|
PR OSTEOT MLT W/RELIGNMT IMED ROD
|
Professional
|
Both
|
$4,867.42
|
|
|
Service Code
|
HCPCS 27712
|
| Min. Negotiated Rate |
$916.17 |
| Max. Negotiated Rate |
$2,944.82 |
| Rate for Payer: Cash Price |
$1,315.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,308.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,177.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,177.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,243.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,308.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,243.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,308.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,308.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$981.61
|
| Rate for Payer: Healthfirst Commercial |
$1,308.81
|
| Rate for Payer: Healthfirst Essential Plan |
$2,944.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,243.37
|
| Rate for Payer: Healthfirst QHP |
$1,308.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$916.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,308.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,112.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$916.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,308.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$981.61
|
| Rate for Payer: SOMOS Essential |
$981.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,308.81
|
|
|
PR OSTEOT MLT W/RELIGNMT IMED ROD FEM SHFT
|
Professional
|
Both
|
$5,715.33
|
|
|
Service Code
|
HCPCS 27454
|
| Min. Negotiated Rate |
$1,072.17 |
| Max. Negotiated Rate |
$3,446.26 |
| Rate for Payer: Cash Price |
$1,539.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,531.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,378.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,378.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,455.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,531.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,455.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,531.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,531.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,148.75
|
| Rate for Payer: Healthfirst Commercial |
$1,531.67
|
| Rate for Payer: Healthfirst Essential Plan |
$3,446.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,455.09
|
| Rate for Payer: Healthfirst QHP |
$1,531.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,072.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,531.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,301.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,072.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,531.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,148.75
|
| Rate for Payer: SOMOS Essential |
$1,148.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,531.67
|
|
|
PR OSTEOTOMY CALCANEUS W/WO INTERNAL FIXATION
|
Professional
|
Both
|
$2,824.54
|
|
|
Service Code
|
HCPCS 28300
|
| Min. Negotiated Rate |
$535.53 |
| Max. Negotiated Rate |
$1,721.36 |
| Rate for Payer: Cash Price |
$767.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$765.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$688.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$688.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$726.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$765.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$726.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$765.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$765.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$573.79
|
| Rate for Payer: Healthfirst Commercial |
$765.05
|
| Rate for Payer: Healthfirst Essential Plan |
$1,721.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$726.80
|
| Rate for Payer: Healthfirst QHP |
$765.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$535.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$765.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$650.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$535.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$765.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$573.79
|
| Rate for Payer: SOMOS Essential |
$573.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$765.05
|
|
|
PR OSTEOTOMY CLAVICLE W/WO INTERNAL FIXATION
|
Professional
|
Both
|
$3,639.69
|
|
|
Service Code
|
HCPCS 23480
|
| Min. Negotiated Rate |
$684.99 |
| Max. Negotiated Rate |
$2,201.74 |
| Rate for Payer: Cash Price |
$982.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$978.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$880.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$880.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$929.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$978.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$929.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$978.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$978.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$733.91
|
| Rate for Payer: Healthfirst Commercial |
$978.55
|
| Rate for Payer: Healthfirst Essential Plan |
$2,201.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$929.62
|
| Rate for Payer: Healthfirst QHP |
$978.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$684.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$978.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$831.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$684.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$978.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$733.91
|
| Rate for Payer: SOMOS Essential |
$733.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$978.55
|
|
|
PR OSTEOTOMY CLAV W/WO INT FIXJ W/BONE GRF NON/MAL
|
Professional
|
Both
|
$4,215.47
|
|
|
Service Code
|
HCPCS 23485
|
| Min. Negotiated Rate |
$791.55 |
| Max. Negotiated Rate |
$2,544.28 |
| Rate for Payer: Cash Price |
$1,137.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,130.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,017.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,017.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,074.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,130.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,074.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,130.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,130.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$848.09
|
| Rate for Payer: Healthfirst Commercial |
$1,130.79
|
| Rate for Payer: Healthfirst Essential Plan |
$2,544.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,074.25
|
| Rate for Payer: Healthfirst QHP |
$1,130.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$791.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,130.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$961.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$791.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,130.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$848.09
|
| Rate for Payer: SOMOS Essential |
$848.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,130.79
|
|
|
PR OSTEOTOMY FEMORAL NECK SEPARATE PROCEDURE
|
Professional
|
Both
|
$5,386.40
|
|
|
Service Code
|
HCPCS 27161
|
| Min. Negotiated Rate |
$1,011.85 |
| Max. Negotiated Rate |
$3,252.38 |
| Rate for Payer: Cash Price |
$1,453.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,445.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,300.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,300.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,373.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,445.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,373.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,445.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,445.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,084.12
|
| Rate for Payer: Healthfirst Commercial |
$1,445.50
|
| Rate for Payer: Healthfirst Essential Plan |
$3,252.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,373.22
|
| Rate for Payer: Healthfirst QHP |
$1,445.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,011.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,445.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,228.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,011.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,445.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,084.12
|
| Rate for Payer: SOMOS Essential |
$1,084.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,445.50
|
|
|
PR OSTEOTOMY FEMUR SHAFT/SUPRACONDYLAR W/FIXATION
|
Professional
|
Both
|
$4,486.51
|
|
|
Service Code
|
HCPCS 27450
|
| Min. Negotiated Rate |
$835.69 |
| Max. Negotiated Rate |
$2,686.14 |
| Rate for Payer: Cash Price |
$1,202.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,193.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,074.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,074.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,134.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,193.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,134.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,193.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,193.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$895.38
|
| Rate for Payer: Healthfirst Commercial |
$1,193.84
|
| Rate for Payer: Healthfirst Essential Plan |
$2,686.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,134.15
|
| Rate for Payer: Healthfirst QHP |
$1,193.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$835.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,193.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,014.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$835.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,193.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$895.38
|
| Rate for Payer: SOMOS Essential |
$895.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,193.84
|
|
|
PR OSTEOTOMY FEMUR SHAFT/SUPRACONDYLAR W/O FIXATION
|
Professional
|
Both
|
$3,671.50
|
|
|
Service Code
|
HCPCS 27448
|
| Min. Negotiated Rate |
$691.21 |
| Max. Negotiated Rate |
$2,221.74 |
| Rate for Payer: Cash Price |
$991.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$987.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$888.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$888.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$938.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$987.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$938.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$987.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$987.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$740.58
|
| Rate for Payer: Healthfirst Commercial |
$987.44
|
| Rate for Payer: Healthfirst Essential Plan |
$2,221.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$938.07
|
| Rate for Payer: Healthfirst QHP |
$987.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$691.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$987.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$839.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$691.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$987.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$740.58
|
| Rate for Payer: SOMOS Essential |
$740.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$987.44
|
|
|
PR OSTEOTOMY FIBULA
|
Professional
|
Both
|
$1,782.87
|
|
|
Service Code
|
HCPCS 27707
|
| Min. Negotiated Rate |
$339.30 |
| Max. Negotiated Rate |
$1,090.62 |
| Rate for Payer: Cash Price |
$486.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$484.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$436.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$436.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$460.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$484.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$460.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$484.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$484.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$363.54
|
| Rate for Payer: Healthfirst Commercial |
$484.72
|
| Rate for Payer: Healthfirst Essential Plan |
$1,090.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$460.48
|
| Rate for Payer: Healthfirst QHP |
$484.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$339.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$484.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$412.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$339.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$484.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$363.54
|
| Rate for Payer: SOMOS Essential |
$363.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$484.72
|
|
|
PR OSTEOTOMY HUMERUS W/WO INTERNAL FIXATION
|
Professional
|
Both
|
$3,670.28
|
|
|
Service Code
|
HCPCS 24400
|
| Min. Negotiated Rate |
$691.61 |
| Max. Negotiated Rate |
$2,223.05 |
| Rate for Payer: Cash Price |
$990.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$988.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$889.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$889.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$938.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$988.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$938.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$988.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$988.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$741.01
|
| Rate for Payer: Healthfirst Commercial |
$988.02
|
| Rate for Payer: Healthfirst Essential Plan |
$2,223.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$938.62
|
| Rate for Payer: Healthfirst QHP |
$988.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$691.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$988.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$839.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$691.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$988.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$741.01
|
| Rate for Payer: SOMOS Essential |
$741.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$988.02
|
|
|
PR OSTEOTOMY ILIAC ACETABULAR/INNOMINATE BONE
|
Professional
|
Both
|
$5,614.60
|
|
|
Service Code
|
HCPCS 27146
|
| Min. Negotiated Rate |
$1,060.44 |
| Max. Negotiated Rate |
$3,408.57 |
| Rate for Payer: Cash Price |
$1,521.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,514.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,363.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,363.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,439.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,514.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,439.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,514.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,514.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,136.19
|
| Rate for Payer: Healthfirst Commercial |
$1,514.92
|
| Rate for Payer: Healthfirst Essential Plan |
$3,408.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,439.17
|
| Rate for Payer: Healthfirst QHP |
$1,514.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,060.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,514.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,287.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,060.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,514.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,136.19
|
| Rate for Payer: SOMOS Essential |
$1,136.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,514.92
|
|
|
PR OSTEOTOMY ILIAC ACETABULAR/INNOMINATE FEM OSTEOT
|
Professional
|
Both
|
$6,974.21
|
|
|
Service Code
|
HCPCS 27151
|
| Min. Negotiated Rate |
$1,306.86 |
| Max. Negotiated Rate |
$4,200.61 |
| Rate for Payer: Cash Price |
$1,875.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,866.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,680.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,680.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,773.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,866.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,773.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,866.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,866.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,400.20
|
| Rate for Payer: Healthfirst Commercial |
$1,866.94
|
| Rate for Payer: Healthfirst Essential Plan |
$4,200.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,773.59
|
| Rate for Payer: Healthfirst QHP |
$1,866.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,306.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,866.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,586.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,306.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,866.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,400.20
|
| Rate for Payer: SOMOS Essential |
$1,400.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,866.94
|
|
|
PR OSTEOTOMY ILIAC ACETABULAR/INNOMINATE HIP RDCTJ
|
Professional
|
Both
|
$6,447.42
|
|
|
Service Code
|
HCPCS 27147
|
| Min. Negotiated Rate |
$1,209.91 |
| Max. Negotiated Rate |
$3,888.99 |
| Rate for Payer: Cash Price |
$1,737.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,728.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,555.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,555.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,642.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,728.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,642.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,728.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,728.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,296.33
|
| Rate for Payer: Healthfirst Commercial |
$1,728.44
|
| Rate for Payer: Healthfirst Essential Plan |
$3,888.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,642.02
|
| Rate for Payer: Healthfirst QHP |
$1,728.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,209.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,728.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,469.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,209.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,728.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,296.33
|
| Rate for Payer: SOMOS Essential |
$1,296.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,728.44
|
|
|
PR OSTEOTOMY MANDIBLE SEGMENTAL
|
Professional
|
Both
|
$4,352.95
|
|
|
Service Code
|
HCPCS 21198
|
| Min. Negotiated Rate |
$807.72 |
| Max. Negotiated Rate |
$2,596.25 |
| Rate for Payer: Cash Price |
$1,161.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,153.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,038.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,038.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,096.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,153.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,096.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,153.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,153.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$865.42
|
| Rate for Payer: Healthfirst Commercial |
$1,153.89
|
| Rate for Payer: Healthfirst Essential Plan |
$2,596.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,096.20
|
| Rate for Payer: Healthfirst QHP |
$1,153.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$807.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,153.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$980.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$807.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,153.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$865.42
|
| Rate for Payer: SOMOS Essential |
$865.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,153.89
|
|
|
PR OSTEOTOMY MANDIBLE SGMTL W/GENIOGLOSSUS ADVMNT
|
Professional
|
Both
|
$4,264.40
|
|
|
Service Code
|
HCPCS 21199
|
| Min. Negotiated Rate |
$808.09 |
| Max. Negotiated Rate |
$2,597.45 |
| Rate for Payer: Cash Price |
$1,157.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,154.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,038.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,038.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,096.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,154.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,096.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,154.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,154.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$865.82
|
| Rate for Payer: Healthfirst Commercial |
$1,154.42
|
| Rate for Payer: Healthfirst Essential Plan |
$2,597.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,096.70
|
| Rate for Payer: Healthfirst QHP |
$1,154.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$808.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,154.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$981.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$808.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,154.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$865.82
|
| Rate for Payer: SOMOS Essential |
$865.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,154.42
|
|
|
PR OSTEOTOMY MAXILLA SEGMENTAL
|
Professional
|
Both
|
$4,073.23
|
|
|
Service Code
|
HCPCS 21206
|
| Min. Negotiated Rate |
$777.55 |
| Max. Negotiated Rate |
$2,499.26 |
| Rate for Payer: Cash Price |
$1,106.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,110.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$999.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$999.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,055.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,110.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,055.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,110.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,110.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$833.09
|
| Rate for Payer: Healthfirst Commercial |
$1,110.78
|
| Rate for Payer: Healthfirst Essential Plan |
$2,499.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,055.24
|
| Rate for Payer: Healthfirst QHP |
$1,110.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$777.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,110.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$944.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$777.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,110.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$833.09
|
| Rate for Payer: SOMOS Essential |
$833.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,110.78
|
|
|
PR OSTEOTOMY METACARPAL EACH
|
Professional
|
Both
|
$3,164.81
|
|
|
Service Code
|
HCPCS 26565
|
| Min. Negotiated Rate |
$587.47 |
| Max. Negotiated Rate |
$1,888.29 |
| Rate for Payer: Cash Price |
$849.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$839.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$755.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$755.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$797.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$839.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$797.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$839.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$839.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$629.43
|
| Rate for Payer: Healthfirst Commercial |
$839.24
|
| Rate for Payer: Healthfirst Essential Plan |
$1,888.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$797.28
|
| Rate for Payer: Healthfirst QHP |
$839.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$587.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$839.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$713.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$587.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$839.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$629.43
|
| Rate for Payer: SOMOS Essential |
$629.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$839.24
|
|
|
PR OSTEOTOMY PELVIS BILATERAL
|
Professional
|
Both
|
$6,170.36
|
|
|
Service Code
|
HCPCS 27158
|
| Min. Negotiated Rate |
$1,157.94 |
| Max. Negotiated Rate |
$3,721.95 |
| Rate for Payer: Cash Price |
$1,662.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,654.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,488.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,488.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,571.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,654.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,571.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,654.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,654.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,240.65
|
| Rate for Payer: Healthfirst Commercial |
$1,654.20
|
| Rate for Payer: Healthfirst Essential Plan |
$3,721.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,571.49
|
| Rate for Payer: Healthfirst QHP |
$1,654.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,157.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,654.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,406.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,157.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,654.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,240.65
|
| Rate for Payer: SOMOS Essential |
$1,240.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,654.20
|
|
|
PR OSTEOTOMY PHALANX FINGER EACH
|
Professional
|
Both
|
$3,187.77
|
|
|
Service Code
|
HCPCS 26567
|
| Min. Negotiated Rate |
$592.87 |
| Max. Negotiated Rate |
$1,905.64 |
| Rate for Payer: Cash Price |
$859.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$846.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$762.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$762.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$804.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$846.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$804.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$846.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$846.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$635.21
|
| Rate for Payer: Healthfirst Commercial |
$846.95
|
| Rate for Payer: Healthfirst Essential Plan |
$1,905.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$804.60
|
| Rate for Payer: Healthfirst QHP |
$846.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$592.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$846.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$719.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$592.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$846.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$635.21
|
| Rate for Payer: SOMOS Essential |
$635.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$846.95
|
|
|
PR OSTEOTOMY RADIUS DISTAL THIRD
|
Professional
|
Both
|
$2,983.79
|
|
|
Service Code
|
HCPCS 25350
|
| Min. Negotiated Rate |
$563.22 |
| Max. Negotiated Rate |
$1,810.35 |
| Rate for Payer: Cash Price |
$807.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$804.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$724.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$724.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$764.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$804.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$764.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$804.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$804.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$603.45
|
| Rate for Payer: Healthfirst Commercial |
$804.60
|
| Rate for Payer: Healthfirst Essential Plan |
$1,810.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$764.37
|
| Rate for Payer: Healthfirst QHP |
$804.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$563.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$804.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$683.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$563.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$804.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$603.45
|
| Rate for Payer: SOMOS Essential |
$603.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$804.60
|
|
|
PR OSTEOTOMY RADIUS MIDDLE/PROXIMAL THIRD
|
Professional
|
Both
|
$3,392.76
|
|
|
Service Code
|
HCPCS 25355
|
| Min. Negotiated Rate |
$640.24 |
| Max. Negotiated Rate |
$2,057.92 |
| Rate for Payer: Cash Price |
$918.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$914.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$823.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$823.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$868.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$914.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$868.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$914.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$914.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$685.97
|
| Rate for Payer: Healthfirst Commercial |
$914.63
|
| Rate for Payer: Healthfirst Essential Plan |
$2,057.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$868.90
|
| Rate for Payer: Healthfirst QHP |
$914.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$640.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$914.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$777.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$640.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$914.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$685.97
|
| Rate for Payer: SOMOS Essential |
$685.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$914.63
|
|
|
PR OSTEOTOMY RADIUS & ULNA
|
Professional
|
Both
|
$4,067.60
|
|
|
Service Code
|
HCPCS 25365
|
| Min. Negotiated Rate |
$764.64 |
| Max. Negotiated Rate |
$2,457.79 |
| Rate for Payer: Cash Price |
$1,097.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,092.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$983.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$983.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,037.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,092.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,037.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,092.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,092.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$819.26
|
| Rate for Payer: Healthfirst Commercial |
$1,092.35
|
| Rate for Payer: Healthfirst Essential Plan |
$2,457.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,037.73
|
| Rate for Payer: Healthfirst QHP |
$1,092.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$764.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,092.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$928.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$764.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,092.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$819.26
|
| Rate for Payer: SOMOS Essential |
$819.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,092.35
|
|
|
PR OSTEOTOMY SPINE POSTERIOR 3 COLUMN EA ADDL SGM
|
Professional
|
Both
|
$2,731.54
|
|
|
Service Code
|
HCPCS 22208
|
| Min. Negotiated Rate |
$504.43 |
| Max. Negotiated Rate |
$1,621.39 |
| Rate for Payer: Cash Price |
$724.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$720.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$648.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$648.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$684.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$720.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$684.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$720.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$720.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$540.47
|
| Rate for Payer: Healthfirst Commercial |
$720.62
|
| Rate for Payer: Healthfirst Essential Plan |
$1,621.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$684.59
|
| Rate for Payer: Healthfirst QHP |
$720.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$504.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$720.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$612.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$504.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$720.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$540.47
|
| Rate for Payer: SOMOS Essential |
$540.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$720.62
|
|
|
PR OSTEOTOMY SPINE POSTERIOR 3 COLUMN LUMBAR
|
Professional
|
Both
|
$11,010.51
|
|
|
Service Code
|
HCPCS 22207
|
| Min. Negotiated Rate |
$2,031.75 |
| Max. Negotiated Rate |
$6,530.62 |
| Rate for Payer: Cash Price |
$2,938.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,902.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,612.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,612.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,757.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,902.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,757.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,902.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,902.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,176.88
|
| Rate for Payer: Healthfirst Commercial |
$2,902.50
|
| Rate for Payer: Healthfirst Essential Plan |
$6,530.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,757.38
|
| Rate for Payer: Healthfirst QHP |
$2,902.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,031.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,902.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,467.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,031.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,902.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,176.88
|
| Rate for Payer: SOMOS Essential |
$2,176.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,902.50
|
|
|
PR OSTEOTOMY SPINE POSTERIOR 3 COLUMN THORACIC
|
Professional
|
Both
|
$11,299.61
|
|
|
Service Code
|
HCPCS 22206
|
| Min. Negotiated Rate |
$2,102.74 |
| Max. Negotiated Rate |
$6,758.80 |
| Rate for Payer: Cash Price |
$3,020.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,003.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,703.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,703.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,853.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,003.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,853.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,003.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,003.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,252.93
|
| Rate for Payer: Healthfirst Commercial |
$3,003.91
|
| Rate for Payer: Healthfirst Essential Plan |
$6,758.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,853.71
|
| Rate for Payer: Healthfirst QHP |
$3,003.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,102.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,003.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,553.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,102.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,003.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,252.93
|
| Rate for Payer: SOMOS Essential |
$2,252.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,003.91
|
|
