|
PR OPEN IMPLTJ HPGLSL NRV NSTIM RA PG&RESPIR SENSOR
|
Professional
|
Both
|
$3,791.87
|
|
|
Service Code
|
HCPCS 64582
|
| Min. Negotiated Rate |
$674.98 |
| Max. Negotiated Rate |
$2,169.59 |
| Rate for Payer: Cash Price |
$973.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$964.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$867.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$867.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$916.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$964.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$916.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$964.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$964.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$723.20
|
| Rate for Payer: Healthfirst Commercial |
$964.26
|
| Rate for Payer: Healthfirst Essential Plan |
$2,169.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$916.05
|
| Rate for Payer: Healthfirst QHP |
$964.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$674.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$964.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$819.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$674.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$964.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$723.20
|
| Rate for Payer: SOMOS Essential |
$723.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$964.26
|
|
|
PR OPEN OSTEOCHONDRAL AUTOGRAFT TALUS
|
Professional
|
Both
|
$5,411.56
|
|
|
Service Code
|
HCPCS 28446
|
| Min. Negotiated Rate |
$1,017.08 |
| Max. Negotiated Rate |
$3,269.18 |
| Rate for Payer: Cash Price |
$1,459.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,452.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,307.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,307.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,380.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,452.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,380.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,452.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,452.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,089.73
|
| Rate for Payer: Healthfirst Commercial |
$1,452.97
|
| Rate for Payer: Healthfirst Essential Plan |
$3,269.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,380.32
|
| Rate for Payer: Healthfirst QHP |
$1,452.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,017.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,452.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,235.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,017.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,452.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,089.73
|
| Rate for Payer: SOMOS Essential |
$1,089.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,452.97
|
|
|
PR OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL
|
Professional
|
Both
|
$648.55
|
|
|
Service Code
|
HCPCS 37239
|
| Min. Negotiated Rate |
$120.68 |
| Max. Negotiated Rate |
$387.90 |
| Rate for Payer: Cash Price |
$172.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$172.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$155.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$155.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$163.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$172.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$163.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$172.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$172.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$129.30
|
| Rate for Payer: Healthfirst Commercial |
$172.40
|
| Rate for Payer: Healthfirst Essential Plan |
$387.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$163.78
|
| Rate for Payer: Healthfirst QHP |
$172.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$120.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$172.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$146.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$120.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$172.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$129.30
|
| Rate for Payer: SOMOS Essential |
$129.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$172.40
|
|
|
PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL
|
Professional
|
Both
|
$917.88
|
|
|
Service Code
|
HCPCS 37237
|
| Min. Negotiated Rate |
$169.95 |
| Max. Negotiated Rate |
$546.25 |
| Rate for Payer: Cash Price |
$245.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$242.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$218.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$218.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$230.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$242.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$230.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$242.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$242.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$182.09
|
| Rate for Payer: Healthfirst Commercial |
$242.78
|
| Rate for Payer: Healthfirst Essential Plan |
$546.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$230.64
|
| Rate for Payer: Healthfirst QHP |
$242.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$169.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$242.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$206.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$169.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$242.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$182.09
|
| Rate for Payer: SOMOS Essential |
$182.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$242.78
|
|
|
PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL
|
Professional
|
Both
|
$1,930.88
|
|
|
Service Code
|
HCPCS 37236
|
| Min. Negotiated Rate |
$354.13 |
| Max. Negotiated Rate |
$1,138.28 |
| Rate for Payer: Cash Price |
$510.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$505.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$455.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$455.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$480.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$505.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$480.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$505.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$505.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$379.43
|
| Rate for Payer: Healthfirst Commercial |
$505.90
|
| Rate for Payer: Healthfirst Essential Plan |
$1,138.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$480.61
|
| Rate for Payer: Healthfirst QHP |
$505.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$354.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$505.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$430.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$354.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$505.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$379.43
|
| Rate for Payer: SOMOS Essential |
$379.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$505.90
|
|
|
PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST
|
Professional
|
Both
|
$1,315.69
|
|
|
Service Code
|
HCPCS 37238
|
| Min. Negotiated Rate |
$244.53 |
| Max. Negotiated Rate |
$785.99 |
| Rate for Payer: Cash Price |
$352.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$349.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$314.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$314.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$331.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$349.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$331.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$349.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$349.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$262.00
|
| Rate for Payer: Healthfirst Commercial |
$349.33
|
| Rate for Payer: Healthfirst Essential Plan |
$785.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$331.86
|
| Rate for Payer: Healthfirst QHP |
$349.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$244.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$349.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$296.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$244.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$349.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$262.00
|
| Rate for Payer: SOMOS Essential |
$262.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$349.33
|
|
|
PR OPEN PROX HUMERAL FRACTURE PROSTHETIC RPLCMT
|
Professional
|
Both
|
$5,455.77
|
|
|
Service Code
|
HCPCS 23616
|
| Min. Negotiated Rate |
$1,021.25 |
| Max. Negotiated Rate |
$3,282.59 |
| Rate for Payer: Cash Price |
$1,471.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,458.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,313.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,313.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,385.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,458.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,385.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,458.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,458.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,094.20
|
| Rate for Payer: Healthfirst Commercial |
$1,458.93
|
| Rate for Payer: Healthfirst Essential Plan |
$3,282.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,385.98
|
| Rate for Payer: Healthfirst QHP |
$1,458.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,021.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,458.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,240.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,021.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,458.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,094.20
|
| Rate for Payer: SOMOS Essential |
$1,094.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,458.93
|
|
|
PR OPEN RDL SHAFT FX CLOSED RAD/ULN JT DISLOCATE
|
Professional
|
Both
|
$3,501.05
|
|
|
Service Code
|
HCPCS 25525
|
| Min. Negotiated Rate |
$661.98 |
| Max. Negotiated Rate |
$2,127.78 |
| Rate for Payer: Cash Price |
$948.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$945.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$851.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$851.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$898.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$945.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$898.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$945.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$945.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$709.26
|
| Rate for Payer: Healthfirst Commercial |
$945.68
|
| Rate for Payer: Healthfirst Essential Plan |
$2,127.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$898.40
|
| Rate for Payer: Healthfirst QHP |
$945.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$661.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$945.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$803.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$661.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$945.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$709.26
|
| Rate for Payer: SOMOS Essential |
$709.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$945.68
|
|
|
PR OPEN RDL SHAFT FX OPEN RAD/ULN JT DISLOCATE
|
Professional
|
Both
|
$4,239.41
|
|
|
Service Code
|
HCPCS 25526
|
| Min. Negotiated Rate |
$798.63 |
| Max. Negotiated Rate |
$2,567.03 |
| Rate for Payer: Cash Price |
$1,146.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,140.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,026.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,026.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,083.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,140.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,083.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,140.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,140.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$855.67
|
| Rate for Payer: Healthfirst Commercial |
$1,140.90
|
| Rate for Payer: Healthfirst Essential Plan |
$2,567.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,083.86
|
| Rate for Payer: Healthfirst QHP |
$1,140.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$798.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,140.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$969.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$798.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,140.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$855.67
|
| Rate for Payer: SOMOS Essential |
$855.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,140.90
|
|
|
PR OPEN REPAIR OF ROTATOR CUFF ACUTE
|
Professional
|
Both
|
$3,630.66
|
|
|
Service Code
|
HCPCS 23410
|
| Min. Negotiated Rate |
$682.58 |
| Max. Negotiated Rate |
$2,194.02 |
| Rate for Payer: Cash Price |
$979.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$975.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$877.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$877.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$926.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$975.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$926.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$975.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$975.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$731.34
|
| Rate for Payer: Healthfirst Commercial |
$975.12
|
| Rate for Payer: Healthfirst Essential Plan |
$2,194.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$926.36
|
| Rate for Payer: Healthfirst QHP |
$975.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$682.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$975.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$828.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$682.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$975.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$731.34
|
| Rate for Payer: SOMOS Essential |
$731.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$975.12
|
|
|
PR OPEN REPAIR OF ROTATOR CUFF CHRONIC
|
Professional
|
Both
|
$3,771.50
|
|
|
Service Code
|
HCPCS 23412
|
| Min. Negotiated Rate |
$709.65 |
| Max. Negotiated Rate |
$2,281.03 |
| Rate for Payer: Cash Price |
$1,018.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,013.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$912.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$912.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$963.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,013.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$963.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,013.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,013.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$760.34
|
| Rate for Payer: Healthfirst Commercial |
$1,013.79
|
| Rate for Payer: Healthfirst Essential Plan |
$2,281.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$963.10
|
| Rate for Payer: Healthfirst QHP |
$1,013.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$709.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,013.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$861.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$709.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,013.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$760.34
|
| Rate for Payer: SOMOS Essential |
$760.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,013.79
|
|
|
PR OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE
|
Professional
|
Both
|
$3,373.65
|
|
|
Service Code
|
HCPCS 27814
|
| Min. Negotiated Rate |
$633.63 |
| Max. Negotiated Rate |
$2,036.68 |
| Rate for Payer: Cash Price |
$911.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$905.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$814.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$814.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$859.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$905.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$859.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$905.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$905.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$678.89
|
| Rate for Payer: Healthfirst Commercial |
$905.19
|
| Rate for Payer: Healthfirst Essential Plan |
$2,036.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$859.93
|
| Rate for Payer: Healthfirst QHP |
$905.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$633.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$905.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$769.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$633.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$905.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$678.89
|
| Rate for Payer: SOMOS Essential |
$678.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$905.19
|
|
|
PR OPEN TREATMENT CALCANEAL FRACTURE
|
Professional
|
Both
|
$4,894.72
|
|
|
Service Code
|
HCPCS 28415
|
| Min. Negotiated Rate |
$918.35 |
| Max. Negotiated Rate |
$2,951.84 |
| Rate for Payer: Cash Price |
$1,321.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,311.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,180.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,180.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,246.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,311.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,246.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,311.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,311.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$983.95
|
| Rate for Payer: Healthfirst Commercial |
$1,311.93
|
| Rate for Payer: Healthfirst Essential Plan |
$2,951.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,246.33
|
| Rate for Payer: Healthfirst QHP |
$1,311.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$918.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,311.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,115.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$918.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,311.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$983.95
|
| Rate for Payer: SOMOS Essential |
$983.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,311.93
|
|
|
PR OPEN TREATMENT CALCANEAL FRACTURE W BONE GRAFT
|
Professional
|
Both
|
$5,736.36
|
|
|
Service Code
|
HCPCS 28420
|
| Min. Negotiated Rate |
$1,075.00 |
| Max. Negotiated Rate |
$3,455.37 |
| Rate for Payer: Cash Price |
$1,546.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,535.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,382.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,382.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,458.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,535.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,458.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,535.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,535.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,151.79
|
| Rate for Payer: Healthfirst Commercial |
$1,535.72
|
| Rate for Payer: Healthfirst Essential Plan |
$3,455.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,458.93
|
| Rate for Payer: Healthfirst QHP |
$1,535.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,075.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,535.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,305.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,075.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,535.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,151.79
|
| Rate for Payer: SOMOS Essential |
$1,151.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,535.72
|
|
|
PR OPEN TREATMENT COCCYGEAL FRACTURE
|
Professional
|
Both
|
$2,345.46
|
|
|
Service Code
|
HCPCS 27202
|
| Min. Negotiated Rate |
$442.25 |
| Max. Negotiated Rate |
$1,421.51 |
| Rate for Payer: Cash Price |
$634.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$631.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$568.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$568.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$600.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$631.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$600.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$631.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$631.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$473.83
|
| Rate for Payer: Healthfirst Commercial |
$631.78
|
| Rate for Payer: Healthfirst Essential Plan |
$1,421.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$600.19
|
| Rate for Payer: Healthfirst QHP |
$631.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$442.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$631.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$537.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$442.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$631.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$473.83
|
| Rate for Payer: SOMOS Essential |
$473.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$631.78
|
|
|
PR OPEN TREATMENT FRACTURE DISTAL TIBIA & FIBULA
|
Professional
|
Both
|
$5,853.93
|
|
|
Service Code
|
HCPCS 27828
|
| Min. Negotiated Rate |
$1,092.28 |
| Max. Negotiated Rate |
$3,510.90 |
| Rate for Payer: Cash Price |
$1,576.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,560.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,404.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,404.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,482.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,560.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,482.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,560.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,560.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,170.30
|
| Rate for Payer: Healthfirst Commercial |
$1,560.40
|
| Rate for Payer: Healthfirst Essential Plan |
$3,510.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,482.38
|
| Rate for Payer: Healthfirst QHP |
$1,560.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,092.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,560.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,326.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,092.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,560.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,170.30
|
| Rate for Payer: SOMOS Essential |
$1,170.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,560.40
|
|
|
PR OPEN TREATMENT FRACTURE DISTAL TIBIA FIBULA
|
Professional
|
Both
|
$3,755.78
|
|
|
Service Code
|
HCPCS 27826
|
| Min. Negotiated Rate |
$702.93 |
| Max. Negotiated Rate |
$2,259.41 |
| Rate for Payer: Cash Price |
$1,014.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,004.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$903.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$903.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$953.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,004.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$953.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,004.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,004.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$753.13
|
| Rate for Payer: Healthfirst Commercial |
$1,004.18
|
| Rate for Payer: Healthfirst Essential Plan |
$2,259.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$953.97
|
| Rate for Payer: Healthfirst QHP |
$1,004.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$702.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,004.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$853.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$702.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,004.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$753.13
|
| Rate for Payer: SOMOS Essential |
$753.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,004.18
|
|
|
PR OPEN TREATMENT FRACTURE DISTAL TIBIA ONLY
|
Professional
|
Both
|
$4,945.01
|
|
|
Service Code
|
HCPCS 27827
|
| Min. Negotiated Rate |
$927.19 |
| Max. Negotiated Rate |
$2,980.26 |
| Rate for Payer: Cash Price |
$1,333.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,324.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,192.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,192.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,258.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,324.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,258.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,324.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,324.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$993.42
|
| Rate for Payer: Healthfirst Commercial |
$1,324.56
|
| Rate for Payer: Healthfirst Essential Plan |
$2,980.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,258.33
|
| Rate for Payer: Healthfirst QHP |
$1,324.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$927.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,324.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,125.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$927.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,324.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$993.42
|
| Rate for Payer: SOMOS Essential |
$993.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,324.56
|
|
|
PR OPEN TREATMENT GREATER TROCHANTERIC FRACTURE
|
Professional
|
Both
|
$3,298.33
|
|
|
Service Code
|
HCPCS 27248
|
| Min. Negotiated Rate |
$619.47 |
| Max. Negotiated Rate |
$1,991.16 |
| Rate for Payer: Cash Price |
$889.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$884.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$796.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$796.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$840.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$884.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$840.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$884.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$884.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$663.72
|
| Rate for Payer: Healthfirst Commercial |
$884.96
|
| Rate for Payer: Healthfirst Essential Plan |
$1,991.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$840.71
|
| Rate for Payer: Healthfirst QHP |
$884.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$619.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$884.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$752.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$619.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$884.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$663.72
|
| Rate for Payer: SOMOS Essential |
$663.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$884.96
|
|
|
PR OPEN TREATMENT GRTER HUMERAL TUBEROSITY FRACTURE
|
Professional
|
Both
|
$3,455.69
|
|
|
Service Code
|
HCPCS 23630
|
| Min. Negotiated Rate |
$653.22 |
| Max. Negotiated Rate |
$2,099.63 |
| Rate for Payer: Cash Price |
$936.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$933.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$839.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$839.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$886.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$933.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$886.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$933.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$933.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$699.88
|
| Rate for Payer: Healthfirst Commercial |
$933.17
|
| Rate for Payer: Healthfirst Essential Plan |
$2,099.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$886.51
|
| Rate for Payer: Healthfirst QHP |
$933.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$653.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$933.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$793.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$653.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$933.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$699.88
|
| Rate for Payer: SOMOS Essential |
$699.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$933.17
|
|
|
PR OPEN TREATMENT HUMERAL CONDYLAR FRACTURE
|
Professional
|
Both
|
$3,693.24
|
|
|
Service Code
|
HCPCS 24579
|
| Min. Negotiated Rate |
$697.65 |
| Max. Negotiated Rate |
$2,242.44 |
| Rate for Payer: Cash Price |
$999.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$996.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$896.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$896.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$946.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$996.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$946.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$996.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$996.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$747.48
|
| Rate for Payer: Healthfirst Commercial |
$996.64
|
| Rate for Payer: Healthfirst Essential Plan |
$2,242.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$946.81
|
| Rate for Payer: Healthfirst QHP |
$996.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$697.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$996.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$847.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$697.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$996.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$747.48
|
| Rate for Payer: SOMOS Essential |
$747.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$996.64
|
|
|
PR OPEN TREATMENT INTERPHALANGEAL JOINT DISLOCATION
|
Professional
|
Both
|
$1,764.98
|
|
|
Service Code
|
HCPCS 28675
|
| Min. Negotiated Rate |
$338.56 |
| Max. Negotiated Rate |
$1,088.23 |
| Rate for Payer: Cash Price |
$487.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$483.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$435.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$435.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$459.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$483.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$459.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$483.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$362.75
|
| Rate for Payer: Healthfirst Commercial |
$483.66
|
| Rate for Payer: Healthfirst Essential Plan |
$1,088.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$459.48
|
| Rate for Payer: Healthfirst QHP |
$483.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$338.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$483.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$411.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$338.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$483.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$362.75
|
| Rate for Payer: SOMOS Essential |
$362.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$483.66
|
|
|
PR OPEN TREATMENT LUNATE DISLOCATION
|
Professional
|
Both
|
$2,823.17
|
|
|
Service Code
|
HCPCS 25695
|
| Min. Negotiated Rate |
$532.92 |
| Max. Negotiated Rate |
$1,712.97 |
| Rate for Payer: Cash Price |
$764.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$761.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$685.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$685.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$723.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$761.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$723.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$761.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$761.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$570.99
|
| Rate for Payer: Healthfirst Commercial |
$761.32
|
| Rate for Payer: Healthfirst Essential Plan |
$1,712.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$723.25
|
| Rate for Payer: Healthfirst QHP |
$761.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$532.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$761.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$647.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$532.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$761.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$570.99
|
| Rate for Payer: SOMOS Essential |
$570.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$761.32
|
|
|
PR OPEN TREATMENT MANDIBULAR CONDYLAR FRACTURE
|
Professional
|
Both
|
$3,329.48
|
|
|
Service Code
|
HCPCS 21465
|
| Min. Negotiated Rate |
$644.51 |
| Max. Negotiated Rate |
$2,071.64 |
| Rate for Payer: Cash Price |
$911.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$920.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$828.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$828.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$874.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$920.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$874.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$920.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$920.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$690.55
|
| Rate for Payer: Healthfirst Commercial |
$920.73
|
| Rate for Payer: Healthfirst Essential Plan |
$2,071.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$874.69
|
| Rate for Payer: Healthfirst QHP |
$920.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$644.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$920.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$782.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$644.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$920.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$690.55
|
| Rate for Payer: SOMOS Essential |
$690.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$920.73
|
|
|
PR OPEN TREATMENT MEDIAL MALLEOLUS FRACTURE
|
Professional
|
Both
|
$2,679.71
|
|
|
Service Code
|
HCPCS 27766
|
| Min. Negotiated Rate |
$504.93 |
| Max. Negotiated Rate |
$1,622.99 |
| Rate for Payer: Cash Price |
$723.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$721.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$649.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$649.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$685.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$721.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$685.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$721.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$721.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$541.00
|
| Rate for Payer: Healthfirst Commercial |
$721.33
|
| Rate for Payer: Healthfirst Essential Plan |
$1,622.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$685.26
|
| Rate for Payer: Healthfirst QHP |
$721.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$504.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$721.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$613.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$504.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$721.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$541.00
|
| Rate for Payer: SOMOS Essential |
$541.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$721.33
|
|
