|
PR OPEN TX RADIAL HEAD/NECK FRACTURE
|
Professional
|
Both
|
$2,909.41
|
|
|
Service Code
|
HCPCS 24665
|
| Min. Negotiated Rate |
$552.42 |
| Max. Negotiated Rate |
$1,775.63 |
| Rate for Payer: Cash Price |
$790.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$789.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$710.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$710.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$749.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$789.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$749.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$789.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$789.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$591.88
|
| Rate for Payer: Healthfirst Commercial |
$789.17
|
| Rate for Payer: Healthfirst Essential Plan |
$1,775.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$749.71
|
| Rate for Payer: Healthfirst QHP |
$789.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$552.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$789.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$670.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$552.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$789.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$591.88
|
| Rate for Payer: SOMOS Essential |
$591.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$789.17
|
|
|
PR OPEN TX RADIAL HEAD/NECK FRACTURE PROSTHETIC
|
Professional
|
Both
|
$3,245.24
|
|
|
Service Code
|
HCPCS 24666
|
| Min. Negotiated Rate |
$612.61 |
| Max. Negotiated Rate |
$1,969.09 |
| Rate for Payer: Cash Price |
$877.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$875.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$787.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$787.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$831.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$875.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$831.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$875.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$875.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$656.36
|
| Rate for Payer: Healthfirst Commercial |
$875.15
|
| Rate for Payer: Healthfirst Essential Plan |
$1,969.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$831.39
|
| Rate for Payer: Healthfirst QHP |
$875.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$612.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$875.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$743.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$612.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$875.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$656.36
|
| Rate for Payer: SOMOS Essential |
$656.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$875.15
|
|
|
PR OPEN TX RADIAL&ULNAR SHAFT FX W/FIXJ RADIUS&ULNA
|
Professional
|
Both
|
$4,002.64
|
|
|
Service Code
|
HCPCS 25575
|
| Min. Negotiated Rate |
$755.44 |
| Max. Negotiated Rate |
$2,428.20 |
| Rate for Payer: Cash Price |
$1,082.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,079.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$971.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$971.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,025.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,079.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,025.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,079.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,079.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$809.40
|
| Rate for Payer: Healthfirst Commercial |
$1,079.20
|
| Rate for Payer: Healthfirst Essential Plan |
$2,428.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,025.24
|
| Rate for Payer: Healthfirst QHP |
$1,079.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$755.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,079.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$917.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$755.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,079.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$809.40
|
| Rate for Payer: SOMOS Essential |
$809.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,079.20
|
|
|
PR OPEN TX RADIAL&ULNAR SHAFT FX W/FIXJ RADIUS/ULNA
|
Professional
|
Both
|
$2,997.51
|
|
|
Service Code
|
HCPCS 25574
|
| Min. Negotiated Rate |
$567.79 |
| Max. Negotiated Rate |
$1,825.04 |
| Rate for Payer: Cash Price |
$812.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$811.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$730.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$730.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$770.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$811.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$770.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$811.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$811.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$608.35
|
| Rate for Payer: Healthfirst Commercial |
$811.13
|
| Rate for Payer: Healthfirst Essential Plan |
$1,825.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$770.57
|
| Rate for Payer: Healthfirst QHP |
$811.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$567.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$811.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$689.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$567.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$811.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$608.35
|
| Rate for Payer: SOMOS Essential |
$608.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$811.13
|
|
|
PR OPEN TX RADIOCARPAL/INTERCARPAL DISLC 1/> BONES
|
Professional
|
Both
|
$2,700.64
|
|
|
Service Code
|
HCPCS 25670
|
| Min. Negotiated Rate |
$507.94 |
| Max. Negotiated Rate |
$1,632.67 |
| Rate for Payer: Cash Price |
$730.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$725.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$653.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$653.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$689.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$725.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$689.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$725.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$725.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$544.22
|
| Rate for Payer: Healthfirst Commercial |
$725.63
|
| Rate for Payer: Healthfirst Essential Plan |
$1,632.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$689.35
|
| Rate for Payer: Healthfirst QHP |
$725.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$507.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$725.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$616.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$507.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$725.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$544.22
|
| Rate for Payer: SOMOS Essential |
$544.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$725.63
|
|
|
PR OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 1-3 RIBS
|
Professional
|
Both
|
$2,656.05
|
|
|
Service Code
|
HCPCS 21811
|
| Min. Negotiated Rate |
$489.00 |
| Max. Negotiated Rate |
$1,571.78 |
| Rate for Payer: Cash Price |
$706.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$698.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$628.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$628.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$663.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$698.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$663.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$698.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$698.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$523.93
|
| Rate for Payer: Healthfirst Commercial |
$698.57
|
| Rate for Payer: Healthfirst Essential Plan |
$1,571.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$663.64
|
| Rate for Payer: Healthfirst QHP |
$698.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$489.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$698.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$593.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$489.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$698.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$523.93
|
| Rate for Payer: SOMOS Essential |
$523.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$698.57
|
|
|
PR OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 4-6 RIBS
|
Professional
|
Both
|
$3,217.59
|
|
|
Service Code
|
HCPCS 21812
|
| Min. Negotiated Rate |
$591.32 |
| Max. Negotiated Rate |
$1,900.66 |
| Rate for Payer: Cash Price |
$851.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$844.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$760.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$760.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$802.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$844.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$802.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$844.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$844.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$633.55
|
| Rate for Payer: Healthfirst Commercial |
$844.74
|
| Rate for Payer: Healthfirst Essential Plan |
$1,900.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$802.50
|
| Rate for Payer: Healthfirst QHP |
$844.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$591.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$844.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$718.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$591.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$844.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$633.55
|
| Rate for Payer: SOMOS Essential |
$633.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$844.74
|
|
|
PR OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 7+ RIBS
|
Professional
|
Both
|
$4,434.33
|
|
|
Service Code
|
HCPCS 21813
|
| Min. Negotiated Rate |
$816.20 |
| Max. Negotiated Rate |
$2,623.50 |
| Rate for Payer: Cash Price |
$1,174.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,166.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,049.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,049.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,107.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,166.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,107.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,166.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,166.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$874.50
|
| Rate for Payer: Healthfirst Commercial |
$1,166.00
|
| Rate for Payer: Healthfirst Essential Plan |
$2,623.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,107.70
|
| Rate for Payer: Healthfirst QHP |
$1,166.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$816.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,166.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$991.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$816.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,166.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$874.50
|
| Rate for Payer: SOMOS Essential |
$874.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,166.00
|
|
|
PR OPEN TX SCAPULAR FX W/INTERNAL FIXATION IF PFRMD
|
Professional
|
Both
|
$4,309.90
|
|
|
Service Code
|
HCPCS 23585
|
| Min. Negotiated Rate |
$809.05 |
| Max. Negotiated Rate |
$2,600.53 |
| Rate for Payer: Cash Price |
$1,161.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,155.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,040.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,040.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,098.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,155.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,098.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,155.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,155.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$866.84
|
| Rate for Payer: Healthfirst Commercial |
$1,155.79
|
| Rate for Payer: Healthfirst Essential Plan |
$2,600.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,098.00
|
| Rate for Payer: Healthfirst QHP |
$1,155.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$809.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,155.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$982.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$809.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,155.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$866.84
|
| Rate for Payer: SOMOS Essential |
$866.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,155.79
|
|
|
PR OPEN TX SESAMOID FRACTURE W/WO INTERNAL FIXATION
|
Professional
|
Both
|
$751.94
|
|
|
Service Code
|
HCPCS 28531
|
| Min. Negotiated Rate |
$147.14 |
| Max. Negotiated Rate |
$472.95 |
| Rate for Payer: Cash Price |
$210.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$210.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$189.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$189.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$199.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$199.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$210.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$210.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$157.65
|
| Rate for Payer: Healthfirst Commercial |
$210.20
|
| Rate for Payer: Healthfirst Essential Plan |
$472.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$199.69
|
| Rate for Payer: Healthfirst QHP |
$210.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$147.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$210.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$178.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$147.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$210.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$157.65
|
| Rate for Payer: SOMOS Essential |
$157.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$210.20
|
|
|
PR OPEN TX SHOULDER DISLC W/HUMERAL TUBEROSITY FX
|
Professional
|
Both
|
$3,846.68
|
|
|
Service Code
|
HCPCS 23670
|
| Min. Negotiated Rate |
$727.75 |
| Max. Negotiated Rate |
$2,339.21 |
| Rate for Payer: Cash Price |
$1,043.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,039.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$935.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$935.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$987.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,039.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$987.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,039.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,039.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$779.74
|
| Rate for Payer: Healthfirst Commercial |
$1,039.65
|
| Rate for Payer: Healthfirst Essential Plan |
$2,339.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$987.67
|
| Rate for Payer: Healthfirst QHP |
$1,039.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$727.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,039.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$883.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$727.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,039.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$779.74
|
| Rate for Payer: SOMOS Essential |
$779.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,039.65
|
|
|
PR OPEN TX SHOULDER DISLOCATION W/NECK FRACTURE
|
Professional
|
Both
|
$4,116.07
|
|
|
Service Code
|
HCPCS 23680
|
| Min. Negotiated Rate |
$775.80 |
| Max. Negotiated Rate |
$2,493.65 |
| Rate for Payer: Cash Price |
$1,097.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,108.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$997.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$997.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,052.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,108.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,052.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,108.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,108.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$831.22
|
| Rate for Payer: Healthfirst Commercial |
$1,108.29
|
| Rate for Payer: Healthfirst Essential Plan |
$2,493.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,052.88
|
| Rate for Payer: Healthfirst QHP |
$1,108.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$775.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,108.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$942.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$775.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,108.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$831.22
|
| Rate for Payer: SOMOS Essential |
$831.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,108.29
|
|
|
PR OPEN TX STERNOCLAVICULAR DISLC ACUTE/CHRONIC
|
Professional
|
Both
|
$2,567.43
|
|
|
Service Code
|
HCPCS 23530
|
| Min. Negotiated Rate |
$484.76 |
| Max. Negotiated Rate |
$1,558.15 |
| Rate for Payer: Cash Price |
$694.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$692.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$623.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$623.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$657.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$692.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$657.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$692.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$692.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$519.38
|
| Rate for Payer: Healthfirst Commercial |
$692.51
|
| Rate for Payer: Healthfirst Essential Plan |
$1,558.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$657.88
|
| Rate for Payer: Healthfirst QHP |
$692.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$484.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$692.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$588.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$484.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$692.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$519.38
|
| Rate for Payer: SOMOS Essential |
$519.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$692.51
|
|
|
PR OPEN TX STERNUM FRACTURE W/WO SKELETAL FIXATION
|
Professional
|
Both
|
$2,455.15
|
|
|
Service Code
|
HCPCS 21825
|
| Min. Negotiated Rate |
$462.00 |
| Max. Negotiated Rate |
$1,485.00 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$660.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$594.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$594.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$627.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$660.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$627.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$660.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$660.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$495.00
|
| Rate for Payer: Healthfirst Commercial |
$660.00
|
| Rate for Payer: Healthfirst Essential Plan |
$1,485.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$627.00
|
| Rate for Payer: Healthfirst QHP |
$660.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$462.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$660.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$561.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$462.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$660.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$495.00
|
| Rate for Payer: SOMOS Essential |
$495.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$660.00
|
|
|
PR OPEN TX TARSAL FRACTURE XCP TALUS & CALCANEUS EA
|
Professional
|
Both
|
$2,732.91
|
|
|
Service Code
|
HCPCS 28465
|
| Min. Negotiated Rate |
$528.76 |
| Max. Negotiated Rate |
$1,699.58 |
| Rate for Payer: Cash Price |
$756.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$755.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$679.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$679.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$717.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$755.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$717.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$755.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$755.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$566.53
|
| Rate for Payer: Healthfirst Commercial |
$755.37
|
| Rate for Payer: Healthfirst Essential Plan |
$1,699.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$717.60
|
| Rate for Payer: Healthfirst QHP |
$755.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$528.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$755.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$642.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$528.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$755.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$566.53
|
| Rate for Payer: SOMOS Essential |
$566.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$755.37
|
|
|
PR OPEN TX TIBIAL FRACTURE PROXIMAL UNICONDYLAR
|
Professional
|
Both
|
$3,961.20
|
|
|
Service Code
|
HCPCS 27535
|
| Min. Negotiated Rate |
$743.10 |
| Max. Negotiated Rate |
$2,388.53 |
| Rate for Payer: Cash Price |
$1,067.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,061.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$955.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$955.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,008.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,061.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,008.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,061.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,061.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$796.18
|
| Rate for Payer: Healthfirst Commercial |
$1,061.57
|
| Rate for Payer: Healthfirst Essential Plan |
$2,388.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,008.49
|
| Rate for Payer: Healthfirst QHP |
$1,061.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$743.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,061.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$902.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$743.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,061.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$796.18
|
| Rate for Payer: SOMOS Essential |
$796.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,061.57
|
|
|
PR OPEN TX TRANS-SCAPHOPERILUNAR FRACTURE DISLC
|
Professional
|
Both
|
$3,266.76
|
|
|
Service Code
|
HCPCS 25685
|
| Min. Negotiated Rate |
$616.27 |
| Max. Negotiated Rate |
$1,980.88 |
| Rate for Payer: Cash Price |
$883.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$880.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$792.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$792.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$836.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$880.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$836.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$880.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$880.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$660.29
|
| Rate for Payer: Healthfirst Commercial |
$880.39
|
| Rate for Payer: Healthfirst Essential Plan |
$1,980.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$836.37
|
| Rate for Payer: Healthfirst QHP |
$880.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$616.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$880.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$748.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$616.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$880.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$660.29
|
| Rate for Payer: SOMOS Essential |
$660.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$880.39
|
|
|
PR OPEN TX TRIMALLEOLAR ANKLE FX W/FIXJ PST LIP
|
Professional
|
Both
|
$4,337.90
|
|
|
Service Code
|
HCPCS 27823
|
| Min. Negotiated Rate |
$812.00 |
| Max. Negotiated Rate |
$2,610.00 |
| Rate for Payer: Cash Price |
$1,172.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,160.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,044.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,044.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,102.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,160.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,102.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,160.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,160.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$870.00
|
| Rate for Payer: Healthfirst Commercial |
$1,160.00
|
| Rate for Payer: Healthfirst Essential Plan |
$2,610.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,102.00
|
| Rate for Payer: Healthfirst QHP |
$1,160.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$812.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,160.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$986.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$812.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,160.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$870.00
|
| Rate for Payer: SOMOS Essential |
$870.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,160.00
|
|
|
PR OPEN TX TRIMALLEOLAR ANKLE FX W/O FIXJ PST LIP
|
Professional
|
Both
|
$3,849.09
|
|
|
Service Code
|
HCPCS 27822
|
| Min. Negotiated Rate |
$720.99 |
| Max. Negotiated Rate |
$2,317.45 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,029.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$926.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$926.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$978.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,029.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$978.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,029.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,029.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$772.49
|
| Rate for Payer: Healthfirst Commercial |
$1,029.98
|
| Rate for Payer: Healthfirst Essential Plan |
$2,317.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$978.48
|
| Rate for Payer: Healthfirst QHP |
$1,029.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$720.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,029.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$875.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$720.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,029.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$772.49
|
| Rate for Payer: SOMOS Essential |
$772.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,029.98
|
|
|
PR OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL
|
Professional
|
Both
|
$119.25
|
|
|
Service Code
|
HCPCS 92136 26
|
| Min. Negotiated Rate |
$22.69 |
| Max. Negotiated Rate |
$72.94 |
| Rate for Payer: Amida Care Medicaid |
$64.17
|
| Rate for Payer: Cash Price |
$32.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.32
|
| Rate for Payer: Healthfirst Commercial |
$32.42
|
| Rate for Payer: Healthfirst Essential Plan |
$72.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.80
|
| Rate for Payer: Healthfirst QHP |
$32.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.32
|
| Rate for Payer: SOMOS Essential |
$24.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.42
|
|
|
PR OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL
|
Professional
|
Both
|
$74.62
|
|
|
Service Code
|
HCPCS 92136 TC
|
| Min. Negotiated Rate |
$14.29 |
| Max. Negotiated Rate |
$64.17 |
| Rate for Payer: Amida Care Medicaid |
$64.17
|
| Rate for Payer: Cash Price |
$20.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.31
|
| Rate for Payer: Healthfirst Commercial |
$20.41
|
| Rate for Payer: Healthfirst Essential Plan |
$45.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.39
|
| Rate for Payer: Healthfirst QHP |
$20.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.31
|
| Rate for Payer: SOMOS Essential |
$15.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.41
|
|
|
PR OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL
|
Professional
|
Both
|
$193.87
|
|
|
Service Code
|
HCPCS 92136
|
| Min. Negotiated Rate |
$36.98 |
| Max. Negotiated Rate |
$118.87 |
| Rate for Payer: Amida Care Medicaid |
$64.17
|
| Rate for Payer: Cash Price |
$53.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.62
|
| Rate for Payer: Healthfirst Commercial |
$52.83
|
| Rate for Payer: Healthfirst Essential Plan |
$118.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.19
|
| Rate for Payer: Healthfirst QHP |
$52.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.62
|
| Rate for Payer: SOMOS Essential |
$39.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.83
|
|
|
PR OPH SCVS MEDICAL XM&EVAL INTERMEDIATE NEW PT
|
Professional
|
Both
|
$180.39
|
|
|
Service Code
|
HCPCS 92002
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$109.42 |
| Rate for Payer: Amida Care Medicaid |
$30.30
|
| Rate for Payer: Cash Price |
$49.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$48.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.47
|
| Rate for Payer: Healthfirst Commercial |
$48.63
|
| Rate for Payer: Healthfirst Essential Plan |
$109.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.20
|
| Rate for Payer: Healthfirst QHP |
$48.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.47
|
| Rate for Payer: SOMOS Essential |
$36.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.63
|
|
|
PR OPH SVCS MEDICAL XM&EVAL COMPRE EST PT 1/>VST
|
Professional
|
Both
|
$300.93
|
|
|
Service Code
|
HCPCS 92014
|
| Min. Negotiated Rate |
$34.48 |
| Max. Negotiated Rate |
$182.88 |
| Rate for Payer: Amida Care Medicaid |
$34.48
|
| Rate for Payer: Cash Price |
$82.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.96
|
| Rate for Payer: Healthfirst Commercial |
$81.28
|
| Rate for Payer: Healthfirst Essential Plan |
$182.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$77.22
|
| Rate for Payer: Healthfirst QHP |
$81.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$81.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.96
|
| Rate for Payer: SOMOS Essential |
$60.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.28
|
|
|
PR OPH SVCS MEDICAL XM&EVAL COMPRE NEW PT 1/> VST
|
Professional
|
Both
|
$369.71
|
|
|
Service Code
|
HCPCS 92004
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$225.22 |
| Rate for Payer: Amida Care Medicaid |
$44.80
|
| Rate for Payer: Cash Price |
$101.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$100.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$90.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$90.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$95.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$100.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$95.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.08
|
| Rate for Payer: Healthfirst Commercial |
$100.10
|
| Rate for Payer: Healthfirst Essential Plan |
$225.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$95.09
|
| Rate for Payer: Healthfirst QHP |
$100.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$70.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$100.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$85.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$70.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$100.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$75.08
|
| Rate for Payer: SOMOS Essential |
$75.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$100.10
|
|
