|
PR OPEN TREATMENT METACARPOPHALANGEAL DISLOCATION
|
Professional
|
Both
|
$2,538.45
|
|
|
Service Code
|
HCPCS 26715
|
| Min. Negotiated Rate |
$482.96 |
| Max. Negotiated Rate |
$1,552.39 |
| Rate for Payer: Cash Price |
$690.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$689.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$620.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$620.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$655.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$689.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$655.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$689.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$689.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$517.46
|
| Rate for Payer: Healthfirst Commercial |
$689.95
|
| Rate for Payer: Healthfirst Essential Plan |
$1,552.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$655.45
|
| Rate for Payer: Healthfirst QHP |
$689.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$482.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$689.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$586.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$482.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$689.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$517.46
|
| Rate for Payer: SOMOS Essential |
$517.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$689.95
|
|
|
PR OPEN TREATMENT METATARSAL FRACTURE EACH
|
Professional
|
Both
|
$2,412.20
|
|
|
Service Code
|
HCPCS 28485
|
| Min. Negotiated Rate |
$459.94 |
| Max. Negotiated Rate |
$1,478.38 |
| Rate for Payer: Cash Price |
$663.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$657.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$591.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$591.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$624.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$657.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$624.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$657.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$657.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$492.80
|
| Rate for Payer: Healthfirst Commercial |
$657.06
|
| Rate for Payer: Healthfirst Essential Plan |
$1,478.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$624.21
|
| Rate for Payer: Healthfirst QHP |
$657.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$459.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$657.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$558.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$459.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$657.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$492.80
|
| Rate for Payer: SOMOS Essential |
$492.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$657.06
|
|
|
PR OPEN TREATMENT NASAL FRACTURE UNCOMPLICATED
|
Professional
|
Both
|
$1,929.83
|
|
|
Service Code
|
HCPCS 21325
|
| Min. Negotiated Rate |
$361.51 |
| Max. Negotiated Rate |
$1,162.01 |
| Rate for Payer: Cash Price |
$523.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$516.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$464.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$464.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$490.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$516.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$490.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$516.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$516.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$387.34
|
| Rate for Payer: Healthfirst Commercial |
$516.45
|
| Rate for Payer: Healthfirst Essential Plan |
$1,162.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$490.63
|
| Rate for Payer: Healthfirst QHP |
$516.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$361.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$516.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$438.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$361.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$516.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$387.34
|
| Rate for Payer: SOMOS Essential |
$387.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$516.45
|
|
|
PR OPEN TREATMENT OF ULNAR SHAFT FRACTURE
|
Professional
|
Both
|
$2,774.28
|
|
|
Service Code
|
HCPCS 25545
|
| Min. Negotiated Rate |
$525.63 |
| Max. Negotiated Rate |
$1,689.53 |
| Rate for Payer: Cash Price |
$752.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$750.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$675.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$675.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$713.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$750.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$713.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$750.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$750.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$563.17
|
| Rate for Payer: Healthfirst Commercial |
$750.90
|
| Rate for Payer: Healthfirst Essential Plan |
$1,689.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$713.36
|
| Rate for Payer: Healthfirst QHP |
$750.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$525.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$750.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$638.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$525.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$750.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$563.17
|
| Rate for Payer: SOMOS Essential |
$563.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$750.90
|
|
|
PR OPEN TREATMENT PALATAL/MAXILLARY FRACTURE
|
Professional
|
Both
|
$2,700.11
|
|
|
Service Code
|
HCPCS 21422
|
| Min. Negotiated Rate |
$514.47 |
| Max. Negotiated Rate |
$1,653.64 |
| Rate for Payer: Cash Price |
$726.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$734.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$661.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$661.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$698.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$734.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$698.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$734.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$734.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$551.21
|
| Rate for Payer: Healthfirst Commercial |
$734.95
|
| Rate for Payer: Healthfirst Essential Plan |
$1,653.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$698.20
|
| Rate for Payer: Healthfirst QHP |
$734.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$514.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$734.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$624.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$514.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$734.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$551.21
|
| Rate for Payer: SOMOS Essential |
$551.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$734.95
|
|
|
PR OPEN TREATMENT POSTERIOR MALLEOLUS FRACTURE
|
Professional
|
Both
|
$3,208.28
|
|
|
Service Code
|
HCPCS 27769
|
| Min. Negotiated Rate |
$604.57 |
| Max. Negotiated Rate |
$1,943.26 |
| Rate for Payer: Cash Price |
$867.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$863.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$777.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$777.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$820.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$863.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$820.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$863.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$863.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$647.75
|
| Rate for Payer: Healthfirst Commercial |
$863.67
|
| Rate for Payer: Healthfirst Essential Plan |
$1,943.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$820.49
|
| Rate for Payer: Healthfirst QHP |
$863.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$604.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$863.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$734.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$604.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$863.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$647.75
|
| Rate for Payer: SOMOS Essential |
$647.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$863.67
|
|
|
PR OPEN TREATMENT PROXIMAL FIBULA/SHAFT FRACTURE
|
Professional
|
Both
|
$3,140.31
|
|
|
Service Code
|
HCPCS 27784
|
| Min. Negotiated Rate |
$591.79 |
| Max. Negotiated Rate |
$1,902.17 |
| Rate for Payer: Cash Price |
$856.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$845.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$760.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$760.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$803.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$845.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$803.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$845.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$845.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$634.06
|
| Rate for Payer: Healthfirst Commercial |
$845.41
|
| Rate for Payer: Healthfirst Essential Plan |
$1,902.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$803.14
|
| Rate for Payer: Healthfirst QHP |
$845.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$591.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$845.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$718.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$591.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$845.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$634.06
|
| Rate for Payer: SOMOS Essential |
$634.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$845.41
|
|
|
PR OPEN TREATMENT PROXIMAL HUMERAL FRACTURE
|
Professional
|
Both
|
$3,906.14
|
|
|
Service Code
|
HCPCS 23615
|
| Min. Negotiated Rate |
$735.85 |
| Max. Negotiated Rate |
$2,365.22 |
| Rate for Payer: Cash Price |
$1,055.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,051.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$946.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$946.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$998.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,051.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$998.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,051.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,051.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$788.41
|
| Rate for Payer: Healthfirst Commercial |
$1,051.21
|
| Rate for Payer: Healthfirst Essential Plan |
$2,365.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$998.65
|
| Rate for Payer: Healthfirst QHP |
$1,051.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$735.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,051.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$893.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$735.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,051.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$788.41
|
| Rate for Payer: SOMOS Essential |
$788.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,051.21
|
|
|
PR OPEN TREATMENT RADIAL SHAFT FRACTURE
|
Professional
|
Both
|
$2,967.58
|
|
|
Service Code
|
HCPCS 25515
|
| Min. Negotiated Rate |
$562.41 |
| Max. Negotiated Rate |
$1,807.76 |
| Rate for Payer: Cash Price |
$806.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$803.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$723.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$723.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$763.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$803.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$763.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$803.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$803.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$602.59
|
| Rate for Payer: Healthfirst Commercial |
$803.45
|
| Rate for Payer: Healthfirst Essential Plan |
$1,807.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$763.28
|
| Rate for Payer: Healthfirst QHP |
$803.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$562.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$803.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$682.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$562.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$803.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$602.59
|
| Rate for Payer: SOMOS Essential |
$602.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$803.45
|
|
|
PR OPEN TREATMENT TALOTARSAL JOINT DISLOCATION
|
Professional
|
Both
|
$2,964.12
|
|
|
Service Code
|
HCPCS 28585
|
| Min. Negotiated Rate |
$580.52 |
| Max. Negotiated Rate |
$1,865.95 |
| Rate for Payer: Cash Price |
$823.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$829.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$746.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$746.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$787.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$829.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$787.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$829.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$829.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$621.98
|
| Rate for Payer: Healthfirst Commercial |
$829.31
|
| Rate for Payer: Healthfirst Essential Plan |
$1,865.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$787.84
|
| Rate for Payer: Healthfirst QHP |
$829.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$580.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$829.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$704.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$580.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$829.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$621.98
|
| Rate for Payer: SOMOS Essential |
$621.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$829.31
|
|
|
PR OPEN TREATMENT TALUS FRACTURE
|
Professional
|
Both
|
$4,524.91
|
|
|
Service Code
|
HCPCS 28445
|
| Min. Negotiated Rate |
$859.12 |
| Max. Negotiated Rate |
$2,761.47 |
| Rate for Payer: Cash Price |
$1,239.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,227.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,104.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,104.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,165.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,227.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,165.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,227.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,227.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$920.49
|
| Rate for Payer: Healthfirst Commercial |
$1,227.32
|
| Rate for Payer: Healthfirst Essential Plan |
$2,761.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,165.95
|
| Rate for Payer: Healthfirst QHP |
$1,227.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$859.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,227.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,043.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$859.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,227.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$920.49
|
| Rate for Payer: SOMOS Essential |
$920.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,227.32
|
|
|
PR OPEN TREATMENT TARSAL BONE DISLOCATION
|
Professional
|
Both
|
$2,882.50
|
|
|
Service Code
|
HCPCS 28555
|
| Min. Negotiated Rate |
$532.92 |
| Max. Negotiated Rate |
$1,712.95 |
| Rate for Payer: Cash Price |
$782.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$761.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$685.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$685.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$723.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$761.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$723.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$761.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$761.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$570.98
|
| Rate for Payer: Healthfirst Commercial |
$761.31
|
| Rate for Payer: Healthfirst Essential Plan |
$1,712.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$723.24
|
| Rate for Payer: Healthfirst QHP |
$761.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$532.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$761.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$647.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$532.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$761.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$570.98
|
| Rate for Payer: SOMOS Essential |
$570.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$761.31
|
|
|
PR OPEN TREATMENT TARSOMETATARSAL JOINT DISLOCATION
|
Professional
|
Both
|
$3,600.17
|
|
|
Service Code
|
HCPCS 28615
|
| Min. Negotiated Rate |
$682.13 |
| Max. Negotiated Rate |
$2,192.56 |
| Rate for Payer: Cash Price |
$981.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$974.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$877.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$877.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$925.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$974.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$925.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$974.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$974.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$730.85
|
| Rate for Payer: Healthfirst Commercial |
$974.47
|
| Rate for Payer: Healthfirst Essential Plan |
$2,192.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$925.75
|
| Rate for Payer: Healthfirst QHP |
$974.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$682.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$974.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$828.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$682.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$974.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$730.85
|
| Rate for Payer: SOMOS Essential |
$730.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$974.47
|
|
|
PR OPEN TREATMENT TEMPOROMANDIBULAR DISLOCATION
|
Professional
|
Both
|
$3,276.98
|
|
|
Service Code
|
HCPCS 21490
|
| Min. Negotiated Rate |
$635.91 |
| Max. Negotiated Rate |
$2,043.99 |
| Rate for Payer: Cash Price |
$898.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$908.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$817.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$817.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$863.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$908.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$863.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$908.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$908.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$681.33
|
| Rate for Payer: Healthfirst Commercial |
$908.44
|
| Rate for Payer: Healthfirst Essential Plan |
$2,043.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$863.02
|
| Rate for Payer: Healthfirst QHP |
$908.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$635.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$908.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$772.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$635.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$908.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$681.33
|
| Rate for Payer: SOMOS Essential |
$681.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$908.44
|
|
|
PR OPEN TREATMENT ULNAR FRACTURE PROXIMAL END
|
Professional
|
Both
|
$2,897.30
|
|
|
Service Code
|
HCPCS 24685
|
| Min. Negotiated Rate |
$548.21 |
| Max. Negotiated Rate |
$1,762.09 |
| Rate for Payer: Cash Price |
$786.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$783.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$704.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$704.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$743.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$783.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$743.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$783.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$783.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$587.36
|
| Rate for Payer: Healthfirst Commercial |
$783.15
|
| Rate for Payer: Healthfirst Essential Plan |
$1,762.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$743.99
|
| Rate for Payer: Healthfirst QHP |
$783.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$548.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$783.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$665.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$548.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$783.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$587.36
|
| Rate for Payer: SOMOS Essential |
$587.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$783.15
|
|
|
PR OPEN TREATMENT ULNAR STYLOID FRACTURE
|
Professional
|
Both
|
$2,764.72
|
|
|
Service Code
|
HCPCS 25652
|
| Min. Negotiated Rate |
$524.61 |
| Max. Negotiated Rate |
$1,686.24 |
| Rate for Payer: Cash Price |
$750.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$749.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$674.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$674.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$711.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$749.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$711.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$749.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$749.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$562.08
|
| Rate for Payer: Healthfirst Commercial |
$749.44
|
| Rate for Payer: Healthfirst Essential Plan |
$1,686.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$711.97
|
| Rate for Payer: Healthfirst QHP |
$749.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$524.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$749.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$637.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$524.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$749.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$562.08
|
| Rate for Payer: SOMOS Essential |
$562.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$749.44
|
|
|
PR OPEN TX ACROMIOCLAVICULAR DISLC ACUTE/CHRONIC
|
Professional
|
Both
|
$2,537.64
|
|
|
Service Code
|
HCPCS 23550
|
| Min. Negotiated Rate |
$478.40 |
| Max. Negotiated Rate |
$1,537.72 |
| Rate for Payer: Cash Price |
$688.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$683.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$615.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$615.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$649.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$683.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$649.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$683.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$683.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$512.57
|
| Rate for Payer: Healthfirst Commercial |
$683.43
|
| Rate for Payer: Healthfirst Essential Plan |
$1,537.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$649.26
|
| Rate for Payer: Healthfirst QHP |
$683.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$478.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$683.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$580.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$478.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$683.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$512.57
|
| Rate for Payer: SOMOS Essential |
$512.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$683.43
|
|
|
PR OPEN TX ACUTE/CHRONIC ELBOW DISLOCATION
|
Professional
|
Both
|
$3,165.30
|
|
|
Service Code
|
HCPCS 24615
|
| Min. Negotiated Rate |
$596.39 |
| Max. Negotiated Rate |
$1,916.98 |
| Rate for Payer: Cash Price |
$855.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$851.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$766.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$766.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$809.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$851.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$809.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$851.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$851.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$638.99
|
| Rate for Payer: Healthfirst Commercial |
$851.99
|
| Rate for Payer: Healthfirst Essential Plan |
$1,916.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$809.39
|
| Rate for Payer: Healthfirst QHP |
$851.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$596.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$851.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$724.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$596.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$851.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$638.99
|
| Rate for Payer: SOMOS Essential |
$638.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$851.99
|
|
|
PR OPEN TX ACUTE SHOULDER DISLOCATION
|
Professional
|
Both
|
$2,607.36
|
|
|
Service Code
|
HCPCS 23660
|
| Min. Negotiated Rate |
$490.95 |
| Max. Negotiated Rate |
$1,578.06 |
| Rate for Payer: Cash Price |
$704.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$701.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$631.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$631.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$666.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$701.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$666.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$701.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$701.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$526.02
|
| Rate for Payer: Healthfirst Commercial |
$701.36
|
| Rate for Payer: Healthfirst Essential Plan |
$1,578.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$666.29
|
| Rate for Payer: Healthfirst QHP |
$701.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$490.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$701.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$596.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$490.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$701.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$526.02
|
| Rate for Payer: SOMOS Essential |
$526.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$701.36
|
|
|
PR OPEN TX ARTICULAR FRACTURE MCP/IP JOINT EA
|
Professional
|
Both
|
$3,275.16
|
|
|
Service Code
|
HCPCS 26746
|
| Min. Negotiated Rate |
$619.98 |
| Max. Negotiated Rate |
$1,992.80 |
| Rate for Payer: Cash Price |
$887.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$885.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$797.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$797.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$841.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$885.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$841.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$885.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$885.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$664.27
|
| Rate for Payer: Healthfirst Commercial |
$885.69
|
| Rate for Payer: Healthfirst Essential Plan |
$1,992.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$841.41
|
| Rate for Payer: Healthfirst QHP |
$885.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$619.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$885.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$752.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$619.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$885.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$664.27
|
| Rate for Payer: SOMOS Essential |
$664.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$885.69
|
|
|
PR OPEN TX CARPAL BONE FRACTURE OTH/THN SCAPHOID EA
|
Professional
|
Both
|
$2,548.70
|
|
|
Service Code
|
HCPCS 25645
|
| Min. Negotiated Rate |
$481.36 |
| Max. Negotiated Rate |
$1,547.21 |
| Rate for Payer: Cash Price |
$690.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$687.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$618.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$618.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$653.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$687.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$653.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$687.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$687.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$515.74
|
| Rate for Payer: Healthfirst Commercial |
$687.65
|
| Rate for Payer: Healthfirst Essential Plan |
$1,547.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$653.27
|
| Rate for Payer: Healthfirst QHP |
$687.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$481.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$687.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$584.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$481.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$687.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$515.74
|
| Rate for Payer: SOMOS Essential |
$515.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$687.65
|
|
|
PR OPEN TX CARPAL SCAPHOID NAVICULAR FRACTURE
|
Professional
|
Both
|
$3,174.50
|
|
|
Service Code
|
HCPCS 25628
|
| Min. Negotiated Rate |
$601.26 |
| Max. Negotiated Rate |
$1,932.62 |
| Rate for Payer: Cash Price |
$860.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$858.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$773.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$773.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$815.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$858.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$815.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$858.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$858.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$644.21
|
| Rate for Payer: Healthfirst Commercial |
$858.94
|
| Rate for Payer: Healthfirst Essential Plan |
$1,932.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$815.99
|
| Rate for Payer: Healthfirst QHP |
$858.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$601.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$858.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$730.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$601.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$858.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$644.21
|
| Rate for Payer: SOMOS Essential |
$644.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$858.94
|
|
|
PR OPEN TX CARPOMETACARPAL DISLOCATE NOT THUMB
|
Professional
|
Both
|
$2,544.89
|
|
|
Service Code
|
HCPCS 26685
|
| Min. Negotiated Rate |
$484.01 |
| Max. Negotiated Rate |
$1,555.74 |
| Rate for Payer: Cash Price |
$690.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$691.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$622.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$622.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$656.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$691.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$656.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$691.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$691.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$518.58
|
| Rate for Payer: Healthfirst Commercial |
$691.44
|
| Rate for Payer: Healthfirst Essential Plan |
$1,555.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$656.87
|
| Rate for Payer: Healthfirst QHP |
$691.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$484.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$691.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$587.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$484.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$691.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$518.58
|
| Rate for Payer: SOMOS Essential |
$518.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$691.44
|
|
|
PR OPEN TX CARPOMETACARPAL FRACTURE DISLOCATE THUMB
|
Professional
|
Both
|
$2,750.02
|
|
|
Service Code
|
HCPCS 26665
|
| Min. Negotiated Rate |
$524.90 |
| Max. Negotiated Rate |
$1,687.18 |
| Rate for Payer: Cash Price |
$749.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$749.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$674.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$674.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$712.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$749.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$712.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$749.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$749.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$562.39
|
| Rate for Payer: Healthfirst Commercial |
$749.86
|
| Rate for Payer: Healthfirst Essential Plan |
$1,687.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$712.37
|
| Rate for Payer: Healthfirst QHP |
$749.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$524.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$749.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$637.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$524.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$749.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$562.39
|
| Rate for Payer: SOMOS Essential |
$562.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$749.86
|
|
|
PR OPEN TX CLAVICULAR FRACTURE INTERNAL FIXATION
|
Professional
|
Both
|
$3,195.33
|
|
|
Service Code
|
HCPCS 23515
|
| Min. Negotiated Rate |
$601.88 |
| Max. Negotiated Rate |
$1,934.62 |
| Rate for Payer: Cash Price |
$863.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$859.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$773.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$773.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$816.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$859.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$816.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$859.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$859.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$644.87
|
| Rate for Payer: Healthfirst Commercial |
$859.83
|
| Rate for Payer: Healthfirst Essential Plan |
$1,934.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$816.84
|
| Rate for Payer: Healthfirst QHP |
$859.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$601.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$859.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$730.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$601.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$859.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$644.87
|
| Rate for Payer: SOMOS Essential |
$644.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$859.83
|
|
