|
PR OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/XTN
|
Professional
|
Both
|
$4,576.85
|
|
|
Service Code
|
HCPCS 24546
|
| Min. Negotiated Rate |
$863.18 |
| Max. Negotiated Rate |
$2,774.50 |
| Rate for Payer: Cash Price |
$1,236.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,233.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,109.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,109.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,171.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,233.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,171.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,233.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,233.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$924.83
|
| Rate for Payer: Healthfirst Commercial |
$1,233.11
|
| Rate for Payer: Healthfirst Essential Plan |
$2,774.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,171.45
|
| Rate for Payer: Healthfirst QHP |
$1,233.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$863.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,233.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,048.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$863.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,233.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$924.83
|
| Rate for Payer: SOMOS Essential |
$924.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,233.11
|
|
|
PR OPEN TX ILIAC SPINE UNI/BIL
|
Professional
|
Both
|
$3,203.20
|
|
|
Service Code
|
HCPCS G0412
|
| Min. Negotiated Rate |
$602.55 |
| Max. Negotiated Rate |
$1,936.78 |
| Rate for Payer: Cash Price |
$865.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$860.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$774.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$774.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$817.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$860.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$817.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$860.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$860.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$645.59
|
| Rate for Payer: Healthfirst Commercial |
$860.79
|
| Rate for Payer: Healthfirst Essential Plan |
$1,936.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$817.75
|
| Rate for Payer: Healthfirst QHP |
$860.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$602.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$860.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$731.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$602.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$860.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$645.59
|
| Rate for Payer: SOMOS Essential |
$645.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$860.79
|
|
|
PR OPEN TX INTERCONDYLAR SPINE/TUBRST FRACTURE KNEE
|
Professional
|
Both
|
$3,613.33
|
|
|
Service Code
|
HCPCS 27540
|
| Min. Negotiated Rate |
$680.41 |
| Max. Negotiated Rate |
$2,187.02 |
| Rate for Payer: Cash Price |
$973.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$972.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$874.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$874.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$923.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$972.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$923.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$972.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$972.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$729.01
|
| Rate for Payer: Healthfirst Commercial |
$972.01
|
| Rate for Payer: Healthfirst Essential Plan |
$2,187.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$923.41
|
| Rate for Payer: Healthfirst QHP |
$972.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$680.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$972.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$826.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$680.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$972.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$729.01
|
| Rate for Payer: SOMOS Essential |
$729.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$972.01
|
|
|
PR OPEN TX INTERPHALANGEAL JOINT DISLOCATION
|
Professional
|
Both
|
$2,429.49
|
|
|
Service Code
|
HCPCS 26785
|
| Min. Negotiated Rate |
$462.56 |
| Max. Negotiated Rate |
$1,486.80 |
| Rate for Payer: Cash Price |
$659.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$660.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$594.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$594.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$627.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$660.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$627.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$660.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$660.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$495.60
|
| Rate for Payer: Healthfirst Commercial |
$660.80
|
| Rate for Payer: Healthfirst Essential Plan |
$1,486.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$627.76
|
| Rate for Payer: Healthfirst QHP |
$660.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$462.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$660.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$561.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$462.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$660.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$495.60
|
| Rate for Payer: SOMOS Essential |
$495.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$660.80
|
|
|
PR OPEN TX KNEE DISLOCATION W/LIGAMENTOUS REPAIR
|
Professional
|
Both
|
$4,612.27
|
|
|
Service Code
|
HCPCS 27557
|
| Min. Negotiated Rate |
$863.25 |
| Max. Negotiated Rate |
$2,774.72 |
| Rate for Payer: Cash Price |
$1,241.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,233.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,109.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,109.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,171.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,233.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,171.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,233.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,233.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$924.91
|
| Rate for Payer: Healthfirst Commercial |
$1,233.21
|
| Rate for Payer: Healthfirst Essential Plan |
$2,774.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,171.55
|
| Rate for Payer: Healthfirst QHP |
$1,233.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$863.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,233.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,048.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$863.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,233.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$924.91
|
| Rate for Payer: SOMOS Essential |
$924.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,233.21
|
|
|
PR OPEN TX KNEE DISLOCATION W/O LIGAMENTOUS REPAIR
|
Professional
|
Both
|
$3,878.77
|
|
|
Service Code
|
HCPCS 27556
|
| Min. Negotiated Rate |
$725.68 |
| Max. Negotiated Rate |
$2,332.53 |
| Rate for Payer: Cash Price |
$1,043.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,036.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$933.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$933.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$984.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,036.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$984.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,036.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,036.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$777.51
|
| Rate for Payer: Healthfirst Commercial |
$1,036.68
|
| Rate for Payer: Healthfirst Essential Plan |
$2,332.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$984.85
|
| Rate for Payer: Healthfirst QHP |
$1,036.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$725.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,036.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$881.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$725.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,036.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$777.51
|
| Rate for Payer: SOMOS Essential |
$777.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,036.68
|
|
|
PR OPEN TX KNEE DISLOCATION W/REPAIR/RECONSTRUCTION
|
Professional
|
Both
|
$5,249.13
|
|
|
Service Code
|
HCPCS 27558
|
| Min. Negotiated Rate |
$981.39 |
| Max. Negotiated Rate |
$3,154.45 |
| Rate for Payer: Cash Price |
$1,410.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,401.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,261.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,261.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,331.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,401.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,331.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,401.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,401.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,051.48
|
| Rate for Payer: Healthfirst Commercial |
$1,401.98
|
| Rate for Payer: Healthfirst Essential Plan |
$3,154.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,331.88
|
| Rate for Payer: Healthfirst QHP |
$1,401.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$981.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,401.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,191.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$981.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,401.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,051.48
|
| Rate for Payer: SOMOS Essential |
$1,051.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,401.98
|
|
|
PR OPEN TX MANDIBULAR FX W/EXTERNAL FIXATION
|
Professional
|
Both
|
$2,044.98
|
|
|
Service Code
|
HCPCS 21454
|
| Min. Negotiated Rate |
$397.86 |
| Max. Negotiated Rate |
$1,278.83 |
| Rate for Payer: Cash Price |
$562.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$568.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$511.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$511.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$539.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$568.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$539.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$568.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$568.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$426.28
|
| Rate for Payer: Healthfirst Commercial |
$568.37
|
| Rate for Payer: Healthfirst Essential Plan |
$1,278.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$539.95
|
| Rate for Payer: Healthfirst QHP |
$568.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$397.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$568.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$483.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$397.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$568.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$426.28
|
| Rate for Payer: SOMOS Essential |
$426.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$568.37
|
|
|
PR OPEN TX MANDIBULAR FX W/INTERDENTAL FIXATION
|
Professional
|
Both
|
$5,022.57
|
|
|
Service Code
|
HCPCS 21462
|
| Min. Negotiated Rate |
$933.61 |
| Max. Negotiated Rate |
$3,000.89 |
| Rate for Payer: Cash Price |
$1,352.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,333.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,200.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,200.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,267.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,333.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,267.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,333.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,333.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,000.30
|
| Rate for Payer: Healthfirst Commercial |
$1,333.73
|
| Rate for Payer: Healthfirst Essential Plan |
$3,000.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,267.04
|
| Rate for Payer: Healthfirst QHP |
$1,333.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$933.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,333.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,133.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$933.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,333.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,000.30
|
| Rate for Payer: SOMOS Essential |
$1,000.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,333.73
|
|
|
PR OPEN TX MANDIBULAR FX W/O INTERDENTAL FIXATION
|
Professional
|
Both
|
$4,556.13
|
|
|
Service Code
|
HCPCS 21461
|
| Min. Negotiated Rate |
$841.95 |
| Max. Negotiated Rate |
$2,706.26 |
| Rate for Payer: Cash Price |
$1,243.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,202.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,082.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,082.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,142.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,202.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,142.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,202.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,202.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$902.09
|
| Rate for Payer: Healthfirst Commercial |
$1,202.78
|
| Rate for Payer: Healthfirst Essential Plan |
$2,706.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,142.64
|
| Rate for Payer: Healthfirst QHP |
$1,202.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$841.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,202.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,022.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$841.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,202.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$902.09
|
| Rate for Payer: SOMOS Essential |
$902.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,202.78
|
|
|
PR OPEN TX METACARPAL FRACTURE SINGLE EA BONE
|
Professional
|
Both
|
$2,546.18
|
|
|
Service Code
|
HCPCS 26615
|
| Min. Negotiated Rate |
$484.58 |
| Max. Negotiated Rate |
$1,557.59 |
| Rate for Payer: Cash Price |
$692.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$692.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$623.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$623.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$657.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$692.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$657.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$692.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$692.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$519.20
|
| Rate for Payer: Healthfirst Commercial |
$692.26
|
| Rate for Payer: Healthfirst Essential Plan |
$1,557.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$657.65
|
| Rate for Payer: Healthfirst QHP |
$692.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$484.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$692.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$588.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$484.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$692.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$519.20
|
| Rate for Payer: SOMOS Essential |
$519.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$692.26
|
|
|
PR OPEN TX METATARSOPHALANGEAL JOINT DISLOCATION
|
Professional
|
Both
|
$2,050.20
|
|
|
Service Code
|
HCPCS 28645
|
| Min. Negotiated Rate |
$394.54 |
| Max. Negotiated Rate |
$1,268.17 |
| Rate for Payer: Cash Price |
$567.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$563.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$507.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$507.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$535.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$563.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$535.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$563.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$563.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$422.72
|
| Rate for Payer: Healthfirst Commercial |
$563.63
|
| Rate for Payer: Healthfirst Essential Plan |
$1,268.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$535.45
|
| Rate for Payer: Healthfirst QHP |
$563.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$394.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$563.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$479.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$394.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$563.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$422.72
|
| Rate for Payer: SOMOS Essential |
$422.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$563.63
|
|
|
PR OPEN TX MONTEGGIA FRACTURE DISLOCATION ELBOW
|
Professional
|
Both
|
$2,998.80
|
|
|
Service Code
|
HCPCS 24635
|
| Min. Negotiated Rate |
$568.88 |
| Max. Negotiated Rate |
$1,828.53 |
| Rate for Payer: Cash Price |
$811.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$812.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$731.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$731.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$772.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$812.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$772.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$812.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$812.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$609.51
|
| Rate for Payer: Healthfirst Commercial |
$812.68
|
| Rate for Payer: Healthfirst Essential Plan |
$1,828.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$772.05
|
| Rate for Payer: Healthfirst QHP |
$812.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$568.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$812.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$690.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$568.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$812.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$609.51
|
| Rate for Payer: SOMOS Essential |
$609.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$812.68
|
|
|
PR OPEN TX NASAL FX COMP W/INT&/XTRNL SKELETAL FI
|
Professional
|
Both
|
$2,318.05
|
|
|
Service Code
|
HCPCS 21330
|
| Min. Negotiated Rate |
$433.93 |
| Max. Negotiated Rate |
$1,394.78 |
| Rate for Payer: Cash Price |
$629.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$619.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$557.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$557.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$588.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$619.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$588.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$619.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$619.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$464.93
|
| Rate for Payer: Healthfirst Commercial |
$619.90
|
| Rate for Payer: Healthfirst Essential Plan |
$1,394.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$588.90
|
| Rate for Payer: Healthfirst QHP |
$619.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$433.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$619.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$526.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$433.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$619.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$464.93
|
| Rate for Payer: SOMOS Essential |
$464.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$619.90
|
|
|
PR OPEN TX NASAL FX W/CONCOMITANT OPTX FXD SEPTUM
|
Professional
|
Both
|
$3,096.73
|
|
|
Service Code
|
HCPCS 21335
|
| Min. Negotiated Rate |
$581.49 |
| Max. Negotiated Rate |
$1,869.08 |
| Rate for Payer: Cash Price |
$842.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$830.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$747.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$747.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$789.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$830.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$789.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$830.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$830.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$623.02
|
| Rate for Payer: Healthfirst Commercial |
$830.70
|
| Rate for Payer: Healthfirst Essential Plan |
$1,869.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$789.16
|
| Rate for Payer: Healthfirst QHP |
$830.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$581.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$830.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$706.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$581.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$830.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$623.02
|
| Rate for Payer: SOMOS Essential |
$623.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$830.70
|
|
|
PR OPEN TX NASAL SEPTAL FRACTURE W/WO STABILIZATION
|
Professional
|
Both
|
$2,753.66
|
|
|
Service Code
|
HCPCS 21336
|
| Min. Negotiated Rate |
$517.31 |
| Max. Negotiated Rate |
$1,662.77 |
| Rate for Payer: Cash Price |
$748.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$739.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$665.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$665.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$702.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$739.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$702.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$739.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$739.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$554.26
|
| Rate for Payer: Healthfirst Commercial |
$739.01
|
| Rate for Payer: Healthfirst Essential Plan |
$1,662.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$702.06
|
| Rate for Payer: Healthfirst QHP |
$739.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$517.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$739.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$628.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$517.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$739.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$554.26
|
| Rate for Payer: SOMOS Essential |
$554.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$739.01
|
|
|
PR OPEN TX NASOETHMOID FX W/EXTERNAL FIXATION
|
Professional
|
Both
|
$3,287.55
|
|
|
Service Code
|
HCPCS 21339
|
| Min. Negotiated Rate |
$617.28 |
| Max. Negotiated Rate |
$1,984.12 |
| Rate for Payer: Cash Price |
$889.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$881.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$793.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$793.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$837.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$881.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$837.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$881.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$881.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$661.37
|
| Rate for Payer: Healthfirst Commercial |
$881.83
|
| Rate for Payer: Healthfirst Essential Plan |
$1,984.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$837.74
|
| Rate for Payer: Healthfirst QHP |
$881.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$617.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$881.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$749.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$617.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$881.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$661.37
|
| Rate for Payer: SOMOS Essential |
$661.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$881.83
|
|
|
PR OPEN TX NASOETHMOID FX W/O EXTERNAL FIXATION
|
Professional
|
Both
|
$2,909.80
|
|
|
Service Code
|
HCPCS 21338
|
| Min. Negotiated Rate |
$546.67 |
| Max. Negotiated Rate |
$1,757.16 |
| Rate for Payer: Cash Price |
$788.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$780.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$702.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$702.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$741.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$780.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$741.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$780.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$780.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$585.72
|
| Rate for Payer: Healthfirst Commercial |
$780.96
|
| Rate for Payer: Healthfirst Essential Plan |
$1,757.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$741.91
|
| Rate for Payer: Healthfirst QHP |
$780.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$546.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$780.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$663.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$546.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$780.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$585.72
|
| Rate for Payer: SOMOS Essential |
$585.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$780.96
|
|
|
PR OPEN TX ORBITAL FLOOR BLOWOUT FX COMBINED APPR
|
Professional
|
Both
|
$3,348.49
|
|
|
Service Code
|
HCPCS 21387
|
| Min. Negotiated Rate |
$629.84 |
| Max. Negotiated Rate |
$2,024.48 |
| Rate for Payer: Cash Price |
$903.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$899.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$809.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$809.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$854.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$899.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$854.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$899.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$899.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$674.83
|
| Rate for Payer: Healthfirst Commercial |
$899.77
|
| Rate for Payer: Healthfirst Essential Plan |
$2,024.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$854.78
|
| Rate for Payer: Healthfirst QHP |
$899.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$629.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$899.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$764.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$629.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$899.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$674.83
|
| Rate for Payer: SOMOS Essential |
$674.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$899.77
|
|
|
PR OPEN TX ORBITAL FLOOR BLOWOUT FX PERIORBITAL
|
Professional
|
Both
|
$3,027.68
|
|
|
Service Code
|
HCPCS 21386
|
| Min. Negotiated Rate |
$571.14 |
| Max. Negotiated Rate |
$1,835.82 |
| Rate for Payer: Cash Price |
$817.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$815.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$734.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$734.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$775.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$815.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$775.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$815.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$815.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$611.94
|
| Rate for Payer: Healthfirst Commercial |
$815.92
|
| Rate for Payer: Healthfirst Essential Plan |
$1,835.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$775.12
|
| Rate for Payer: Healthfirst QHP |
$815.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$571.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$815.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$693.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$571.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$815.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$611.94
|
| Rate for Payer: SOMOS Essential |
$611.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$815.92
|
|
|
PR OPEN TX ORBITAL FLOOR BLOWOUT FX TRANSANTRAL
|
Professional
|
Both
|
$3,208.80
|
|
|
Service Code
|
HCPCS 21385
|
| Min. Negotiated Rate |
$602.66 |
| Max. Negotiated Rate |
$1,937.12 |
| Rate for Payer: Cash Price |
$865.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$860.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$774.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$774.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$817.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$860.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$817.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$860.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$860.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$645.71
|
| Rate for Payer: Healthfirst Commercial |
$860.94
|
| Rate for Payer: Healthfirst Essential Plan |
$1,937.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$817.89
|
| Rate for Payer: Healthfirst QHP |
$860.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$602.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$860.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$731.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$602.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$860.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$645.71
|
| Rate for Payer: SOMOS Essential |
$645.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$860.94
|
|
|
PR OPEN TX PALATAL/MAXILLARY FX COMP MULTIPLE APPR
|
Professional
|
Both
|
$3,493.74
|
|
|
Service Code
|
HCPCS 21423
|
| Min. Negotiated Rate |
$652.99 |
| Max. Negotiated Rate |
$2,098.89 |
| Rate for Payer: Cash Price |
$939.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$932.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$839.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$839.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$886.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$932.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$886.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$932.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$932.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$699.63
|
| Rate for Payer: Healthfirst Commercial |
$932.84
|
| Rate for Payer: Healthfirst Essential Plan |
$2,098.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$886.20
|
| Rate for Payer: Healthfirst QHP |
$932.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$652.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$932.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$792.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$652.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$932.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$699.63
|
| Rate for Payer: SOMOS Essential |
$699.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$932.84
|
|
|
PR OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA
|
Professional
|
Both
|
$2,630.88
|
|
|
Service Code
|
HCPCS 26735
|
| Min. Negotiated Rate |
$499.97 |
| Max. Negotiated Rate |
$1,607.04 |
| Rate for Payer: Cash Price |
$716.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$714.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$642.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$642.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$678.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$714.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$678.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$714.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$714.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$535.68
|
| Rate for Payer: Healthfirst Commercial |
$714.24
|
| Rate for Payer: Healthfirst Essential Plan |
$1,607.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$678.53
|
| Rate for Payer: Healthfirst QHP |
$714.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$499.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$714.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$607.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$499.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$714.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$535.68
|
| Rate for Payer: SOMOS Essential |
$535.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$714.24
|
|
|
PR OPEN TX POST PELVIC FXCTURE
|
Professional
|
Both
|
$6,068.97
|
|
|
Service Code
|
HCPCS G0415
|
| Min. Negotiated Rate |
$1,139.49 |
| Max. Negotiated Rate |
$3,662.66 |
| Rate for Payer: Cash Price |
$1,628.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,627.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,465.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,465.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,546.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,627.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,546.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,627.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,627.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,220.89
|
| Rate for Payer: Healthfirst Commercial |
$1,627.85
|
| Rate for Payer: Healthfirst Essential Plan |
$3,662.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,546.46
|
| Rate for Payer: Healthfirst QHP |
$1,627.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,139.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,627.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,383.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,139.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,627.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,220.89
|
| Rate for Payer: SOMOS Essential |
$1,220.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,627.85
|
|
|
PR OPEN TX PROX TIBFIB JOINT DISLOCATE EXC PROX FIB
|
Professional
|
Both
|
$3,360.00
|
|
|
Service Code
|
HCPCS 27832
|
| Min. Negotiated Rate |
$636.08 |
| Max. Negotiated Rate |
$2,044.53 |
| Rate for Payer: Cash Price |
$910.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$908.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$817.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$817.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$863.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$908.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$863.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$908.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$908.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$681.51
|
| Rate for Payer: Healthfirst Commercial |
$908.68
|
| Rate for Payer: Healthfirst Essential Plan |
$2,044.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$863.25
|
| Rate for Payer: Healthfirst QHP |
$908.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$636.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$908.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$772.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$636.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$908.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$681.51
|
| Rate for Payer: SOMOS Essential |
$681.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$908.68
|
|
