|
PR OPSCPY EXTND OPTIC NRV/MACULA DRAWING I&R UNI/BI
|
Professional
|
Both
|
$58.31
|
|
|
Service Code
|
HCPCS 92202
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$35.53 |
| Rate for Payer: Amida Care Medicaid |
$8.09
|
| Rate for Payer: Cash Price |
$15.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.84
|
| Rate for Payer: Healthfirst Commercial |
$15.79
|
| Rate for Payer: Healthfirst Essential Plan |
$35.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.00
|
| Rate for Payer: Healthfirst QHP |
$15.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.84
|
| Rate for Payer: SOMOS Essential |
$11.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.79
|
|
|
PR OPSCPY EXTND RTA DRAWING & SCL DEPRSN I&R UNI/BI
|
Professional
|
Both
|
$90.06
|
|
|
Service Code
|
HCPCS 92201
|
| Min. Negotiated Rate |
$12.54 |
| Max. Negotiated Rate |
$55.62 |
| Rate for Payer: Amida Care Medicaid |
$12.54
|
| Rate for Payer: Cash Price |
$25.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.54
|
| Rate for Payer: Healthfirst Commercial |
$24.72
|
| Rate for Payer: Healthfirst Essential Plan |
$55.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.48
|
| Rate for Payer: Healthfirst QHP |
$24.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.54
|
| Rate for Payer: SOMOS Essential |
$18.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.72
|
|
|
PR OPTICAL ENDOMICROSCOPIC IMAGE INTERP & REPORT
|
Professional
|
Both
|
$189.60
|
|
|
Service Code
|
HCPCS 88375
|
| Min. Negotiated Rate |
$35.63 |
| Max. Negotiated Rate |
$114.53 |
| Rate for Payer: Cash Price |
$52.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$50.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$45.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$48.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$50.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$48.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.17
|
| Rate for Payer: Healthfirst Commercial |
$50.90
|
| Rate for Payer: Healthfirst Essential Plan |
$114.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$48.35
|
| Rate for Payer: Healthfirst QHP |
$50.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$50.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.17
|
| Rate for Payer: SOMOS Essential |
$38.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.90
|
|
|
PR OPTIC NERVE DECOMPRESSION
|
Professional
|
Both
|
$5,324.41
|
|
|
Service Code
|
HCPCS 67570
|
| Min. Negotiated Rate |
$992.00 |
| Max. Negotiated Rate |
$3,188.59 |
| Rate for Payer: Cash Price |
$1,454.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,417.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,275.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,275.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,346.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,417.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,346.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,417.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,417.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,062.86
|
| Rate for Payer: Healthfirst Commercial |
$1,417.15
|
| Rate for Payer: Healthfirst Essential Plan |
$3,188.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,346.29
|
| Rate for Payer: Healthfirst QHP |
$1,417.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$992.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,417.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,204.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$992.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,417.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,062.86
|
| Rate for Payer: SOMOS Essential |
$1,062.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,417.15
|
|
|
PR OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC
|
Professional
|
Both
|
$56.67
|
|
|
Service Code
|
HCPCS 92544 26
|
| Min. Negotiated Rate |
$11.02 |
| Max. Negotiated Rate |
$37.71 |
| Rate for Payer: Amida Care Medicaid |
$37.71
|
| Rate for Payer: Cash Price |
$15.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.80
|
| Rate for Payer: Healthfirst Commercial |
$15.74
|
| Rate for Payer: Healthfirst Essential Plan |
$35.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.95
|
| Rate for Payer: Healthfirst QHP |
$15.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.80
|
| Rate for Payer: SOMOS Essential |
$11.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.74
|
|
|
PR OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC
|
Professional
|
Both
|
$17.12
|
|
|
Service Code
|
HCPCS 92544 TC
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$37.71 |
| Rate for Payer: Amida Care Medicaid |
$37.71
|
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.38
|
| Rate for Payer: Healthfirst Commercial |
$4.50
|
| Rate for Payer: Healthfirst Essential Plan |
$10.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.28
|
| Rate for Payer: Healthfirst QHP |
$4.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.38
|
| Rate for Payer: SOMOS Essential |
$3.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.50
|
|
|
PR OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC
|
Professional
|
Both
|
$73.78
|
|
|
Service Code
|
HCPCS 92544
|
| Min. Negotiated Rate |
$14.17 |
| Max. Negotiated Rate |
$45.54 |
| Rate for Payer: Amida Care Medicaid |
$37.71
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.18
|
| Rate for Payer: Healthfirst Commercial |
$20.24
|
| Rate for Payer: Healthfirst Essential Plan |
$45.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.23
|
| Rate for Payer: Healthfirst QHP |
$20.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.18
|
| Rate for Payer: SOMOS Essential |
$15.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.24
|
|
|
PR OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF
|
Professional
|
Both
|
$2,866.89
|
|
|
Service Code
|
HCPCS 23552
|
| Min. Negotiated Rate |
$538.52 |
| Max. Negotiated Rate |
$1,730.95 |
| Rate for Payer: Cash Price |
$778.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$769.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$692.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$692.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$730.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$769.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$730.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$769.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$769.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$576.98
|
| Rate for Payer: Healthfirst Commercial |
$769.31
|
| Rate for Payer: Healthfirst Essential Plan |
$1,730.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$730.84
|
| Rate for Payer: Healthfirst QHP |
$769.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$538.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$769.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$653.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$538.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$769.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$576.98
|
| Rate for Payer: SOMOS Essential |
$576.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$769.31
|
|
|
PR OPTX ACTBLR FX INVG ANT&POST 2 COLUMNS FX W/INT
|
Professional
|
Both
|
$8,277.57
|
|
|
Service Code
|
HCPCS 27228
|
| Min. Negotiated Rate |
$1,548.19 |
| Max. Negotiated Rate |
$4,976.32 |
| Rate for Payer: Cash Price |
$2,224.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,211.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,990.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,990.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,101.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,211.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,101.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,211.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,211.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,658.78
|
| Rate for Payer: Healthfirst Commercial |
$2,211.70
|
| Rate for Payer: Healthfirst Essential Plan |
$4,976.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,101.11
|
| Rate for Payer: Healthfirst QHP |
$2,211.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,548.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,211.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,879.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,548.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,211.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,658.78
|
| Rate for Payer: SOMOS Essential |
$1,658.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,211.70
|
|
|
PR OPTX ACTBLR FX INVG ANT/PST 1 COLUMN/FX W/INT
|
Professional
|
Both
|
$7,273.18
|
|
|
Service Code
|
HCPCS 27227
|
| Min. Negotiated Rate |
$1,363.84 |
| Max. Negotiated Rate |
$4,383.77 |
| Rate for Payer: Cash Price |
$1,957.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,948.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,753.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,753.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,850.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,948.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,850.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,948.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,948.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,461.26
|
| Rate for Payer: Healthfirst Commercial |
$1,948.34
|
| Rate for Payer: Healthfirst Essential Plan |
$4,383.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,850.92
|
| Rate for Payer: Healthfirst QHP |
$1,948.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,363.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,948.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,656.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,363.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,948.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,461.26
|
| Rate for Payer: SOMOS Essential |
$1,461.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,948.34
|
|
|
PR OPTX ANKLE DISLOCATION W/O REPAIR/INTERNAL FIXJ
|
Professional
|
Both
|
$3,152.73
|
|
|
Service Code
|
HCPCS 27846
|
| Min. Negotiated Rate |
$600.30 |
| Max. Negotiated Rate |
$1,929.53 |
| Rate for Payer: Cash Price |
$868.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$857.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$771.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$771.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$814.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$857.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$814.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$857.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$857.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$643.18
|
| Rate for Payer: Healthfirst Commercial |
$857.57
|
| Rate for Payer: Healthfirst Essential Plan |
$1,929.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$814.69
|
| Rate for Payer: Healthfirst QHP |
$857.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$600.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$857.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$728.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$600.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$857.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$643.18
|
| Rate for Payer: SOMOS Essential |
$643.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$857.57
|
|
|
PR OPTX ANKLE DISLOCATION W/REPAIR/INT/XTRNL FIXJ
|
Professional
|
Both
|
$3,437.14
|
|
|
Service Code
|
HCPCS 27848
|
| Min. Negotiated Rate |
$657.54 |
| Max. Negotiated Rate |
$2,113.54 |
| Rate for Payer: Cash Price |
$935.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$939.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$845.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$845.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$892.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$939.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$892.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$939.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$939.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$704.51
|
| Rate for Payer: Healthfirst Commercial |
$939.35
|
| Rate for Payer: Healthfirst Essential Plan |
$2,113.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$892.38
|
| Rate for Payer: Healthfirst QHP |
$939.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$657.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$939.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$798.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$657.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$939.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$704.51
|
| Rate for Payer: SOMOS Essential |
$704.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$939.35
|
|
|
PR OPTX CARP/MTCRPL DISLC THMB CPLX MLT/DLYD RDCTJ
|
Professional
|
Both
|
$2,772.81
|
|
|
Service Code
|
HCPCS 26686
|
| Min. Negotiated Rate |
$523.22 |
| Max. Negotiated Rate |
$1,681.76 |
| Rate for Payer: Cash Price |
$750.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$747.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$672.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$672.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$710.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$747.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$710.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$747.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$747.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$560.59
|
| Rate for Payer: Healthfirst Commercial |
$747.45
|
| Rate for Payer: Healthfirst Essential Plan |
$1,681.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$710.08
|
| Rate for Payer: Healthfirst QHP |
$747.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$523.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$747.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$635.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$523.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$747.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$560.59
|
| Rate for Payer: SOMOS Essential |
$560.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$747.45
|
|
|
PR OPTX COMP MANDIBULAR FX MLT APPR W/INT FIXATION
|
Professional
|
Both
|
$4,949.63
|
|
|
Service Code
|
HCPCS 21470
|
| Min. Negotiated Rate |
$941.07 |
| Max. Negotiated Rate |
$3,024.88 |
| Rate for Payer: Cash Price |
$1,352.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,344.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,209.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,209.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,277.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,344.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,277.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,344.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,344.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,008.29
|
| Rate for Payer: Healthfirst Commercial |
$1,344.39
|
| Rate for Payer: Healthfirst Essential Plan |
$3,024.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,277.17
|
| Rate for Payer: Healthfirst QHP |
$1,344.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$941.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,344.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,142.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$941.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,344.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,008.29
|
| Rate for Payer: SOMOS Essential |
$1,008.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,344.39
|
|
|
PR OPTX CRNFCL SEP LFT III TYP COMP INT FIXJ W/BONE
|
Professional
|
Both
|
$8,891.33
|
|
|
Service Code
|
HCPCS 21436
|
| Min. Negotiated Rate |
$1,668.72 |
| Max. Negotiated Rate |
$5,363.75 |
| Rate for Payer: Cash Price |
$2,393.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,383.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,145.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,145.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,264.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,383.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,264.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,383.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,383.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,787.92
|
| Rate for Payer: Healthfirst Commercial |
$2,383.89
|
| Rate for Payer: Healthfirst Essential Plan |
$5,363.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,264.70
|
| Rate for Payer: Healthfirst QHP |
$2,383.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,668.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,383.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,026.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,668.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,383.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,787.92
|
| Rate for Payer: SOMOS Essential |
$1,787.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,383.89
|
|
|
PR OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 2 FRAG
|
Professional
|
Both
|
$3,661.25
|
|
|
Service Code
|
HCPCS 25608
|
| Min. Negotiated Rate |
$692.66 |
| Max. Negotiated Rate |
$2,226.40 |
| Rate for Payer: Cash Price |
$993.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$989.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$890.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$890.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$940.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$989.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$940.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$989.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$989.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$742.13
|
| Rate for Payer: Healthfirst Commercial |
$989.51
|
| Rate for Payer: Healthfirst Essential Plan |
$2,226.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$940.03
|
| Rate for Payer: Healthfirst QHP |
$989.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$692.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$989.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$841.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$692.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$989.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$742.13
|
| Rate for Payer: SOMOS Essential |
$742.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$989.51
|
|
|
PR OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 3 FRAG
|
Professional
|
Both
|
$4,639.60
|
|
|
Service Code
|
HCPCS 25609
|
| Min. Negotiated Rate |
$877.56 |
| Max. Negotiated Rate |
$2,820.74 |
| Rate for Payer: Cash Price |
$1,256.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,253.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,128.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,128.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,190.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,253.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,190.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,253.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,253.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$940.25
|
| Rate for Payer: Healthfirst Commercial |
$1,253.66
|
| Rate for Payer: Healthfirst Essential Plan |
$2,820.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,190.98
|
| Rate for Payer: Healthfirst QHP |
$1,253.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$877.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,253.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,065.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$877.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,253.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$940.25
|
| Rate for Payer: SOMOS Essential |
$940.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,253.66
|
|
|
PR OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP
|
Professional
|
Both
|
$3,279.05
|
|
|
Service Code
|
HCPCS 25607
|
| Min. Negotiated Rate |
$622.61 |
| Max. Negotiated Rate |
$2,001.24 |
| Rate for Payer: Cash Price |
$889.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$889.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$800.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$800.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$844.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$889.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$844.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$889.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$889.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$667.08
|
| Rate for Payer: Healthfirst Commercial |
$889.44
|
| Rate for Payer: Healthfirst Essential Plan |
$2,001.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$844.97
|
| Rate for Payer: Healthfirst QHP |
$889.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$622.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$889.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$756.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$622.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$889.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$667.08
|
| Rate for Payer: SOMOS Essential |
$667.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$889.44
|
|
|
PR OPTX FEM FX PROX END NCK INT FIXJ/PROSTC RPLCMT
|
Professional
|
Both
|
$5,259.28
|
|
|
Service Code
|
HCPCS 27236
|
| Min. Negotiated Rate |
$988.11 |
| Max. Negotiated Rate |
$3,176.08 |
| Rate for Payer: Cash Price |
$1,420.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,411.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,270.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,270.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,341.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,411.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,341.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,411.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,411.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,058.69
|
| Rate for Payer: Healthfirst Commercial |
$1,411.59
|
| Rate for Payer: Healthfirst Essential Plan |
$3,176.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,341.01
|
| Rate for Payer: Healthfirst QHP |
$1,411.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$988.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,411.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,199.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$988.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,411.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,058.69
|
| Rate for Payer: SOMOS Essential |
$1,058.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,411.59
|
|
|
PR OPTX FEM SHFT FX W/INSJ IMED IMPLT W/WO SCREW
|
Professional
|
Both
|
$5,904.01
|
|
|
Service Code
|
HCPCS 27506
|
| Min. Negotiated Rate |
$1,108.79 |
| Max. Negotiated Rate |
$3,563.95 |
| Rate for Payer: Cash Price |
$1,591.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,583.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,425.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,425.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,504.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,583.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,504.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,583.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,583.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,187.98
|
| Rate for Payer: Healthfirst Commercial |
$1,583.98
|
| Rate for Payer: Healthfirst Essential Plan |
$3,563.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,504.78
|
| Rate for Payer: Healthfirst QHP |
$1,583.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,108.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,583.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,346.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,108.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,583.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,187.98
|
| Rate for Payer: SOMOS Essential |
$1,187.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,583.98
|
|
|
PR OPTX FEM SHFT FX W/PLATE/SCREWS W/WO CERCLAGE
|
Professional
|
Both
|
$4,274.73
|
|
|
Service Code
|
HCPCS 27507
|
| Min. Negotiated Rate |
$802.45 |
| Max. Negotiated Rate |
$2,579.29 |
| Rate for Payer: Cash Price |
$1,150.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,146.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,031.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,031.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,089.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,146.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,089.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,146.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,146.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$859.76
|
| Rate for Payer: Healthfirst Commercial |
$1,146.35
|
| Rate for Payer: Healthfirst Essential Plan |
$2,579.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,089.03
|
| Rate for Payer: Healthfirst QHP |
$1,146.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$802.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,146.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$974.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$802.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,146.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$859.76
|
| Rate for Payer: SOMOS Essential |
$859.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,146.35
|
|
|
PR OPTX HIP DISLC TRAUMTC W/ACTBLR WALL&FEM HEAD
|
Professional
|
Both
|
$5,611.45
|
|
|
Service Code
|
HCPCS 27254
|
| Min. Negotiated Rate |
$1,052.78 |
| Max. Negotiated Rate |
$3,383.93 |
| Rate for Payer: Cash Price |
$1,512.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,503.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,353.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,353.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,428.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,503.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,428.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,503.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,503.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,127.98
|
| Rate for Payer: Healthfirst Commercial |
$1,503.97
|
| Rate for Payer: Healthfirst Essential Plan |
$3,383.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,428.77
|
| Rate for Payer: Healthfirst QHP |
$1,503.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,052.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,503.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,278.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,052.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,503.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,127.98
|
| Rate for Payer: SOMOS Essential |
$1,127.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,503.97
|
|
|
PR OPTX HIP DISLOCATION TRAUMATIC W/O INTERNAL FIXJ
|
Professional
|
Both
|
$4,157.30
|
|
|
Service Code
|
HCPCS 27253
|
| Min. Negotiated Rate |
$781.15 |
| Max. Negotiated Rate |
$2,510.84 |
| Rate for Payer: Cash Price |
$1,120.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,115.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,004.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,004.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,060.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,115.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,060.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,115.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,115.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$836.95
|
| Rate for Payer: Healthfirst Commercial |
$1,115.93
|
| Rate for Payer: Healthfirst Essential Plan |
$2,510.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,060.13
|
| Rate for Payer: Healthfirst QHP |
$1,115.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$781.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,115.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$948.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$781.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,115.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$836.95
|
| Rate for Payer: SOMOS Essential |
$836.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,115.93
|
|
|
PR OPTX HUMERAL SHFT FX W/PLATE/SCREWS W/WOCERCLAGE
|
Professional
|
Both
|
$3,899.67
|
|
|
Service Code
|
HCPCS 24515
|
| Min. Negotiated Rate |
$733.74 |
| Max. Negotiated Rate |
$2,358.45 |
| Rate for Payer: Cash Price |
$1,053.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$943.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$943.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$995.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$995.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,048.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$786.15
|
| Rate for Payer: Healthfirst Commercial |
$1,048.20
|
| Rate for Payer: Healthfirst Essential Plan |
$2,358.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$995.79
|
| Rate for Payer: Healthfirst QHP |
$1,048.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$733.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,048.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$890.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$733.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$786.15
|
| Rate for Payer: SOMOS Essential |
$786.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.20
|
|
|
PR OPTX MANDIBULAR/MAXILLARY ALVEOLAR RIDGE FX SPX
|
Professional
|
Both
|
$2,715.65
|
|
|
Service Code
|
HCPCS 21445
|
| Min. Negotiated Rate |
$501.28 |
| Max. Negotiated Rate |
$1,611.25 |
| Rate for Payer: Cash Price |
$730.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$716.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$644.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$644.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$680.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$716.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$680.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$716.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$716.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$537.08
|
| Rate for Payer: Healthfirst Commercial |
$716.11
|
| Rate for Payer: Healthfirst Essential Plan |
$1,611.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$680.30
|
| Rate for Payer: Healthfirst QHP |
$716.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$501.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$716.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$608.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$501.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$716.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$537.08
|
| Rate for Payer: SOMOS Essential |
$537.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$716.11
|
|
