|
PR OSTECTOMY SCAPULA PARTIAL
|
Professional
|
Both
|
$2,562.00
|
|
|
Service Code
|
HCPCS 23190
|
| Min. Negotiated Rate |
$484.08 |
| Max. Negotiated Rate |
$1,555.99 |
| Rate for Payer: Cash Price |
$694.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$691.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$622.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$622.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$656.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$691.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$656.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$691.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$691.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$518.66
|
| Rate for Payer: Healthfirst Commercial |
$691.55
|
| Rate for Payer: Healthfirst Essential Plan |
$1,555.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$656.97
|
| Rate for Payer: Healthfirst QHP |
$691.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$484.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$691.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$587.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$484.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$691.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$518.66
|
| Rate for Payer: SOMOS Essential |
$518.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$691.55
|
|
|
PR OSTECTOMY STERNUM PARTIAL
|
Professional
|
Both
|
$2,252.81
|
|
|
Service Code
|
HCPCS 21620
|
| Min. Negotiated Rate |
$419.20 |
| Max. Negotiated Rate |
$1,347.43 |
| Rate for Payer: Cash Price |
$603.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$598.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$538.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$538.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$568.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$598.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$568.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$598.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$598.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$449.14
|
| Rate for Payer: Healthfirst Commercial |
$598.86
|
| Rate for Payer: Healthfirst Essential Plan |
$1,347.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$568.92
|
| Rate for Payer: Healthfirst QHP |
$598.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$419.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$598.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$509.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$419.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$598.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$449.14
|
| Rate for Payer: SOMOS Essential |
$449.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$598.86
|
|
|
PR OSTECTOMY TARSAL COALITION
|
Professional
|
Both
|
$2,511.95
|
|
|
Service Code
|
HCPCS 28116
|
| Min. Negotiated Rate |
$413.88 |
| Max. Negotiated Rate |
$1,330.34 |
| Rate for Payer: Cash Price |
$677.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$591.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$532.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$532.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$561.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$591.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$561.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$591.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$591.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$443.44
|
| Rate for Payer: Healthfirst Commercial |
$591.26
|
| Rate for Payer: Healthfirst Essential Plan |
$1,330.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$561.70
|
| Rate for Payer: Healthfirst QHP |
$591.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$413.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$591.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$502.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$413.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$591.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$443.44
|
| Rate for Payer: SOMOS Essential |
$443.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$591.26
|
|
|
PR OSTEOARTICULAR ALLOGRAFT W/ARTICULAR SURF & BONE
|
Professional
|
Both
|
$3,317.97
|
|
|
Service Code
|
HCPCS 20932
|
| Min. Negotiated Rate |
$616.03 |
| Max. Negotiated Rate |
$1,980.11 |
| Rate for Payer: Cash Price |
$886.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$880.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$792.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$792.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$836.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$880.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$836.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$880.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$880.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$660.04
|
| Rate for Payer: Healthfirst Commercial |
$880.05
|
| Rate for Payer: Healthfirst Essential Plan |
$1,980.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$836.05
|
| Rate for Payer: Healthfirst QHP |
$880.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$616.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$880.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$748.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$616.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$880.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$660.04
|
| Rate for Payer: SOMOS Essential |
$660.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$880.05
|
|
|
PR OSTEOCHONDRAL ALLOGRAFT KNEE OPEN
|
Professional
|
Both
|
$6,060.01
|
|
|
Service Code
|
HCPCS 27415
|
| Min. Negotiated Rate |
$1,139.10 |
| Max. Negotiated Rate |
$3,661.40 |
| Rate for Payer: Cash Price |
$1,634.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,627.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,464.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,464.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,545.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,627.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,545.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,627.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,627.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,220.47
|
| Rate for Payer: Healthfirst Commercial |
$1,627.29
|
| Rate for Payer: Healthfirst Essential Plan |
$3,661.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,545.93
|
| Rate for Payer: Healthfirst QHP |
$1,627.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,139.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,627.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,383.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,139.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,627.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,220.47
|
| Rate for Payer: SOMOS Essential |
$1,220.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,627.29
|
|
|
PR OSTEOCHONDRAL AUTOGRAFT KNEE OPEN MOSAICPLASTY
|
Professional
|
Both
|
$4,341.44
|
|
|
Service Code
|
HCPCS 27416
|
| Min. Negotiated Rate |
$816.20 |
| Max. Negotiated Rate |
$2,623.50 |
| Rate for Payer: Cash Price |
$1,170.19
|
| 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 OSTEOPATHIC MANIPULATIVE TX 1-2 BODY REGIONS
|
Professional
|
Both
|
$95.87
|
|
|
Service Code
|
HCPCS 98925
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$56.43 |
| Rate for Payer: Amida Care Medicaid |
$10.88
|
| Rate for Payer: Cash Price |
$25.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.81
|
| Rate for Payer: Healthfirst Commercial |
$25.08
|
| Rate for Payer: Healthfirst Essential Plan |
$56.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.83
|
| Rate for Payer: Healthfirst QHP |
$25.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$25.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.81
|
| Rate for Payer: SOMOS Essential |
$18.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.08
|
|
|
PR OSTEOPATHIC MANIPULATIVE TX 3-4 BODY REGIONS
|
Professional
|
Both
|
$140.11
|
|
|
Service Code
|
HCPCS 98926
|
| Min. Negotiated Rate |
$16.04 |
| Max. Negotiated Rate |
$85.05 |
| Rate for Payer: Amida Care Medicaid |
$16.04
|
| Rate for Payer: Cash Price |
$38.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.35
|
| Rate for Payer: Healthfirst Commercial |
$37.80
|
| Rate for Payer: Healthfirst Essential Plan |
$85.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.91
|
| Rate for Payer: Healthfirst QHP |
$37.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.35
|
| Rate for Payer: SOMOS Essential |
$28.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.80
|
|
|
PR OSTEOPATHIC MANIPULATIVE TX 5-6 BODY REGIONS
|
Professional
|
Both
|
$181.51
|
|
|
Service Code
|
HCPCS 98927
|
| Min. Negotiated Rate |
$20.98 |
| Max. Negotiated Rate |
$112.81 |
| Rate for Payer: Amida Care Medicaid |
$20.98
|
| Rate for Payer: Cash Price |
$50.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$50.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$45.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$50.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$47.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.60
|
| Rate for Payer: Healthfirst Commercial |
$50.14
|
| Rate for Payer: Healthfirst Essential Plan |
$112.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.63
|
| Rate for Payer: Healthfirst QHP |
$50.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$50.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$42.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$37.60
|
| Rate for Payer: SOMOS Essential |
$37.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.14
|
|
|
PR OSTEOPATHIC MANIPULATIVE TX 7-8 BODY REGIONS
|
Professional
|
Both
|
$233.94
|
|
|
Service Code
|
HCPCS 98928
|
| Min. Negotiated Rate |
$24.72 |
| Max. Negotiated Rate |
$142.31 |
| Rate for Payer: Amida Care Medicaid |
$24.72
|
| Rate for Payer: Cash Price |
$64.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$63.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$60.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$63.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$60.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.44
|
| Rate for Payer: Healthfirst Commercial |
$63.25
|
| Rate for Payer: Healthfirst Essential Plan |
$142.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.09
|
| Rate for Payer: Healthfirst QHP |
$63.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$44.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$63.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$44.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$63.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.44
|
| Rate for Payer: SOMOS Essential |
$47.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.25
|
|
|
PR OSTEOPATHIC MANIPULATIVE TX 9-10 BODY REGIONS
|
Professional
|
Both
|
$279.51
|
|
|
Service Code
|
HCPCS 98929
|
| Min. Negotiated Rate |
$28.26 |
| Max. Negotiated Rate |
$169.18 |
| Rate for Payer: Amida Care Medicaid |
$28.26
|
| Rate for Payer: Cash Price |
$76.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$75.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$75.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$71.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.39
|
| Rate for Payer: Healthfirst Commercial |
$75.19
|
| Rate for Payer: Healthfirst Essential Plan |
$169.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$71.43
|
| Rate for Payer: Healthfirst QHP |
$75.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$75.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$75.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56.39
|
| Rate for Payer: SOMOS Essential |
$56.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.19
|
|
|
PR OSTEOPLASTY CARPAL BONE SHORTENING
|
Professional
|
Both
|
$3,476.59
|
|
|
Service Code
|
HCPCS 25394
|
| Min. Negotiated Rate |
$657.29 |
| Max. Negotiated Rate |
$2,112.70 |
| Rate for Payer: Cash Price |
$941.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$938.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$845.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$845.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$892.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$938.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$892.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$938.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$938.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$704.24
|
| Rate for Payer: Healthfirst Commercial |
$938.98
|
| Rate for Payer: Healthfirst Essential Plan |
$2,112.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$892.03
|
| Rate for Payer: Healthfirst QHP |
$938.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$657.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$938.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$798.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$657.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$938.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$704.24
|
| Rate for Payer: SOMOS Essential |
$704.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$938.98
|
|
|
PR OSTEOPLASTY FACIAL BONES AUGMENTATION
|
Professional
|
Both
|
$3,081.12
|
|
|
Service Code
|
HCPCS 21208
|
| Min. Negotiated Rate |
$593.22 |
| Max. Negotiated Rate |
$1,906.79 |
| Rate for Payer: Cash Price |
$843.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$847.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$762.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$762.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$805.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$847.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$805.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$847.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$847.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$635.60
|
| Rate for Payer: Healthfirst Commercial |
$847.46
|
| Rate for Payer: Healthfirst Essential Plan |
$1,906.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$805.09
|
| Rate for Payer: Healthfirst QHP |
$847.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$593.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$847.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$720.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$593.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$847.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$635.60
|
| Rate for Payer: SOMOS Essential |
$635.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$847.46
|
|
|
PR OSTEOPLASTY FACIAL BONES REDUCTION
|
Professional
|
Both
|
$2,641.91
|
|
|
Service Code
|
HCPCS 21209
|
| Min. Negotiated Rate |
$484.57 |
| Max. Negotiated Rate |
$1,557.56 |
| Rate for Payer: Cash Price |
$700.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$692.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$623.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$623.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$657.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$692.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$657.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$692.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$692.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$519.19
|
| Rate for Payer: Healthfirst Commercial |
$692.25
|
| Rate for Payer: Healthfirst Essential Plan |
$1,557.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$657.64
|
| Rate for Payer: Healthfirst QHP |
$692.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$484.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$692.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$588.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$484.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$692.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$519.19
|
| Rate for Payer: SOMOS Essential |
$519.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$692.25
|
|
|
PR OSTEOPLASTY FEMUR LENGTHENING
|
Professional
|
Both
|
$5,235.34
|
|
|
Service Code
|
HCPCS 27466
|
| Min. Negotiated Rate |
$982.82 |
| Max. Negotiated Rate |
$3,159.07 |
| Rate for Payer: Cash Price |
$1,411.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,404.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,263.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,263.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,333.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,404.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,333.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,404.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,404.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,053.02
|
| Rate for Payer: Healthfirst Commercial |
$1,404.03
|
| Rate for Payer: Healthfirst Essential Plan |
$3,159.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,333.83
|
| Rate for Payer: Healthfirst QHP |
$1,404.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$982.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,404.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,193.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$982.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,404.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,053.02
|
| Rate for Payer: SOMOS Essential |
$1,053.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,404.03
|
|
|
PR OSTEOPLASTY FEMUR SHORTENING EXCLUDING 64876
|
Professional
|
Both
|
$5,514.67
|
|
|
Service Code
|
HCPCS 27465
|
| Min. Negotiated Rate |
$1,034.10 |
| Max. Negotiated Rate |
$3,323.90 |
| Rate for Payer: Cash Price |
$1,484.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,477.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,329.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,329.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,403.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,477.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,403.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,477.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,477.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,107.97
|
| Rate for Payer: Healthfirst Commercial |
$1,477.29
|
| Rate for Payer: Healthfirst Essential Plan |
$3,323.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,403.43
|
| Rate for Payer: Healthfirst QHP |
$1,477.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,034.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,477.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,255.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,034.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,477.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,107.97
|
| Rate for Payer: SOMOS Essential |
$1,107.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,477.29
|
|
|
PR OSTEOPLASTY HUMERUS
|
Professional
|
Both
|
$4,715.90
|
|
|
Service Code
|
HCPCS 24420
|
| Min. Negotiated Rate |
$882.09 |
| Max. Negotiated Rate |
$2,835.29 |
| Rate for Payer: Cash Price |
$1,270.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,260.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,134.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,134.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,197.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,260.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,197.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,260.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,260.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$945.10
|
| Rate for Payer: Healthfirst Commercial |
$1,260.13
|
| Rate for Payer: Healthfirst Essential Plan |
$2,835.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,197.12
|
| Rate for Payer: Healthfirst QHP |
$1,260.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$882.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,260.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,071.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$882.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,260.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$945.10
|
| Rate for Payer: SOMOS Essential |
$945.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,260.13
|
|
|
PR OSTEOPLASTY LENGTHENING METACARPAL/PHALANX
|
Professional
|
Both
|
$4,140.75
|
|
|
Service Code
|
HCPCS 26568
|
| Min. Negotiated Rate |
$765.49 |
| Max. Negotiated Rate |
$2,460.49 |
| Rate for Payer: Cash Price |
$1,112.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,093.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$984.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$984.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,038.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,093.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,038.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,093.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,093.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$820.16
|
| Rate for Payer: Healthfirst Commercial |
$1,093.55
|
| Rate for Payer: Healthfirst Essential Plan |
$2,460.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,038.87
|
| Rate for Payer: Healthfirst QHP |
$1,093.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$765.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,093.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$929.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$765.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,093.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$820.16
|
| Rate for Payer: SOMOS Essential |
$820.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,093.55
|
|
|
PR OSTEOPLASTY RADIUS&ULNA LENGTHENING W/AUTOGRAF
|
Professional
|
Both
|
$4,993.45
|
|
|
Service Code
|
HCPCS 25393
|
| Min. Negotiated Rate |
$937.55 |
| Max. Negotiated Rate |
$3,013.56 |
| Rate for Payer: Cash Price |
$1,346.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,339.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,205.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,205.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,272.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,339.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,272.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,339.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,339.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,004.52
|
| Rate for Payer: Healthfirst Commercial |
$1,339.36
|
| Rate for Payer: Healthfirst Essential Plan |
$3,013.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,272.39
|
| Rate for Payer: Healthfirst QHP |
$1,339.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$937.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,339.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,138.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$937.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,339.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,004.52
|
| Rate for Payer: SOMOS Essential |
$1,004.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,339.36
|
|
|
PR OSTEOPLASTY RADIUS/ULNA LENGTHENING W/AUTOGRAFT
|
Professional
|
Both
|
$4,410.95
|
|
|
Service Code
|
HCPCS 25391
|
| Min. Negotiated Rate |
$829.36 |
| Max. Negotiated Rate |
$2,665.80 |
| Rate for Payer: Cash Price |
$1,189.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,184.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,066.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,066.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,125.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,184.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,125.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,184.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,184.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$888.60
|
| Rate for Payer: Healthfirst Commercial |
$1,184.80
|
| Rate for Payer: Healthfirst Essential Plan |
$2,665.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,125.56
|
| Rate for Payer: Healthfirst QHP |
$1,184.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$829.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,184.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,007.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$829.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,184.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$888.60
|
| Rate for Payer: SOMOS Essential |
$888.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,184.80
|
|
|
PR OSTEOPLASTY RADIUS & ULNA SHORTENING
|
Professional
|
Both
|
$4,487.95
|
|
|
Service Code
|
HCPCS 25392
|
| Min. Negotiated Rate |
$843.97 |
| Max. Negotiated Rate |
$2,712.76 |
| Rate for Payer: Cash Price |
$1,209.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,205.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,085.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,085.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,145.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,205.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,145.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,205.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,205.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$904.25
|
| Rate for Payer: Healthfirst Commercial |
$1,205.67
|
| Rate for Payer: Healthfirst Essential Plan |
$2,712.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,145.39
|
| Rate for Payer: Healthfirst QHP |
$1,205.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$843.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,205.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,024.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$843.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,205.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$904.25
|
| Rate for Payer: SOMOS Essential |
$904.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,205.67
|
|
|
PR OSTEOPLASTY RADIUS/ULNA SHORTENING
|
Professional
|
Both
|
$3,394.02
|
|
|
Service Code
|
HCPCS 25390
|
| Min. Negotiated Rate |
$640.46 |
| Max. Negotiated Rate |
$2,058.61 |
| Rate for Payer: Cash Price |
$917.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$914.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$823.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$823.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$869.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$914.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$869.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$914.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$914.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$686.21
|
| Rate for Payer: Healthfirst Commercial |
$914.94
|
| Rate for Payer: Healthfirst Essential Plan |
$2,058.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$869.19
|
| Rate for Payer: Healthfirst QHP |
$914.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$640.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$914.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$777.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$640.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$914.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$686.21
|
| Rate for Payer: SOMOS Essential |
$686.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$914.94
|
|
|
PR OSTEOPLASTY TIBIA & FIBULA LENGTHENING/SHORTENIN
|
Professional
|
Both
|
$4,741.42
|
|
|
Service Code
|
HCPCS 27715
|
| Min. Negotiated Rate |
$889.92 |
| Max. Negotiated Rate |
$2,860.47 |
| Rate for Payer: Cash Price |
$1,279.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,271.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,144.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,144.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,207.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,271.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,207.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,271.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,271.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$953.49
|
| Rate for Payer: Healthfirst Commercial |
$1,271.32
|
| Rate for Payer: Healthfirst Essential Plan |
$2,860.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,207.75
|
| Rate for Payer: Healthfirst QHP |
$1,271.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$889.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,271.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,080.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$889.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,271.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$953.49
|
| Rate for Payer: SOMOS Essential |
$953.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,271.32
|
|
|
PR OSTEOT ILIAC ACTBLR/INNOMINATE BONE OSTEOT RDCTJ
|
Professional
|
Both
|
$7,511.53
|
|
|
Service Code
|
HCPCS 27156
|
| Min. Negotiated Rate |
$1,407.64 |
| Max. Negotiated Rate |
$4,524.57 |
| Rate for Payer: Cash Price |
$2,020.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,010.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,809.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,809.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,910.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,010.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,910.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,010.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,010.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,508.19
|
| Rate for Payer: Healthfirst Commercial |
$2,010.92
|
| Rate for Payer: Healthfirst Essential Plan |
$4,524.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,910.37
|
| Rate for Payer: Healthfirst QHP |
$2,010.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,407.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,010.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,709.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,407.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,010.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,508.19
|
| Rate for Payer: SOMOS Essential |
$1,508.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,010.92
|
|
|
PR OSTEOT INTERTRCHNTRIC/SUBTRCHNTRIC W/INT/XTRNL
|
Professional
|
Both
|
$6,064.42
|
|
|
Service Code
|
HCPCS 27165
|
| Min. Negotiated Rate |
$1,133.06 |
| Max. Negotiated Rate |
$3,641.96 |
| Rate for Payer: Cash Price |
$1,630.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,618.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,456.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,456.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,537.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,618.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,537.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,618.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,618.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,213.99
|
| Rate for Payer: Healthfirst Commercial |
$1,618.65
|
| Rate for Payer: Healthfirst Essential Plan |
$3,641.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,537.72
|
| Rate for Payer: Healthfirst QHP |
$1,618.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,133.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,618.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,375.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,133.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,618.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,213.99
|
| Rate for Payer: SOMOS Essential |
$1,213.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,618.65
|
|
