
| Rate for Payer: Cofinity Commercial |
$1,006.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$699.08
|
| Rate for Payer: Healthscope Commercial |
$838.90
|
| Rate for Payer: Healthscope Whirlpool |
$838.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$734.03
|
| Rate for Payer: Nomi Health Commercial |
$838.90
|
| Rate for Payer: PACE SWMI |
$699.08
|
| Rate for Payer: PHP Medicare Advantage |
$699.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,712.10
|
| Rate for Payer: Priority Health Medicare |
$699.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$699.08
|
| Rate for Payer: UHC Medicare Advantage |
$699.08
|
| Rate for Payer: UHCCP DNSP |
$699.08
|
|
|
PR OPEN TX INTERCONDYLAR SPINE/TUBRST FRACTURE KNEE
|
Professional
|
Both
|
$2,749.00
|
|
|
Service Code
|
HCPCS 27540
|
| Min. Negotiated Rate |
$787.24 |
| Max. Negotiated Rate |
$1,786.85 |
| Rate for Payer: Aetna Commercial |
$1,054.90
|
| Rate for Payer: Aetna Medicare |
$787.24
|
| Rate for Payer: BCBS Complete |
$1,099.60
|
| Rate for Payer: BCBS MAPPO |
$787.24
|
| Rate for Payer: BCN Medicare Advantage |
$787.24
|
| Rate for Payer: Cash Price |
$2,199.20
|
| Rate for Payer: Cash Price |
$2,199.20
|
| Rate for Payer: Cofinity Commercial |
$1,133.63
|
| Rate for Payer: Cofinity Commercial |
$1,054.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$787.24
|
| Rate for Payer: Healthscope Commercial |
$944.69
|
| Rate for Payer: Healthscope Whirlpool |
$944.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$826.60
|
| Rate for Payer: Nomi Health Commercial |
$944.69
|
| Rate for Payer: PACE SWMI |
$787.24
|
| Rate for Payer: PHP Medicare Advantage |
$787.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,786.85
|
| Rate for Payer: Priority Health Medicare |
$787.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$787.24
|
| Rate for Payer: UHC Medicare Advantage |
$787.24
|
| Rate for Payer: UHCCP DNSP |
$787.24
|
|
|
PR OPEN TX INTERPHALANGEAL JOINT DISLOCATION
|
Professional
|
Both
|
$1,540.00
|
|
|
Service Code
|
HCPCS 26785
|
| Min. Negotiated Rate |
$531.22 |
| Max. Negotiated Rate |
$1,001.00 |
| Rate for Payer: Aetna Commercial |
$711.83
|
| Rate for Payer: Aetna Medicare |
$531.22
|
| Rate for Payer: BCBS Complete |
$616.00
|
| Rate for Payer: BCBS MAPPO |
$531.22
|
| Rate for Payer: BCN Medicare Advantage |
$531.22
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cofinity Commercial |
$764.96
|
| Rate for Payer: Cofinity Commercial |
$711.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$531.22
|
| Rate for Payer: Healthscope Commercial |
$637.46
|
| Rate for Payer: Healthscope Whirlpool |
$637.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$557.78
|
| Rate for Payer: Nomi Health Commercial |
$637.46
|
| Rate for Payer: PACE SWMI |
$531.22
|
| Rate for Payer: PHP Medicare Advantage |
$531.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,001.00
|
| Rate for Payer: Priority Health Medicare |
$531.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$531.22
|
| Rate for Payer: UHC Medicare Advantage |
$531.22
|
| Rate for Payer: UHCCP DNSP |
$531.22
|
|
|
PR OPEN TX KNEE DISLOCATION W/LIGAMENTOUS REPAIR
|
Professional
|
Both
|
$2,150.00
|
|
|
Service Code
|
HCPCS 27557
|
| Min. Negotiated Rate |
$860.00 |
| Max. Negotiated Rate |
$1,448.05 |
| Rate for Payer: Aetna Commercial |
$1,347.49
|
| Rate for Payer: Aetna Medicare |
$1,005.59
|
| Rate for Payer: BCBS Complete |
$860.00
|
| Rate for Payer: BCBS MAPPO |
$1,005.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,005.59
|
| Rate for Payer: Cash Price |
$1,720.00
|
| Rate for Payer: Cash Price |
$1,720.00
|
| Rate for Payer: Cofinity Commercial |
$1,448.05
|
| Rate for Payer: Cofinity Commercial |
$1,347.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,005.59
|
| Rate for Payer: Healthscope Commercial |
$1,206.71
|
| Rate for Payer: Healthscope Whirlpool |
$1,206.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,055.87
|
| Rate for Payer: Nomi Health Commercial |
$1,206.71
|
| Rate for Payer: PACE SWMI |
$1,005.59
|
| Rate for Payer: PHP Medicare Advantage |
$1,005.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,397.50
|
| Rate for Payer: Priority Health Medicare |
$1,005.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,005.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,005.59
|
| Rate for Payer: UHCCP DNSP |
$1,005.59
|
|
|
PR OPEN TX KNEE DISLOCATION W/O LIGAMENTOUS REPAIR
|
Professional
|
Both
|
$1,775.00
|
|
|
Service Code
|
HCPCS 27556
|
| Min. Negotiated Rate |
$710.00 |
| Max. Negotiated Rate |
$1,214.96 |
| Rate for Payer: Aetna Commercial |
$1,130.58
|
| Rate for Payer: Aetna Medicare |
$843.72
|
| Rate for Payer: BCBS Complete |
$710.00
|
| Rate for Payer: BCBS MAPPO |
$843.72
|
| Rate for Payer: BCN Medicare Advantage |
$843.72
|
| Rate for Payer: Cash Price |
$1,420.00
|
| Rate for Payer: Cash Price |
$1,420.00
|
| Rate for Payer: Cofinity Commercial |
$1,214.96
|
| Rate for Payer: Cofinity Commercial |
$1,130.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$843.72
|
| Rate for Payer: Healthscope Commercial |
$1,012.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,012.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$885.91
|
| Rate for Payer: Nomi Health Commercial |
$1,012.46
|
| Rate for Payer: PACE SWMI |
$843.72
|
| Rate for Payer: PHP Medicare Advantage |
$843.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,153.75
|
| Rate for Payer: Priority Health Medicare |
$843.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$843.72
|
| Rate for Payer: UHC Medicare Advantage |
$843.72
|
| Rate for Payer: UHCCP DNSP |
$843.72
|
|
|
PR OPEN TX KNEE DISLOCATION W/REPAIR/RECONSTRUCTION
|
Professional
|
Both
|
$5,350.00
|
|
|
Service Code
|
HCPCS 27558
|
| Min. Negotiated Rate |
$1,144.46 |
| Max. Negotiated Rate |
$3,477.50 |
| Rate for Payer: Aetna Commercial |
$1,533.58
|
| Rate for Payer: Aetna Medicare |
$1,144.46
|
| Rate for Payer: BCBS Complete |
$2,140.00
|
| Rate for Payer: BCBS MAPPO |
$1,144.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,144.46
|
| Rate for Payer: Cash Price |
$4,280.00
|
| Rate for Payer: Cash Price |
$4,280.00
|
| Rate for Payer: Cofinity Commercial |
$1,648.02
|
| Rate for Payer: Cofinity Commercial |
$1,533.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,144.46
|
| Rate for Payer: Healthscope Commercial |
$1,373.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,373.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,201.68
|
| Rate for Payer: Nomi Health Commercial |
$1,373.35
|
| Rate for Payer: PACE SWMI |
$1,144.46
|
| Rate for Payer: PHP Medicare Advantage |
$1,144.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,477.50
|
| Rate for Payer: Priority Health Medicare |
$1,144.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,144.46
|
| Rate for Payer: UHC Medicare Advantage |
$1,144.46
|
| Rate for Payer: UHCCP DNSP |
$1,144.46
|
|
|
PR OPEN TX MANDIBULAR FX W/INTERDENTAL FIXATION
|
Professional
|
Both
|
$3,401.00
|
|
|
Service Code
|
HCPCS 21462
|
| Min. Negotiated Rate |
$1,067.69 |
| Max. Negotiated Rate |
$2,210.65 |
| Rate for Payer: Aetna Commercial |
$1,430.70
|
| Rate for Payer: Aetna Medicare |
$1,067.69
|
| Rate for Payer: BCBS Complete |
$1,360.40
|
| Rate for Payer: BCBS MAPPO |
$1,067.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,067.69
|
| Rate for Payer: Cash Price |
$2,720.80
|
| Rate for Payer: Cash Price |
$2,720.80
|
| Rate for Payer: Cofinity Commercial |
$1,537.47
|
| Rate for Payer: Cofinity Commercial |
$1,430.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,067.69
|
| Rate for Payer: Healthscope Commercial |
$1,281.23
|
| Rate for Payer: Healthscope Whirlpool |
$1,281.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,121.07
|
| Rate for Payer: Nomi Health Commercial |
$1,281.23
|
| Rate for Payer: PACE SWMI |
$1,067.69
|
| Rate for Payer: PHP Medicare Advantage |
$1,067.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,210.65
|
| Rate for Payer: Priority Health Medicare |
$1,067.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,067.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,067.69
|
| Rate for Payer: UHCCP DNSP |
$1,067.69
|
|
|
PR OPEN TX MANDIBULAR FX W/O INTERDENTAL FIXATION
|
Professional
|
Both
|
$4,190.00
|
|
|
Service Code
|
HCPCS 21461
|
| Min. Negotiated Rate |
$959.19 |
| Max. Negotiated Rate |
$2,723.50 |
| Rate for Payer: Aetna Commercial |
$1,285.31
|
| Rate for Payer: Aetna Medicare |
$959.19
|
| Rate for Payer: BCBS Complete |
$1,676.00
|
| Rate for Payer: BCBS MAPPO |
$959.19
|
| Rate for Payer: BCN Medicare Advantage |
$959.19
|
| Rate for Payer: Cash Price |
$3,352.00
|
| Rate for Payer: Cash Price |
$3,352.00
|
| Rate for Payer: Cofinity Commercial |
$1,381.23
|
| Rate for Payer: Cofinity Commercial |
$1,285.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$959.19
|
| Rate for Payer: Healthscope Commercial |
$1,151.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,151.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,007.15
|
| Rate for Payer: Nomi Health Commercial |
$1,151.03
|
| Rate for Payer: PACE SWMI |
$959.19
|
| Rate for Payer: PHP Medicare Advantage |
$959.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,723.50
|
| Rate for Payer: Priority Health Medicare |
$959.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$959.19
|
| Rate for Payer: UHC Medicare Advantage |
$959.19
|
| Rate for Payer: UHCCP DNSP |
$959.19
|
|
|
PR OPEN TX METACARPAL FRACTURE SINGLE EA BONE
|
Professional
|
Both
|
$1,925.00
|
|
|
Service Code
|
HCPCS 26615
|
| Min. Negotiated Rate |
$557.20 |
| Max. Negotiated Rate |
$1,251.25 |
| Rate for Payer: Aetna Commercial |
$746.65
|
| Rate for Payer: Aetna Medicare |
$557.20
|
| Rate for Payer: BCBS Complete |
$770.00
|
| Rate for Payer: BCBS MAPPO |
$557.20
|
| Rate for Payer: BCN Medicare Advantage |
$557.20
|
| Rate for Payer: Cash Price |
$1,540.00
|
| Rate for Payer: Cash Price |
$1,540.00
|
| Rate for Payer: Cofinity Commercial |
$802.37
|
| Rate for Payer: Cofinity Commercial |
$746.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$557.20
|
| Rate for Payer: Healthscope Commercial |
$668.64
|
| Rate for Payer: Healthscope Whirlpool |
$668.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$585.06
|
| Rate for Payer: Nomi Health Commercial |
$668.64
|
| Rate for Payer: PACE SWMI |
$557.20
|
| Rate for Payer: PHP Medicare Advantage |
$557.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,251.25
|
| Rate for Payer: Priority Health Medicare |
$557.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$557.20
|
| Rate for Payer: UHC Medicare Advantage |
$557.20
|
| Rate for Payer: UHCCP DNSP |
$557.20
|
|
|
PR OPEN TX METATARSOPHALANGEAL JOINT DISLOCATION
|
Professional
|
Both
|
$1,037.00
|
|
|
Service Code
|
HCPCS 28645
|
| Min. Negotiated Rate |
$414.80 |
| Max. Negotiated Rate |
$674.05 |
| Rate for Payer: Aetna Commercial |
$625.02
|
| Rate for Payer: Aetna Medicare |
$466.43
|
| Rate for Payer: BCBS Complete |
$414.80
|
| Rate for Payer: BCBS MAPPO |
$466.43
|
| Rate for Payer: BCN Medicare Advantage |
$466.43
|
| Rate for Payer: Cash Price |
$829.60
|
| Rate for Payer: Cash Price |
$829.60
|
| Rate for Payer: Cofinity Commercial |
$671.66
|
| Rate for Payer: Cofinity Commercial |
$625.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$466.43
|
| Rate for Payer: Healthscope Commercial |
$559.72
|
| Rate for Payer: Healthscope Whirlpool |
$559.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$489.75
|
| Rate for Payer: Nomi Health Commercial |
$559.72
|
| Rate for Payer: PACE SWMI |
$466.43
|
| Rate for Payer: PHP Medicare Advantage |
$466.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.05
|
| Rate for Payer: Priority Health Medicare |
$466.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$466.43
|
| Rate for Payer: UHC Medicare Advantage |
$466.43
|
| Rate for Payer: UHCCP DNSP |
$466.43
|
|
|
PR OPEN TX MONTEGGIA FRACTURE DISLOCATION ELBOW
|
Professional
|
Both
|
$3,444.00
|
|
|
Service Code
|
HCPCS 24635
|
| Min. Negotiated Rate |
$655.74 |
| Max. Negotiated Rate |
$2,238.60 |
| Rate for Payer: Aetna Commercial |
$878.69
|
| Rate for Payer: Aetna Medicare |
$655.74
|
| Rate for Payer: BCBS Complete |
$1,377.60
|
| Rate for Payer: BCBS MAPPO |
$655.74
|
| Rate for Payer: BCN Medicare Advantage |
$655.74
|
| Rate for Payer: Cash Price |
$2,755.20
|
| Rate for Payer: Cash Price |
$2,755.20
|
| Rate for Payer: Cofinity Commercial |
$944.27
|
| Rate for Payer: Cofinity Commercial |
$878.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$655.74
|
| Rate for Payer: Healthscope Commercial |
$786.89
|
| Rate for Payer: Healthscope Whirlpool |
$786.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$688.53
|
| Rate for Payer: Nomi Health Commercial |
$786.89
|
| Rate for Payer: PACE SWMI |
$655.74
|
| Rate for Payer: PHP Medicare Advantage |
$655.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,238.60
|
| Rate for Payer: Priority Health Medicare |
$655.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$655.74
|
| Rate for Payer: UHC Medicare Advantage |
$655.74
|
| Rate for Payer: UHCCP DNSP |
$655.74
|
|
|
PR OPEN TX NASAL FX COMP W/INT&/XTRNL SKELETAL FI
|
Professional
|
Both
|
$1,655.00
|
|
|
Service Code
|
HCPCS 21330
|
| Min. Negotiated Rate |
$499.02 |
| Max. Negotiated Rate |
$1,075.75 |
| Rate for Payer: Aetna Commercial |
$668.69
|
| Rate for Payer: Aetna Medicare |
$499.02
|
| Rate for Payer: BCBS Complete |
$662.00
|
| Rate for Payer: BCBS MAPPO |
$499.02
|
| Rate for Payer: BCN Medicare Advantage |
$499.02
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cofinity Commercial |
$718.59
|
| Rate for Payer: Cofinity Commercial |
$668.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$499.02
|
| Rate for Payer: Healthscope Commercial |
$598.82
|
| Rate for Payer: Healthscope Whirlpool |
$598.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$523.97
|
| Rate for Payer: Nomi Health Commercial |
$598.82
|
| Rate for Payer: PACE SWMI |
$499.02
|
| Rate for Payer: PHP Medicare Advantage |
$499.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,075.75
|
| Rate for Payer: Priority Health Medicare |
$499.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$499.02
|
| Rate for Payer: UHC Medicare Advantage |
$499.02
|
| Rate for Payer: UHCCP DNSP |
$499.02
|
|
|
PR OPEN TX NASAL SEPTAL FRACTURE W/WO STABILIZATION
|
Professional
|
Both
|
$1,476.00
|
|
|
Service Code
|
HCPCS 21336
|
| Min. Negotiated Rate |
$590.40 |
| Max. Negotiated Rate |
$959.40 |
| Rate for Payer: Aetna Commercial |
$796.17
|
| Rate for Payer: Aetna Medicare |
$594.16
|
| Rate for Payer: BCBS Complete |
$590.40
|
| Rate for Payer: BCBS MAPPO |
$594.16
|
| Rate for Payer: BCN Medicare Advantage |
$594.16
|
| Rate for Payer: Cash Price |
$1,180.80
|
| Rate for Payer: Cash Price |
$1,180.80
|
| Rate for Payer: Cofinity Commercial |
$855.59
|
| Rate for Payer: Cofinity Commercial |
$796.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$594.16
|
| Rate for Payer: Healthscope Commercial |
$712.99
|
| Rate for Payer: Healthscope Whirlpool |
$712.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$623.87
|
| Rate for Payer: Nomi Health Commercial |
$712.99
|
| Rate for Payer: PACE SWMI |
$594.16
|
| Rate for Payer: PHP Medicare Advantage |
$594.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$959.40
|
| Rate for Payer: Priority Health Medicare |
$594.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$594.16
|
| Rate for Payer: UHC Medicare Advantage |
$594.16
|
| Rate for Payer: UHCCP DNSP |
$594.16
|
|
|
PR OPEN TX NASOETHMOID FX W/O EXTERNAL FIXATION
|
Professional
|
Both
|
$1,874.00
|
|
|
Service Code
|
HCPCS 21338
|
| Min. Negotiated Rate |
$626.45 |
| Max. Negotiated Rate |
$1,218.10 |
| Rate for Payer: Aetna Commercial |
$839.44
|
| Rate for Payer: Aetna Medicare |
$626.45
|
| Rate for Payer: BCBS Complete |
$749.60
|
| Rate for Payer: BCBS MAPPO |
$626.45
|
| Rate for Payer: BCN Medicare Advantage |
$626.45
|
| Rate for Payer: Cash Price |
$1,499.20
|
| Rate for Payer: Cash Price |
$1,499.20
|
| Rate for Payer: Cofinity Commercial |
$902.09
|
| Rate for Payer: Cofinity Commercial |
$839.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$626.45
|
| Rate for Payer: Healthscope Commercial |
$751.74
|
| Rate for Payer: Healthscope Whirlpool |
$751.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$657.77
|
| Rate for Payer: Nomi Health Commercial |
$751.74
|
| Rate for Payer: PACE SWMI |
$626.45
|
| Rate for Payer: PHP Medicare Advantage |
$626.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,218.10
|
| Rate for Payer: Priority Health Medicare |
$626.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$626.45
|
| Rate for Payer: UHC Medicare Advantage |
$626.45
|
| Rate for Payer: UHCCP DNSP |
$626.45
|
|
|
PR OPEN TX ORBITAL FLOOR BLOWOUT FX PERIORBITAL
|
Professional
|
Both
|
$1,196.00
|
|
|
Service Code
|
HCPCS 21386
|
| Min. Negotiated Rate |
$478.40 |
| Max. Negotiated Rate |
$954.68 |
| Rate for Payer: Aetna Commercial |
$888.38
|
| Rate for Payer: Aetna Medicare |
$662.97
|
| Rate for Payer: BCBS Complete |
$478.40
|
| Rate for Payer: BCBS MAPPO |
$662.97
|
| Rate for Payer: BCN Medicare Advantage |
$662.97
|
| Rate for Payer: Cash Price |
$956.80
|
| Rate for Payer: Cash Price |
$956.80
|
| Rate for Payer: Cofinity Commercial |
$954.68
|
| Rate for Payer: Cofinity Commercial |
$888.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$662.97
|
| Rate for Payer: Healthscope Commercial |
$795.56
|
| Rate for Payer: Healthscope Whirlpool |
$795.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$696.12
|
| Rate for Payer: Nomi Health Commercial |
$795.56
|
| Rate for Payer: PACE SWMI |
$662.97
|
| Rate for Payer: PHP Medicare Advantage |
$662.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$777.40
|
| Rate for Payer: Priority Health Medicare |
$662.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$662.97
|
| Rate for Payer: UHC Medicare Advantage |
$662.97
|
| Rate for Payer: UHCCP DNSP |
$662.97
|
|
|
PR OPEN TX ORBITAL FLOOR BLOWOUT FX TRANSANTRAL
|
Professional
|
Both
|
$1,545.00
|
|
|
Service Code
|
HCPCS 21385
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,004.25 |
| Rate for Payer: Aetna Commercial |
$934.18
|
| Rate for Payer: Aetna Medicare |
$697.15
|
| Rate for Payer: BCBS Complete |
$618.00
|
| Rate for Payer: BCBS MAPPO |
$697.15
|
| Rate for Payer: BCN Medicare Advantage |
$697.15
|
| Rate for Payer: Cash Price |
$1,236.00
|
| Rate for Payer: Cash Price |
$1,236.00
|
| Rate for Payer: Cofinity Commercial |
$934.18
|
| Rate for Payer: Cofinity Commercial |
$1,003.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$697.15
|
| Rate for Payer: Healthscope Commercial |
$836.58
|
| Rate for Payer: Healthscope Whirlpool |
$836.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$732.01
|
| Rate for Payer: Nomi Health Commercial |
$836.58
|
| Rate for Payer: PACE SWMI |
$697.15
|
| Rate for Payer: PHP Medicare Advantage |
$697.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,004.25
|
| Rate for Payer: Priority Health Medicare |
$697.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$697.15
|
| Rate for Payer: UHC Medicare Advantage |
$697.15
|
| Rate for Payer: UHCCP DNSP |
$697.15
|
|
|
PR OPEN TX PALATAL/MAXILLARY FX COMP MULTIPLE APPR
|
Professional
|
Both
|
$1,579.00
|
|
|
Service Code
|
HCPCS 21423
|
| Min. Negotiated Rate |
$631.60 |
| Max. Negotiated Rate |
$1,090.94 |
| Rate for Payer: Aetna Commercial |
$1,015.18
|
| Rate for Payer: Aetna Medicare |
$757.60
|
| Rate for Payer: BCBS Complete |
$631.60
|
| Rate for Payer: BCBS MAPPO |
$757.60
|
| Rate for Payer: BCN Medicare Advantage |
$757.60
|
| Rate for Payer: Cash Price |
$1,263.20
|
| Rate for Payer: Cash Price |
$1,263.20
|
| Rate for Payer: Cofinity Commercial |
$1,090.94
|
| Rate for Payer: Cofinity Commercial |
$1,015.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$757.60
|
| Rate for Payer: Healthscope Commercial |
$909.12
|
| Rate for Payer: Healthscope Whirlpool |
$909.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$795.48
|
| Rate for Payer: Nomi Health Commercial |
$909.12
|
| Rate for Payer: PACE SWMI |
$757.60
|
| Rate for Payer: PHP Medicare Advantage |
$757.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,026.35
|
| Rate for Payer: Priority Health Medicare |
$757.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$757.60
|
| Rate for Payer: UHC Medicare Advantage |
$757.60
|
| Rate for Payer: UHCCP DNSP |
$757.60
|
|
|
PR OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA
|
Professional
|
Both
|
$1,815.00
|
|
|
Service Code
|
HCPCS 26735
|
| Min. Negotiated Rate |
$575.52 |
| Max. Negotiated Rate |
$1,179.75 |
| Rate for Payer: Aetna Commercial |
$771.20
|
| Rate for Payer: Aetna Medicare |
$575.52
|
| Rate for Payer: BCBS Complete |
$726.00
|
| Rate for Payer: BCBS MAPPO |
$575.52
|
| Rate for Payer: BCN Medicare Advantage |
$575.52
|
| Rate for Payer: Cash Price |
$1,452.00
|
| Rate for Payer: Cash Price |
$1,452.00
|
| Rate for Payer: Cofinity Commercial |
$828.75
|
| Rate for Payer: Cofinity Commercial |
$771.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$575.52
|
| Rate for Payer: Healthscope Commercial |
$690.62
|
| Rate for Payer: Healthscope Whirlpool |
$690.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$604.30
|
| Rate for Payer: Nomi Health Commercial |
$690.62
|
| Rate for Payer: PACE SWMI |
$575.52
|
| Rate for Payer: PHP Medicare Advantage |
$575.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,179.75
|
| Rate for Payer: Priority Health Medicare |
$575.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$575.52
|
| Rate for Payer: UHC Medicare Advantage |
$575.52
|
| Rate for Payer: UHCCP DNSP |
$575.52
|
|
|
PR OPEN TX POST PELVIC FXCTURE
|
Professional
|
Both
|
$2,367.00
|
|
|
Service Code
|
HCPCS G0415
|
| Min. Negotiated Rate |
$946.80 |
| Max. Negotiated Rate |
$1,908.55 |
| Rate for Payer: Aetna Commercial |
$1,776.01
|
| Rate for Payer: Aetna Medicare |
$1,325.38
|
| Rate for Payer: BCBS Complete |
$946.80
|
| Rate for Payer: BCBS MAPPO |
$1,325.38
|
| Rate for Payer: BCN Medicare Advantage |
$1,325.38
|
| Rate for Payer: Cash Price |
$1,893.60
|
| Rate for Payer: Cash Price |
$1,893.60
|
| Rate for Payer: Cofinity Commercial |
$1,908.55
|
| Rate for Payer: Cofinity Commercial |
$1,776.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,325.38
|
| Rate for Payer: Healthscope Commercial |
$1,590.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,590.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,391.65
|
| Rate for Payer: Nomi Health Commercial |
$1,590.46
|
| Rate for Payer: PACE SWMI |
$1,325.38
|
| Rate for Payer: PHP Medicare Advantage |
$1,325.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,538.55
|
| Rate for Payer: Priority Health Medicare |
$1,325.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,325.38
|
| Rate for Payer: UHC Medicare Advantage |
$1,325.38
|
| Rate for Payer: UHCCP DNSP |
$1,325.38
|
|
|
PR OPEN TX PROX TIBFIB JOINT DISLOCATE EXC PROX FIB
|
Professional
|
Both
|
$1,843.00
|
|
|
Service Code
|
HCPCS 27832
|
| Min. Negotiated Rate |
$733.97 |
| Max. Negotiated Rate |
$1,197.95 |
| Rate for Payer: Aetna Commercial |
$983.52
|
| Rate for Payer: Aetna Medicare |
$733.97
|
| Rate for Payer: BCBS Complete |
$737.20
|
| Rate for Payer: BCBS MAPPO |
$733.97
|
| Rate for Payer: BCN Medicare Advantage |
$733.97
|
| Rate for Payer: Cash Price |
$1,474.40
|
| Rate for Payer: Cash Price |
$1,474.40
|
| Rate for Payer: Cofinity Commercial |
$983.52
|
| Rate for Payer: Cofinity Commercial |
$1,056.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$733.97
|
| Rate for Payer: Healthscope Commercial |
$880.76
|
| Rate for Payer: Healthscope Whirlpool |
$880.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$770.67
|
| Rate for Payer: Nomi Health Commercial |
$880.76
|
| Rate for Payer: PACE SWMI |
$733.97
|
| Rate for Payer: PHP Medicare Advantage |
$733.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,197.95
|
| Rate for Payer: Priority Health Medicare |
$733.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$733.97
|
| Rate for Payer: UHC Medicare Advantage |
$733.97
|
| Rate for Payer: UHCCP DNSP |
$733.97
|
|
|
PR OPEN TX RADIAL HEAD/NECK FRACTURE
|
Professional
|
Both
|
$2,365.00
|
|
|
Service Code
|
HCPCS 24665
|
| Min. Negotiated Rate |
$636.16 |
| Max. Negotiated Rate |
$1,537.25 |
| Rate for Payer: Aetna Commercial |
$852.45
|
| Rate for Payer: Aetna Medicare |
$636.16
|
| Rate for Payer: BCBS Complete |
$946.00
|
| Rate for Payer: BCBS MAPPO |
$636.16
|
| Rate for Payer: BCN Medicare Advantage |
$636.16
|
| Rate for Payer: Cash Price |
$1,892.00
|
| Rate for Payer: Cash Price |
$1,892.00
|
| Rate for Payer: Cofinity Commercial |
$916.07
|
| Rate for Payer: Cofinity Commercial |
$852.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$636.16
|
| Rate for Payer: Healthscope Commercial |
$763.39
|
| Rate for Payer: Healthscope Whirlpool |
$763.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$667.97
|
| Rate for Payer: Nomi Health Commercial |
$763.39
|
| Rate for Payer: PACE SWMI |
$636.16
|
| Rate for Payer: PHP Medicare Advantage |
$636.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,537.25
|
| Rate for Payer: Priority Health Medicare |
$636.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$636.16
|
| Rate for Payer: UHC Medicare Advantage |
$636.16
|
| Rate for Payer: UHCCP DNSP |
$636.16
|
|
|
PR OPEN TX RADIAL HEAD/NECK FRACTURE PROSTHETIC
|
Professional
|
Both
|
$2,905.00
|
|
|
Service Code
|
HCPCS 24666
|
| Min. Negotiated Rate |
$707.93 |
| Max. Negotiated Rate |
$1,888.25 |
| Rate for Payer: Aetna Commercial |
$948.63
|
| Rate for Payer: Aetna Medicare |
$707.93
|
| Rate for Payer: BCBS Complete |
$1,162.00
|
| Rate for Payer: BCBS MAPPO |
$707.93
|
| Rate for Payer: BCN Medicare Advantage |
$707.93
|
| Rate for Payer: Cash Price |
$2,324.00
|
| Rate for Payer: Cash Price |
$2,324.00
|
| Rate for Payer: Cofinity Commercial |
$948.63
|
| Rate for Payer: Cofinity Commercial |
$1,019.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$707.93
|
| Rate for Payer: Healthscope Commercial |
$849.52
|
| Rate for Payer: Healthscope Whirlpool |
$849.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$743.33
|
| Rate for Payer: Nomi Health Commercial |
$849.52
|
| Rate for Payer: PACE SWMI |
$707.93
|
| Rate for Payer: PHP Medicare Advantage |
$707.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,888.25
|
| Rate for Payer: Priority Health Medicare |
$707.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$707.93
|
| Rate for Payer: UHC Medicare Advantage |
$707.93
|
| Rate for Payer: UHCCP DNSP |
$707.93
|
|
|
PR OPEN TX RADIOCARPAL/INTERCARPAL DISLC 1/> BONES
|
Professional
|
Both
|
$1,984.00
|
|
|
Service Code
|
HCPCS 25670
|
| Min. Negotiated Rate |
$586.97 |
| Max. Negotiated Rate |
$1,289.60 |
| Rate for Payer: Aetna Commercial |
$786.54
|
| Rate for Payer: Aetna Medicare |
$586.97
|
| Rate for Payer: BCBS Complete |
$793.60
|
| Rate for Payer: BCBS MAPPO |
$586.97
|
| Rate for Payer: BCN Medicare Advantage |
$586.97
|
| Rate for Payer: Cash Price |
$1,587.20
|
| Rate for Payer: Cash Price |
$1,587.20
|
| Rate for Payer: Cofinity Commercial |
$845.24
|
| Rate for Payer: Cofinity Commercial |
$786.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$586.97
|
| Rate for Payer: Healthscope Commercial |
$704.36
|
| Rate for Payer: Healthscope Whirlpool |
$704.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$616.32
|
| Rate for Payer: Nomi Health Commercial |
$704.36
|
| Rate for Payer: PACE SWMI |
$586.97
|
| Rate for Payer: PHP Medicare Advantage |
$586.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,289.60
|
| Rate for Payer: Priority Health Medicare |
$586.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$586.97
|
| Rate for Payer: UHC Medicare Advantage |
$586.97
|
| Rate for Payer: UHCCP DNSP |
$586.97
|
|
|
PR OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 1-3 RIBS
|
Professional
|
Both
|
$1,263.00
|
|
|
Service Code
|
HCPCS 21811
|
| Min. Negotiated Rate |
$505.20 |
| Max. Negotiated Rate |
$826.92 |
| Rate for Payer: Aetna Commercial |
$769.50
|
| Rate for Payer: Aetna Medicare |
$574.25
|
| Rate for Payer: BCBS Complete |
$505.20
|
| Rate for Payer: BCBS MAPPO |
$574.25
|
| Rate for Payer: BCN Medicare Advantage |
$574.25
|
| Rate for Payer: Cash Price |
$1,010.40
|
| Rate for Payer: Cash Price |
$1,010.40
|
| Rate for Payer: Cofinity Commercial |
$826.92
|
| Rate for Payer: Cofinity Commercial |
$769.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$574.25
|
| Rate for Payer: Healthscope Commercial |
$689.10
|
| Rate for Payer: Healthscope Whirlpool |
$689.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$602.96
|
| Rate for Payer: Nomi Health Commercial |
$689.10
|
| Rate for Payer: PACE SWMI |
$574.25
|
| Rate for Payer: PHP Medicare Advantage |
$574.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$820.95
|
| Rate for Payer: Priority Health Medicare |
$574.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$574.25
|
| Rate for Payer: UHC Medicare Advantage |
$574.25
|
| Rate for Payer: UHCCP DNSP |
$574.25
|
|
|
PR OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 4-6 RIBS
|
Professional
|
Both
|
$1,763.00
|
|
|
Service Code
|
HCPCS 21812
|
| Min. Negotiated Rate |
$694.60 |
| Max. Negotiated Rate |
$1,145.95 |
| Rate for Payer: Aetna Commercial |
$930.76
|
| Rate for Payer: Aetna Medicare |
$694.60
|
| Rate for Payer: BCBS Complete |
$705.20
|
| Rate for Payer: BCBS MAPPO |
$694.60
|
| Rate for Payer: BCN Medicare Advantage |
$694.60
|
| Rate for Payer: Cash Price |
$1,410.40
|
| Rate for Payer: Cash Price |
$1,410.40
|
| Rate for Payer: Cofinity Commercial |
$930.76
|
| Rate for Payer: Cofinity Commercial |
$1,000.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$694.60
|
| Rate for Payer: Healthscope Commercial |
$833.52
|
| Rate for Payer: Healthscope Whirlpool |
$833.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$729.33
|
| Rate for Payer: Nomi Health Commercial |
$833.52
|
| Rate for Payer: PACE SWMI |
$694.60
|
| Rate for Payer: PHP Medicare Advantage |
$694.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,145.95
|
| Rate for Payer: Priority Health Medicare |
$694.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$694.60
|
| Rate for Payer: UHC Medicare Advantage |
$694.60
|
| Rate for Payer: UHCCP DNSP |
$694.60
|
|
