|
PR OPTX NASOMAX CPLX FX LEFT II TYPE REQ MLT OPN
|
Professional
|
Both
|
$4,495.37
|
|
|
Service Code
|
HCPCS 21347
|
| Min. Negotiated Rate |
$842.28 |
| Max. Negotiated Rate |
$2,707.34 |
| Rate for Payer: Cash Price |
$1,212.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,203.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,082.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,082.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,143.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,203.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,143.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,203.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,203.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$902.45
|
| Rate for Payer: Healthfirst Commercial |
$1,203.26
|
| Rate for Payer: Healthfirst Essential Plan |
$2,707.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,143.10
|
| Rate for Payer: Healthfirst QHP |
$1,203.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$842.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,203.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,022.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$842.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,203.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$902.45
|
| Rate for Payer: SOMOS Essential |
$902.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,203.26
|
|
|
PR OPTX NASOMAX CPLX FX LEFT II TYPE W/BONE GRAFT
|
Professional
|
Both
|
$4,712.89
|
|
|
Service Code
|
HCPCS 21348
|
| Min. Negotiated Rate |
$882.96 |
| Max. Negotiated Rate |
$2,838.08 |
| Rate for Payer: Cash Price |
$1,276.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,261.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,135.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,135.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,198.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,261.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,198.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,261.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,261.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$946.03
|
| Rate for Payer: Healthfirst Commercial |
$1,261.37
|
| Rate for Payer: Healthfirst Essential Plan |
$2,838.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,198.30
|
| Rate for Payer: Healthfirst QHP |
$1,261.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$882.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,261.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,072.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$882.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,261.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$946.03
|
| Rate for Payer: SOMOS Essential |
$946.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,261.37
|
|
|
PR OPTX NASOMAX CPLX FX LEFT II TYPE W/WIRG & FXJ
|
Professional
|
Both
|
$4,436.08
|
|
|
Service Code
|
HCPCS 21346
|
| Min. Negotiated Rate |
$816.21 |
| Max. Negotiated Rate |
$2,623.52 |
| Rate for Payer: Cash Price |
$1,195.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,166.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,049.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,049.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,107.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,166.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,107.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,166.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,166.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$874.51
|
| Rate for Payer: Healthfirst Commercial |
$1,166.01
|
| Rate for Payer: Healthfirst Essential Plan |
$2,623.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,107.71
|
| Rate for Payer: Healthfirst QHP |
$1,166.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$816.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,166.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$991.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$816.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,166.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$874.51
|
| Rate for Payer: SOMOS Essential |
$874.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,166.01
|
|
|
PR OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/ALLPLSTC
|
Professional
|
Both
|
$3,442.64
|
|
|
Service Code
|
HCPCS 21390
|
| Min. Negotiated Rate |
$644.65 |
| Max. Negotiated Rate |
$2,072.09 |
| Rate for Payer: Cash Price |
$934.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$920.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$828.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$828.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$874.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$920.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$874.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$920.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$920.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$690.70
|
| Rate for Payer: Healthfirst Commercial |
$920.93
|
| Rate for Payer: Healthfirst Essential Plan |
$2,072.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$874.88
|
| Rate for Payer: Healthfirst QHP |
$920.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$644.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$920.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$782.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$644.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$920.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$690.70
|
| Rate for Payer: SOMOS Essential |
$690.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$920.93
|
|
|
PR OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/BONE GRF
|
Professional
|
Both
|
$4,411.96
|
|
|
Service Code
|
HCPCS 21395
|
| Min. Negotiated Rate |
$824.48 |
| Max. Negotiated Rate |
$2,650.12 |
| Rate for Payer: Cash Price |
$1,185.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,177.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,060.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,060.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,118.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,177.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,118.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,177.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,177.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$883.37
|
| Rate for Payer: Healthfirst Commercial |
$1,177.83
|
| Rate for Payer: Healthfirst Essential Plan |
$2,650.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,118.94
|
| Rate for Payer: Healthfirst QHP |
$1,177.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$824.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,177.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,001.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$824.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,177.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$883.37
|
| Rate for Payer: SOMOS Essential |
$883.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,177.83
|
|
|
PR OPTX PATELLAR DISLC W/WO PRTL/TOT PATELLECTOMY
|
Professional
|
Both
|
$3,951.36
|
|
|
Service Code
|
HCPCS 27566
|
| Min. Negotiated Rate |
$744.23 |
| Max. Negotiated Rate |
$2,392.18 |
| Rate for Payer: Cash Price |
$1,068.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,063.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$956.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$956.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,010.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,063.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,010.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,063.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,063.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$797.39
|
| Rate for Payer: Healthfirst Commercial |
$1,063.19
|
| Rate for Payer: Healthfirst Essential Plan |
$2,392.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,010.03
|
| Rate for Payer: Healthfirst QHP |
$1,063.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$744.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,063.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$903.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$744.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,063.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$797.39
|
| Rate for Payer: SOMOS Essential |
$797.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,063.19
|
|
|
PR OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR
|
Professional
|
Both
|
$3,337.50
|
|
|
Service Code
|
HCPCS 27524
|
| Min. Negotiated Rate |
$629.49 |
| Max. Negotiated Rate |
$2,023.36 |
| Rate for Payer: Cash Price |
$902.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$899.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$809.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$809.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$854.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$899.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$854.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$899.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$899.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$674.45
|
| Rate for Payer: Healthfirst Commercial |
$899.27
|
| Rate for Payer: Healthfirst Essential Plan |
$2,023.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$854.31
|
| Rate for Payer: Healthfirst QHP |
$899.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$629.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$899.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$764.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$629.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$899.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$674.45
|
| Rate for Payer: SOMOS Essential |
$674.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$899.27
|
|
|
PR OPTX PERIARTICULAR FRACTURE &/DISLOCATION ELBO
|
Professional
|
Both
|
$4,795.56
|
|
|
Service Code
|
HCPCS 24586
|
| Min. Negotiated Rate |
$897.72 |
| Max. Negotiated Rate |
$2,885.53 |
| Rate for Payer: Cash Price |
$1,293.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,282.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,154.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,154.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,218.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,282.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,218.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,282.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,282.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$961.85
|
| Rate for Payer: Healthfirst Commercial |
$1,282.46
|
| Rate for Payer: Healthfirst Essential Plan |
$2,885.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,218.34
|
| Rate for Payer: Healthfirst QHP |
$1,282.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$897.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,282.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,090.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$897.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,282.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$961.85
|
| Rate for Payer: SOMOS Essential |
$961.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,282.46
|
|
|
PR OPTX PRIARTICULAR FX&/DISLC ELBW W/IMPLT ARTHR
|
Professional
|
Both
|
$4,815.69
|
|
|
Service Code
|
HCPCS 24587
|
| Min. Negotiated Rate |
$903.59 |
| Max. Negotiated Rate |
$2,904.39 |
| Rate for Payer: Cash Price |
$1,299.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,290.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,161.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,161.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,226.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,290.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,226.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,290.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,290.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$968.13
|
| Rate for Payer: Healthfirst Commercial |
$1,290.84
|
| Rate for Payer: Healthfirst Essential Plan |
$2,904.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,226.30
|
| Rate for Payer: Healthfirst QHP |
$1,290.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$903.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,290.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,097.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$903.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,290.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$968.13
|
| Rate for Payer: SOMOS Essential |
$968.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,290.84
|
|
|
PR OPTX PST/ANT ACTBLR WALL FX W/INT FIXJ
|
Professional
|
Both
|
$4,670.68
|
|
|
Service Code
|
HCPCS 27226
|
| Min. Negotiated Rate |
$873.46 |
| Max. Negotiated Rate |
$2,807.55 |
| Rate for Payer: Cash Price |
$1,260.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,247.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,123.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,123.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,185.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,247.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,185.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,247.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,247.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$935.85
|
| Rate for Payer: Healthfirst Commercial |
$1,247.80
|
| Rate for Payer: Healthfirst Essential Plan |
$2,807.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,185.41
|
| Rate for Payer: Healthfirst QHP |
$1,247.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$873.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,247.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,060.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$873.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,247.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$935.85
|
| Rate for Payer: SOMOS Essential |
$935.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,247.80
|
|
|
PR OPTX&/RDCTJ ODNTD FX&/DISLC ANT FIXJ W/O GRAFT
|
Professional
|
Both
|
$7,888.41
|
|
|
Service Code
|
HCPCS 22318
|
| Min. Negotiated Rate |
$1,447.49 |
| Max. Negotiated Rate |
$4,652.64 |
| Rate for Payer: Cash Price |
$2,092.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,067.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,861.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,861.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,964.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,067.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,964.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,067.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,067.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,550.88
|
| Rate for Payer: Healthfirst Commercial |
$2,067.84
|
| Rate for Payer: Healthfirst Essential Plan |
$4,652.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,964.45
|
| Rate for Payer: Healthfirst QHP |
$2,067.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,447.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,067.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,757.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,447.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,067.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,550.88
|
| Rate for Payer: SOMOS Essential |
$1,550.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,067.84
|
|
|
PR OPTX&/RDCTJ ODNTD FX&/DISLC ANT W/INT FIXJ
|
Professional
|
Both
|
$8,817.62
|
|
|
Service Code
|
HCPCS 22319
|
| Min. Negotiated Rate |
$1,616.25 |
| Max. Negotiated Rate |
$5,195.09 |
| Rate for Payer: Cash Price |
$2,330.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,308.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,078.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,078.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,193.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,308.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,193.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,308.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,308.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,731.70
|
| Rate for Payer: Healthfirst Commercial |
$2,308.93
|
| Rate for Payer: Healthfirst Essential Plan |
$5,195.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,193.48
|
| Rate for Payer: Healthfirst QHP |
$2,308.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,616.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,308.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,962.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,616.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,308.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,731.70
|
| Rate for Payer: SOMOS Essential |
$1,731.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,308.93
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM CR
|
Professional
|
Both
|
$7,107.94
|
|
|
Service Code
|
HCPCS 22326
|
| Min. Negotiated Rate |
$1,310.74 |
| Max. Negotiated Rate |
$4,213.10 |
| Rate for Payer: Cash Price |
$1,888.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,872.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,685.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,685.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,778.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,872.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,778.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,872.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,872.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,404.37
|
| Rate for Payer: Healthfirst Commercial |
$1,872.49
|
| Rate for Payer: Healthfirst Essential Plan |
$4,213.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,778.87
|
| Rate for Payer: Healthfirst QHP |
$1,872.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,310.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,872.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,591.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,310.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,872.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,404.37
|
| Rate for Payer: SOMOS Essential |
$1,404.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,872.49
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM EA
|
Professional
|
Both
|
$1,328.01
|
|
|
Service Code
|
HCPCS 22328
|
| Min. Negotiated Rate |
$242.06 |
| Max. Negotiated Rate |
$778.05 |
| Rate for Payer: Cash Price |
$346.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$345.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$311.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$311.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$328.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$345.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$328.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$345.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$345.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$259.35
|
| Rate for Payer: Healthfirst Commercial |
$345.80
|
| Rate for Payer: Healthfirst Essential Plan |
$778.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$328.51
|
| Rate for Payer: Healthfirst QHP |
$345.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$242.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$345.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$293.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$242.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$345.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$259.35
|
| Rate for Payer: SOMOS Essential |
$259.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$345.80
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM LM
|
Professional
|
Both
|
$6,885.83
|
|
|
Service Code
|
HCPCS 22325
|
| Min. Negotiated Rate |
$1,282.13 |
| Max. Negotiated Rate |
$4,121.12 |
| Rate for Payer: Cash Price |
$1,836.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,831.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,648.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,648.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,740.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,831.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,740.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,831.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,831.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,373.71
|
| Rate for Payer: Healthfirst Commercial |
$1,831.61
|
| Rate for Payer: Healthfirst Essential Plan |
$4,121.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,740.03
|
| Rate for Payer: Healthfirst QHP |
$1,831.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,282.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,831.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,556.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,282.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,831.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,373.71
|
| Rate for Payer: SOMOS Essential |
$1,373.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,831.61
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM TH
|
Professional
|
Both
|
$7,192.54
|
|
|
Service Code
|
HCPCS 22327
|
| Min. Negotiated Rate |
$1,332.56 |
| Max. Negotiated Rate |
$4,283.23 |
| Rate for Payer: Cash Price |
$1,918.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,903.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,713.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,713.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,808.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,903.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,808.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,903.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,903.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,427.74
|
| Rate for Payer: Healthfirst Commercial |
$1,903.66
|
| Rate for Payer: Healthfirst Essential Plan |
$4,283.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,808.48
|
| Rate for Payer: Healthfirst QHP |
$1,903.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,332.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,903.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,618.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,332.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,903.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,427.74
|
| Rate for Payer: SOMOS Essential |
$1,427.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,903.66
|
|
|
PR OPTX SLP FEM EPIPHYSIS CLSD MANJ SINGL/MLTPL PIN
|
Professional
|
Both
|
$4,086.08
|
|
|
Service Code
|
HCPCS 27178
|
| Min. Negotiated Rate |
$768.85 |
| Max. Negotiated Rate |
$2,471.31 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,098.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$988.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$988.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,043.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,098.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,043.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,098.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,098.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$823.77
|
| Rate for Payer: Healthfirst Commercial |
$1,098.36
|
| Rate for Payer: Healthfirst Essential Plan |
$2,471.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,043.44
|
| Rate for Payer: Healthfirst QHP |
$1,098.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$768.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,098.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$933.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$768.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,098.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$823.77
|
| Rate for Payer: SOMOS Essential |
$823.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,098.36
|
|
|
PR OPTX SLP FEM EPIPHYSIS OSTEOT&INT FIXJ
|
Professional
|
Both
|
$4,948.41
|
|
|
Service Code
|
HCPCS 27181
|
| Min. Negotiated Rate |
$930.75 |
| Max. Negotiated Rate |
$2,991.69 |
| Rate for Payer: Cash Price |
$1,336.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,329.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,196.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,196.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,263.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,329.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,263.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,329.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,329.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$997.23
|
| Rate for Payer: Healthfirst Commercial |
$1,329.64
|
| Rate for Payer: Healthfirst Essential Plan |
$2,991.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,263.16
|
| Rate for Payer: Healthfirst QHP |
$1,329.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$930.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,329.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,130.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$930.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,329.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$997.23
|
| Rate for Payer: SOMOS Essential |
$997.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,329.64
|
|
|
PR OPTX SLP FEM EPIPHYSIS OSTPL FEM NCK HEYMAN PX
|
Professional
|
Both
|
$4,334.02
|
|
|
Service Code
|
HCPCS 27179
|
| Min. Negotiated Rate |
$814.39 |
| Max. Negotiated Rate |
$2,617.70 |
| Rate for Payer: Cash Price |
$1,168.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,163.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,047.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,047.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,105.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,163.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,105.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,163.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,163.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$872.57
|
| Rate for Payer: Healthfirst Commercial |
$1,163.42
|
| Rate for Payer: Healthfirst Essential Plan |
$2,617.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,105.25
|
| Rate for Payer: Healthfirst QHP |
$1,163.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$814.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,163.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$988.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$814.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,163.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$872.57
|
| Rate for Payer: SOMOS Essential |
$872.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,163.42
|
|
|
PR OPTX SLP FEM EPIPHYSIS SINGLE/MULT PIN/BONE GRFT
|
Professional
|
Both
|
$4,932.94
|
|
|
Service Code
|
HCPCS 27177
|
| Min. Negotiated Rate |
$927.05 |
| Max. Negotiated Rate |
$2,979.81 |
| Rate for Payer: Cash Price |
$1,330.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,324.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,191.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,191.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,258.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,324.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,258.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,324.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,324.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$993.27
|
| Rate for Payer: Healthfirst Commercial |
$1,324.36
|
| Rate for Payer: Healthfirst Essential Plan |
$2,979.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,258.14
|
| Rate for Payer: Healthfirst QHP |
$1,324.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$927.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,324.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,125.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$927.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,324.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$993.27
|
| Rate for Payer: SOMOS Essential |
$993.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,324.36
|
|
|
PR OPTX SPON HIP DISLC RPLCMT FEM HEAD ACTBLM
|
Professional
|
Both
|
$4,912.46
|
|
|
Service Code
|
HCPCS 27258
|
| Min. Negotiated Rate |
$922.59 |
| Max. Negotiated Rate |
$2,965.48 |
| Rate for Payer: Cash Price |
$1,325.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,317.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,186.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,186.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,252.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,317.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,252.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,317.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,317.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$988.49
|
| Rate for Payer: Healthfirst Commercial |
$1,317.99
|
| Rate for Payer: Healthfirst Essential Plan |
$2,965.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,252.09
|
| Rate for Payer: Healthfirst QHP |
$1,317.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$922.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,317.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,120.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$922.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,317.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$988.49
|
| Rate for Payer: SOMOS Essential |
$988.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,317.99
|
|
|
PR OPTX SPON HIP DISLC RPLCMT FEM HEAD ACTBLM SHRT
|
Professional
|
Both
|
$6,802.99
|
|
|
Service Code
|
HCPCS 27259
|
| Min. Negotiated Rate |
$1,276.97 |
| Max. Negotiated Rate |
$4,104.56 |
| Rate for Payer: Cash Price |
$1,832.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,824.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,641.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,641.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,733.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,824.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,733.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,824.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,824.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,368.19
|
| Rate for Payer: Healthfirst Commercial |
$1,824.25
|
| Rate for Payer: Healthfirst Essential Plan |
$4,104.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,733.04
|
| Rate for Payer: Healthfirst QHP |
$1,824.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,276.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,824.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,550.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,276.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,824.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,368.19
|
| Rate for Payer: SOMOS Essential |
$1,368.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,824.25
|
|
|
PR OPTX STRNCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF
|
Professional
|
Both
|
$2,789.36
|
|
|
Service Code
|
HCPCS 23532
|
| Min. Negotiated Rate |
$527.36 |
| Max. Negotiated Rate |
$1,695.08 |
| Rate for Payer: Cash Price |
$755.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$753.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$678.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$678.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$715.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$753.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$715.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$753.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$753.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$565.03
|
| Rate for Payer: Healthfirst Commercial |
$753.37
|
| Rate for Payer: Healthfirst Essential Plan |
$1,695.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$715.70
|
| Rate for Payer: Healthfirst QHP |
$753.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$527.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$753.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$640.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$527.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$753.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$565.03
|
| Rate for Payer: SOMOS Essential |
$565.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$753.37
|
|
|
PR OPTX TIBIAL FX PROX BICONDYLAR W/WO INT FIXJ
|
Professional
|
Both
|
$5,240.48
|
|
|
Service Code
|
HCPCS 27536
|
| Min. Negotiated Rate |
$985.20 |
| Max. Negotiated Rate |
$3,166.72 |
| Rate for Payer: Cash Price |
$1,414.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,407.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,266.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,266.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,337.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,407.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,337.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,407.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,407.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,055.57
|
| Rate for Payer: Healthfirst Commercial |
$1,407.43
|
| Rate for Payer: Healthfirst Essential Plan |
$3,166.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,337.06
|
| Rate for Payer: Healthfirst QHP |
$1,407.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$985.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,407.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,196.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$985.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,407.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,055.57
|
| Rate for Payer: SOMOS Essential |
$1,055.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,407.43
|
|
|
PR OPTX TIBIAL SHFT FX W/PLATE/SCREWS W/WO CERCLAGE
|
Professional
|
Both
|
$3,962.67
|
|
|
Service Code
|
HCPCS 27758
|
| Min. Negotiated Rate |
$746.02 |
| Max. Negotiated Rate |
$2,397.91 |
| Rate for Payer: Cash Price |
$1,071.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,065.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$959.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$959.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,012.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,065.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,012.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,065.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,065.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$799.30
|
| Rate for Payer: Healthfirst Commercial |
$1,065.74
|
| Rate for Payer: Healthfirst Essential Plan |
$2,397.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,012.45
|
| Rate for Payer: Healthfirst QHP |
$1,065.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$746.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,065.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$905.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$746.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,065.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$799.30
|
| Rate for Payer: SOMOS Essential |
$799.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,065.74
|
|
