The CHIROmax Plan
The CHIROmax plan can save your family from 10% to50% on your chiropractic needs based on the fee schedule. Any chiropractic procedure that is not listed in the fee schedule will be charged to the member at a rate of 30% off the usual and customary fee. In the event that a doctor's usual and customary fee is the same as or less than the listed member pay fee an additional 10% discount will be given.
CHIROmax Fee Schedule
| CPT Code | Description of Services |
Average Charge | Member Plays |
| Evaluation and Management | |||
| 99201 | Office or outpatient visit for evaluation and management of new patient | $33 | $23 |
| 99202 | Office or outpatient visit for evaluation and management of new patient, expanded | $46 | $32 |
| 99203 | Office or outpatient visit for evaluation and management of new patient, expanded | $65 | $45 |
| 99204 | Office or outpatient visit for evaluation and management of new patient, detailed | $65 | $45 |
| 99211 | Office or outpatient visit for evaluation and management of established patient that may not require presence of a physician | $22 | $15 |
| 99212 | Office or outpatient visit for evaluation and management of established patient | $35 | $25 |
| 99213 | Office or outpatient visit for evaluation and management of established patient, expanded | $44 | $31 |
| 99214 | Office or outpatient visit for evaluation and management of established patient, detailed | $94 | $65 |
| Modalities | Average Charge | Member Plays | |
| 97010 | Hot or cold packs | $20 | $13 |
| 97012 | Traction, mechanical | $21 | $14 |
| 97014 | Electrical stimulation (attended) | $21 | $14 |
| 97024 | Diathermy | $21 | $14 |
| 97032 | Electric stimulation (manual), each 15 minutes | $23 | $16 |
| 97035 | Ultrasound, each 15 minutes | $22 | $15 |
| Therapeutic Procedures | Average Charge | Member Plays | |
| (Physician or therapist required to have direct, one on one, patient contact) | |||
| 97122 | Traction, manual | $22 | $15 |
| 97124 | Massage (15minutes) | $24 | $17 |
| 97250 | Myofascial release/soft tissue Mobilization | $24 | $17 |
| 98940 | Chiropractic manipulative treatment (CMT); spinal, one to two regions | 30% off | Customary Charge |
| 98941 | CMT; spinal, three to four regions | 30% off | Customary Charge |
| 98942 | CMT; spinal, five regions | 30% off | Customary Charge |
| 98943 | CMT; extra spinal, one or more regions | 30% off | Customary Charge |
| Radiology | Average Charge | Member Plays | |
| 72010 | Spine; entire, survey study, AP and lateral | $102 | $71 |
| 72020 | Spine; single view, specify level | $40 | $28 |
| 72040 | Spine; cervical, AP and lateral | ||
| 72050 | Spine; minimum of four views | $63 | $44 |
| 7252 | Spine; complete, including oblique and flexion and /or extensions studies | $120 | $84 |
| 72070 | Spine; thoracic, AP and lateral | $186 | $58 |
| 72100 | Spine; lumbrosacral, AP and lateral | $82 | $59 |
| 72110 | Spine; lumbrosacral, complete, with oblique views | $107 | $85 |
| 72114 | Spine; lumbrosacral, complete, including bending views | $153 | $122 |
| 73030 | Shoulder; complete, minumum of 2 views | $174 | $48 |
| 73070 | Elbow, AP and lateral | $68 | $48 |
| 73100 | Wrist, AP and lateral | $68 | $34 |
| 73120 | Hand; 2 views | $49 | $28 |
| 73560 | Knee; AP and lateral | $55 | $38 |
| 73600 | Ankle; AP and lateral | $55 | $38 |