|
PR OPEN TX COMP FRACTURE MALAR AREA W/BONE GRAFT
|
Professional
|
Both
|
$5,577.85
|
|
|
Service Code
|
HCPCS 21366
|
| Min. Negotiated Rate |
$1,047.12 |
| Max. Negotiated Rate |
$3,365.73 |
| Rate for Payer: Cash Price |
$1,502.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,495.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,346.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,346.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,421.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,495.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,421.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,495.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,495.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,121.91
|
| Rate for Payer: Healthfirst Commercial |
$1,495.88
|
| Rate for Payer: Healthfirst Essential Plan |
$3,365.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,421.09
|
| Rate for Payer: Healthfirst QHP |
$1,495.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,047.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,495.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,271.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,047.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,495.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,121.91
|
| Rate for Payer: SOMOS Essential |
$1,121.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,495.88
|
|
|
PR OPEN TX COMP FX MALAR W/INTERNAL FX&MULT SURG
|
Professional
|
Both
|
$4,660.04
|
|
|
Service Code
|
HCPCS 21365
|
| Min. Negotiated Rate |
$879.12 |
| Max. Negotiated Rate |
$2,825.75 |
| Rate for Payer: Cash Price |
$1,256.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,255.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,130.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,130.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,193.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,255.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,193.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,255.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,255.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$941.92
|
| Rate for Payer: Healthfirst Commercial |
$1,255.89
|
| Rate for Payer: Healthfirst Essential Plan |
$2,825.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,193.10
|
| Rate for Payer: Healthfirst QHP |
$1,255.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$879.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,255.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,067.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$879.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,255.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$941.92
|
| Rate for Payer: SOMOS Essential |
$941.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,255.89
|
|
|
PR OPEN TX COMPLICATED FRONTAL SINUS FRACTURE
|
Professional
|
Both
|
$6,012.79
|
|
|
Service Code
|
HCPCS 21344
|
| Min. Negotiated Rate |
$1,123.42 |
| Max. Negotiated Rate |
$3,610.98 |
| Rate for Payer: Cash Price |
$1,622.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,604.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,444.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,444.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,524.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,604.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,524.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,604.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,604.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,203.66
|
| Rate for Payer: Healthfirst Commercial |
$1,604.88
|
| Rate for Payer: Healthfirst Essential Plan |
$3,610.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,524.64
|
| Rate for Payer: Healthfirst QHP |
$1,604.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,123.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,604.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,364.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,123.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,604.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,203.66
|
| Rate for Payer: SOMOS Essential |
$1,203.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,604.88
|
|
|
PR OPEN TX CRANIOFACIAL SEP COMPLICATED MLT APPR
|
Professional
|
Both
|
$7,572.53
|
|
|
Service Code
|
HCPCS 21433
|
| Min. Negotiated Rate |
$1,419.10 |
| Max. Negotiated Rate |
$4,561.38 |
| Rate for Payer: Cash Price |
$2,034.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,027.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,824.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,824.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,925.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,027.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,925.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,027.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,027.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,520.46
|
| Rate for Payer: Healthfirst Commercial |
$2,027.28
|
| Rate for Payer: Healthfirst Essential Plan |
$4,561.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,925.92
|
| Rate for Payer: Healthfirst QHP |
$2,027.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,419.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,027.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,723.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,419.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,027.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,520.46
|
| Rate for Payer: SOMOS Essential |
$1,520.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,027.28
|
|
|
PR OPEN TX CRANIOFACIAL SEP COMP W/INT&/XTRNL FIX
|
Professional
|
Both
|
$6,148.17
|
|
|
Service Code
|
HCPCS 21435
|
| Min. Negotiated Rate |
$1,155.55 |
| Max. Negotiated Rate |
$3,714.28 |
| Rate for Payer: Cash Price |
$1,656.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,650.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,485.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,485.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,568.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,650.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,568.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,650.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,650.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,238.09
|
| Rate for Payer: Healthfirst Commercial |
$1,650.79
|
| Rate for Payer: Healthfirst Essential Plan |
$3,714.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,568.25
|
| Rate for Payer: Healthfirst QHP |
$1,650.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,155.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,650.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,403.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,155.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,650.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,238.09
|
| Rate for Payer: SOMOS Essential |
$1,238.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,650.79
|
|
|
PR OPEN TX CRANIOFACIAL SEP W/WIRING&/INT FIXJ
|
Professional
|
Both
|
$3,133.94
|
|
|
Service Code
|
HCPCS 21432
|
| Min. Negotiated Rate |
$586.94 |
| Max. Negotiated Rate |
$1,886.60 |
| Rate for Payer: Cash Price |
$840.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$838.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$754.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$754.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$796.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$838.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$796.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$838.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$838.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$628.87
|
| Rate for Payer: Healthfirst Commercial |
$838.49
|
| Rate for Payer: Healthfirst Essential Plan |
$1,886.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$796.57
|
| Rate for Payer: Healthfirst QHP |
$838.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$586.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$838.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$712.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$586.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$838.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$628.87
|
| Rate for Payer: SOMOS Essential |
$628.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$838.49
|
|
|
PR OPEN TX DEPRESSED FRONTAL SINUS FRACTURE
|
Professional
|
Both
|
$4,700.75
|
|
|
Service Code
|
HCPCS 21343
|
| Min. Negotiated Rate |
$881.03 |
| Max. Negotiated Rate |
$2,831.89 |
| Rate for Payer: Cash Price |
$1,272.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,258.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,132.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,132.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,195.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,258.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,195.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,258.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,258.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$943.97
|
| Rate for Payer: Healthfirst Commercial |
$1,258.62
|
| Rate for Payer: Healthfirst Essential Plan |
$2,831.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,195.69
|
| Rate for Payer: Healthfirst QHP |
$1,258.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$881.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,258.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,069.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$881.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,258.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$943.97
|
| Rate for Payer: SOMOS Essential |
$943.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,258.62
|
|
|
PR OPEN TX DEPRESSED MALAR FRACTURE
|
Professional
|
Both
|
$2,267.79
|
|
|
Service Code
|
HCPCS 21360
|
| Min. Negotiated Rate |
$428.69 |
| Max. Negotiated Rate |
$1,377.92 |
| Rate for Payer: Cash Price |
$618.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$612.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$551.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$551.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$581.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$612.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$581.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$612.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$612.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$459.31
|
| Rate for Payer: Healthfirst Commercial |
$612.41
|
| Rate for Payer: Healthfirst Essential Plan |
$1,377.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$581.79
|
| Rate for Payer: Healthfirst QHP |
$612.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$428.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$612.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$520.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$428.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$612.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$459.31
|
| Rate for Payer: SOMOS Essential |
$459.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$612.41
|
|
|
PR OPEN TX DEPRESSED ZYGOMATIC ARCH FRACTURE
|
Professional
|
Both
|
$1,764.56
|
|
|
Service Code
|
HCPCS 21356
|
| Min. Negotiated Rate |
$333.07 |
| Max. Negotiated Rate |
$1,070.57 |
| Rate for Payer: Cash Price |
$478.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$475.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$428.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$428.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$452.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$475.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$452.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$475.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$475.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$356.86
|
| Rate for Payer: Healthfirst Commercial |
$475.81
|
| Rate for Payer: Healthfirst Essential Plan |
$1,070.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$452.02
|
| Rate for Payer: Healthfirst QHP |
$475.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$333.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$475.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$404.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$333.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$475.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$356.86
|
| Rate for Payer: SOMOS Essential |
$356.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$475.81
|
|
|
PR OPEN TX DISTAL FEMORAL EPIPHYSEAL SEPARATION
|
Professional
|
Both
|
$3,939.71
|
|
|
Service Code
|
HCPCS 27519
|
| Min. Negotiated Rate |
$738.97 |
| Max. Negotiated Rate |
$2,375.26 |
| Rate for Payer: Cash Price |
$1,060.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,055.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$950.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$950.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,002.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,055.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,002.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,055.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,055.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$791.75
|
| Rate for Payer: Healthfirst Commercial |
$1,055.67
|
| Rate for Payer: Healthfirst Essential Plan |
$2,375.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,002.89
|
| Rate for Payer: Healthfirst QHP |
$1,055.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$738.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,055.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$897.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$738.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,055.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$791.75
|
| Rate for Payer: SOMOS Essential |
$791.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,055.67
|
|
|
PR OPEN TX DISTAL FIBULAR FRACTURE LAT MALLEOLUS
|
Professional
|
Both
|
$2,841.83
|
|
|
Service Code
|
HCPCS 27792
|
| Min. Negotiated Rate |
$534.23 |
| Max. Negotiated Rate |
$1,717.18 |
| Rate for Payer: Cash Price |
$769.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$763.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$686.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$686.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$725.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$763.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$725.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$763.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$763.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$572.39
|
| Rate for Payer: Healthfirst Commercial |
$763.19
|
| Rate for Payer: Healthfirst Essential Plan |
$1,717.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$725.03
|
| Rate for Payer: Healthfirst QHP |
$763.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$534.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$763.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$648.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$534.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$763.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$572.39
|
| Rate for Payer: SOMOS Essential |
$572.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$763.19
|
|
|
PR OPEN TX DISTAL PHALANGEAL FRACTURE EACH
|
Professional
|
Both
|
$2,230.94
|
|
|
Service Code
|
HCPCS 26765
|
| Min. Negotiated Rate |
$424.37 |
| Max. Negotiated Rate |
$1,364.04 |
| Rate for Payer: Cash Price |
$608.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$606.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$545.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$545.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$575.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$606.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$575.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$606.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$606.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$454.68
|
| Rate for Payer: Healthfirst Commercial |
$606.24
|
| Rate for Payer: Healthfirst Essential Plan |
$1,364.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$575.93
|
| Rate for Payer: Healthfirst QHP |
$606.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$424.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$606.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$515.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$424.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$606.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$454.68
|
| Rate for Payer: SOMOS Essential |
$454.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$606.24
|
|
|
PR OPEN TX DISTAL RADIOULNAR DISLC ACUTE/CHRONIC
|
Professional
|
Both
|
$2,791.95
|
|
|
Service Code
|
HCPCS 25676
|
| Min. Negotiated Rate |
$527.71 |
| Max. Negotiated Rate |
$1,696.21 |
| Rate for Payer: Cash Price |
$757.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$753.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$678.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$678.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$716.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$753.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$716.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$753.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$753.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$565.40
|
| Rate for Payer: Healthfirst Commercial |
$753.87
|
| Rate for Payer: Healthfirst Essential Plan |
$1,696.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$716.18
|
| Rate for Payer: Healthfirst QHP |
$753.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$527.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$753.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$640.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$527.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$753.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$565.40
|
| Rate for Payer: SOMOS Essential |
$565.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$753.87
|
|
|
PR OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION
|
Professional
|
Both
|
$3,112.59
|
|
|
Service Code
|
HCPCS 27829
|
| Min. Negotiated Rate |
$583.20 |
| Max. Negotiated Rate |
$1,874.57 |
| Rate for Payer: Cash Price |
$843.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$833.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$749.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$749.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$791.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$833.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$791.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$833.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$833.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$624.86
|
| Rate for Payer: Healthfirst Commercial |
$833.14
|
| Rate for Payer: Healthfirst Essential Plan |
$1,874.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$791.48
|
| Rate for Payer: Healthfirst QHP |
$833.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$583.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$833.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$708.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$583.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$833.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$624.86
|
| Rate for Payer: SOMOS Essential |
$624.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$833.14
|
|
|
PR OPEN TX FEMORAL FRACTURE DISTAL MED/LAT CONDYLE
|
Professional
|
Both
|
$4,261.01
|
|
|
Service Code
|
HCPCS 27514
|
| Min. Negotiated Rate |
$799.84 |
| Max. Negotiated Rate |
$2,570.92 |
| Rate for Payer: Cash Price |
$1,147.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,142.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,028.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,028.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,085.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,142.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,085.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,142.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,142.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$856.97
|
| Rate for Payer: Healthfirst Commercial |
$1,142.63
|
| Rate for Payer: Healthfirst Essential Plan |
$2,570.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,085.50
|
| Rate for Payer: Healthfirst QHP |
$1,142.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$799.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,142.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$971.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$799.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,142.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$856.97
|
| Rate for Payer: SOMOS Essential |
$856.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,142.63
|
|
|
PR OPEN TX FEMORAL FRACTURE PROXIMAL END HEAD
|
Professional
|
Both
|
$5,473.09
|
|
|
Service Code
|
HCPCS 27269
|
| Min. Negotiated Rate |
$1,026.84 |
| Max. Negotiated Rate |
$3,300.57 |
| Rate for Payer: Cash Price |
$1,472.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,466.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,320.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,320.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,393.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,466.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,393.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,466.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,466.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,100.19
|
| Rate for Payer: Healthfirst Commercial |
$1,466.92
|
| Rate for Payer: Healthfirst Essential Plan |
$3,300.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,393.57
|
| Rate for Payer: Healthfirst QHP |
$1,466.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,026.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,466.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,246.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,026.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,466.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,100.19
|
| Rate for Payer: SOMOS Essential |
$1,100.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,466.92
|
|
|
PR OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W/O XTN
|
Professional
|
Both
|
$4,399.26
|
|
|
Service Code
|
HCPCS 27511
|
| Min. Negotiated Rate |
$822.67 |
| Max. Negotiated Rate |
$2,644.29 |
| Rate for Payer: Cash Price |
$1,183.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,175.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,057.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,057.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,116.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,175.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,116.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,175.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,175.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$881.43
|
| Rate for Payer: Healthfirst Commercial |
$1,175.24
|
| Rate for Payer: Healthfirst Essential Plan |
$2,644.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,116.48
|
| Rate for Payer: Healthfirst QHP |
$1,175.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$822.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,175.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$998.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$822.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,175.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$881.43
|
| Rate for Payer: SOMOS Essential |
$881.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,175.24
|
|
|
PR OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W/XTN
|
Professional
|
Both
|
$5,456.54
|
|
|
Service Code
|
HCPCS 27513
|
| Min. Negotiated Rate |
$1,018.08 |
| Max. Negotiated Rate |
$3,272.40 |
| Rate for Payer: Cash Price |
$1,464.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,454.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,308.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,308.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,381.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,454.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,381.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,454.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,454.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,090.80
|
| Rate for Payer: Healthfirst Commercial |
$1,454.40
|
| Rate for Payer: Healthfirst Essential Plan |
$3,272.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,381.68
|
| Rate for Payer: Healthfirst QHP |
$1,454.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,018.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,454.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,236.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,018.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,454.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,090.80
|
| Rate for Payer: SOMOS Essential |
$1,090.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,454.40
|
|
|
PR OPEN TX FRACTURE GREAT TOE/PHALANX/PHALANGES
|
Professional
|
Both
|
$2,108.16
|
|
|
Service Code
|
HCPCS 28505
|
| Min. Negotiated Rate |
$402.95 |
| Max. Negotiated Rate |
$1,295.21 |
| Rate for Payer: Cash Price |
$579.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$575.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$518.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$518.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$546.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$575.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$546.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$575.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$575.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$431.74
|
| Rate for Payer: Healthfirst Commercial |
$575.65
|
| Rate for Payer: Healthfirst Essential Plan |
$1,295.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$546.87
|
| Rate for Payer: Healthfirst QHP |
$575.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$402.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$575.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$489.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$402.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$575.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$431.74
|
| Rate for Payer: SOMOS Essential |
$431.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$575.65
|
|
|
PR OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE
|
Professional
|
Both
|
$1,728.16
|
|
|
Service Code
|
HCPCS 28525
|
| Min. Negotiated Rate |
$328.19 |
| Max. Negotiated Rate |
$1,054.91 |
| Rate for Payer: Cash Price |
$478.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$468.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$421.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$421.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$445.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$468.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$445.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$468.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$468.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$351.64
|
| Rate for Payer: Healthfirst Commercial |
$468.85
|
| Rate for Payer: Healthfirst Essential Plan |
$1,054.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$445.41
|
| Rate for Payer: Healthfirst QHP |
$468.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$328.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$468.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$398.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$328.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$468.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$351.64
|
| Rate for Payer: SOMOS Essential |
$351.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$468.85
|
|
|
PR OPEN TX FX ORBIT EXCEPT BLOWOUT W/BONE GRAFT
|
Professional
|
Both
|
$3,950.66
|
|
|
Service Code
|
HCPCS 21408
|
| Min. Negotiated Rate |
$741.57 |
| Max. Negotiated Rate |
$2,383.63 |
| Rate for Payer: Cash Price |
$1,063.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,059.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$953.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$953.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,006.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,059.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,006.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,059.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,059.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$794.54
|
| Rate for Payer: Healthfirst Commercial |
$1,059.39
|
| Rate for Payer: Healthfirst Essential Plan |
$2,383.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,006.42
|
| Rate for Payer: Healthfirst QHP |
$1,059.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$741.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,059.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$900.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$741.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,059.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$794.54
|
| Rate for Payer: SOMOS Essential |
$794.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,059.39
|
|
|
PR OPEN TX FX ORBIT EXCEPT BLOWOUT W/IMPLANT
|
Professional
|
Both
|
$2,760.00
|
|
|
Service Code
|
HCPCS 21407
|
| Min. Negotiated Rate |
$526.69 |
| Max. Negotiated Rate |
$1,692.92 |
| Rate for Payer: Cash Price |
$746.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$752.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$677.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$677.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$714.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$752.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$714.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$752.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$752.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$564.31
|
| Rate for Payer: Healthfirst Commercial |
$752.41
|
| Rate for Payer: Healthfirst Essential Plan |
$1,692.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$714.79
|
| Rate for Payer: Healthfirst QHP |
$752.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$526.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$752.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$639.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$526.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$752.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$564.31
|
| Rate for Payer: SOMOS Essential |
$564.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$752.41
|
|
|
PR OPEN TX FX ORBIT EXCEPT BLOWOUT W/O IMPLANT
|
Professional
|
Both
|
$2,552.62
|
|
|
Service Code
|
HCPCS 21406
|
| Min. Negotiated Rate |
$483.02 |
| Max. Negotiated Rate |
$1,552.57 |
| Rate for Payer: Cash Price |
$691.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$690.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$621.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$621.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$655.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$690.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$655.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$690.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$690.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$517.52
|
| Rate for Payer: Healthfirst Commercial |
$690.03
|
| Rate for Payer: Healthfirst Essential Plan |
$1,552.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$655.53
|
| Rate for Payer: Healthfirst QHP |
$690.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$483.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$690.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$586.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$483.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$690.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$517.52
|
| Rate for Payer: SOMOS Essential |
$517.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$690.03
|
|
|
PR OPEN TX HUMERAL EPICONDYLAR FRACTURE
|
Professional
|
Both
|
$3,241.35
|
|
|
Service Code
|
HCPCS 24575
|
| Min. Negotiated Rate |
$614.59 |
| Max. Negotiated Rate |
$1,975.48 |
| Rate for Payer: Cash Price |
$879.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$877.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$790.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$790.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$834.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$877.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$834.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$877.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$877.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$658.49
|
| Rate for Payer: Healthfirst Commercial |
$877.99
|
| Rate for Payer: Healthfirst Essential Plan |
$1,975.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$834.09
|
| Rate for Payer: Healthfirst QHP |
$877.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$614.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$877.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$746.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$614.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$877.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$658.49
|
| Rate for Payer: SOMOS Essential |
$658.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$877.99
|
|
|
PR OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/O XTN
|
Professional
|
Both
|
$4,094.02
|
|
|
Service Code
|
HCPCS 24545
|
| Min. Negotiated Rate |
$773.80 |
| Max. Negotiated Rate |
$2,487.22 |
| Rate for Payer: Cash Price |
$1,109.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,105.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$994.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$994.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,050.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,105.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,050.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,105.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,105.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$829.07
|
| Rate for Payer: Healthfirst Commercial |
$1,105.43
|
| Rate for Payer: Healthfirst Essential Plan |
$2,487.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,050.16
|
| Rate for Payer: Healthfirst QHP |
$1,105.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$773.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,105.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$939.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$773.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,105.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$829.07
|
| Rate for Payer: SOMOS Essential |
$829.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,105.43
|
|
