|
PR OSTEOTOMY SPINE PST/PSTLAT APPR 1 VRT SGM CRV
|
Professional
|
Both
|
$8,231.93
|
|
|
Service Code
|
HCPCS 22210
|
| Min. Negotiated Rate |
$1,528.54 |
| Max. Negotiated Rate |
$4,913.17 |
| Rate for Payer: Cash Price |
$2,205.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,183.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,965.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,965.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,074.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,183.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,074.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,183.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,183.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,637.72
|
| Rate for Payer: Healthfirst Commercial |
$2,183.63
|
| Rate for Payer: Healthfirst Essential Plan |
$4,913.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,074.45
|
| Rate for Payer: Healthfirst QHP |
$2,183.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,528.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,183.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,856.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,528.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,183.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,637.72
|
| Rate for Payer: SOMOS Essential |
$1,637.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,183.63
|
|
|
PR OSTEOTOMY SPINE PST/PSTLAT APPR 1 VRT SGM LMBR
|
Professional
|
Both
|
$6,938.44
|
|
|
Service Code
|
HCPCS 22214
|
| Min. Negotiated Rate |
$1,292.01 |
| Max. Negotiated Rate |
$4,152.89 |
| Rate for Payer: Cash Price |
$1,856.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,845.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,661.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,661.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,753.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,845.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,753.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,845.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,845.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,384.30
|
| Rate for Payer: Healthfirst Commercial |
$1,845.73
|
| Rate for Payer: Healthfirst Essential Plan |
$4,152.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,753.44
|
| Rate for Payer: Healthfirst QHP |
$1,845.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,292.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,845.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,568.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,292.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,845.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,384.30
|
| Rate for Payer: SOMOS Essential |
$1,384.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,845.73
|
|
|
PR OSTEOTOMY SPINE PST/PSTLAT APPR 1 VRT SGM THRC
|
Professional
|
Both
|
$6,934.97
|
|
|
Service Code
|
HCPCS 22212
|
| Min. Negotiated Rate |
$1,294.97 |
| Max. Negotiated Rate |
$4,162.41 |
| Rate for Payer: Cash Price |
$1,855.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,849.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,664.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,664.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,757.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,849.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,757.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,849.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,849.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,387.47
|
| Rate for Payer: Healthfirst Commercial |
$1,849.96
|
| Rate for Payer: Healthfirst Essential Plan |
$4,162.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,757.46
|
| Rate for Payer: Healthfirst QHP |
$1,849.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,294.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,849.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,572.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,294.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,849.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,387.47
|
| Rate for Payer: SOMOS Essential |
$1,387.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,849.96
|
|
|
PR OSTEOTOMY SPINE W/DSKC ANT APPR 1 VRT SGM CRV
|
Professional
|
Both
|
$7,430.01
|
|
|
Service Code
|
HCPCS 22220
|
| Min. Negotiated Rate |
$1,392.70 |
| Max. Negotiated Rate |
$4,476.53 |
| Rate for Payer: Cash Price |
$1,983.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,989.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,790.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,790.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,890.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,989.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,890.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,989.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,989.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,492.18
|
| Rate for Payer: Healthfirst Commercial |
$1,989.57
|
| Rate for Payer: Healthfirst Essential Plan |
$4,476.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,890.09
|
| Rate for Payer: Healthfirst QHP |
$1,989.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,392.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,989.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,691.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,392.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,989.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,492.18
|
| Rate for Payer: SOMOS Essential |
$1,492.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,989.57
|
|
|
PR OSTEOTOMY SPINE W/DSKC ANT APPR 1 VRT SGM LMBR
|
Professional
|
Both
|
$7,117.22
|
|
|
Service Code
|
HCPCS 22224
|
| Min. Negotiated Rate |
$1,335.85 |
| Max. Negotiated Rate |
$4,293.81 |
| Rate for Payer: Cash Price |
$1,908.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,908.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,717.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,717.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,812.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,908.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,812.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,908.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,908.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,431.27
|
| Rate for Payer: Healthfirst Commercial |
$1,908.36
|
| Rate for Payer: Healthfirst Essential Plan |
$4,293.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,812.94
|
| Rate for Payer: Healthfirst QHP |
$1,908.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,335.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,908.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,622.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,335.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,908.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,431.27
|
| Rate for Payer: SOMOS Essential |
$1,431.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,908.36
|
|
|
PR OSTEOTOMY SPINE W/DSKC ANT APPR 1 VRT SGM THRC
|
Professional
|
Both
|
$8,433.11
|
|
|
Service Code
|
HCPCS 22222
|
| Min. Negotiated Rate |
$1,552.15 |
| Max. Negotiated Rate |
$4,989.06 |
| Rate for Payer: Cash Price |
$2,236.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,217.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,995.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,995.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,106.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,217.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,106.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,217.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,217.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,663.02
|
| Rate for Payer: Healthfirst Commercial |
$2,217.36
|
| Rate for Payer: Healthfirst Essential Plan |
$4,989.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,106.49
|
| Rate for Payer: Healthfirst QHP |
$2,217.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,552.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,217.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,884.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,552.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,217.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,663.02
|
| Rate for Payer: SOMOS Essential |
$1,663.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,217.36
|
|
|
PR OSTEOTOMY TALUS
|
Professional
|
Both
|
$3,177.90
|
|
|
Service Code
|
HCPCS 28302
|
| Min. Negotiated Rate |
$599.21 |
| Max. Negotiated Rate |
$1,926.05 |
| Rate for Payer: Cash Price |
$859.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$856.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$770.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$770.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$813.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$856.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$813.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$856.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$856.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$642.01
|
| Rate for Payer: Healthfirst Commercial |
$856.02
|
| Rate for Payer: Healthfirst Essential Plan |
$1,926.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$813.22
|
| Rate for Payer: Healthfirst QHP |
$856.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$599.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$856.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$727.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$599.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$856.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$642.01
|
| Rate for Payer: SOMOS Essential |
$642.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$856.02
|
|
|
PR OSTEOTOMY TARSAL BONES OTH/THN CALCANEUS/TALUS
|
Professional
|
Both
|
$2,642.19
|
|
|
Service Code
|
HCPCS 28304
|
| Min. Negotiated Rate |
$503.13 |
| Max. Negotiated Rate |
$1,617.21 |
| Rate for Payer: Cash Price |
$720.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$718.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$646.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$646.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$682.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$718.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$682.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$718.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$718.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$539.07
|
| Rate for Payer: Healthfirst Commercial |
$718.76
|
| Rate for Payer: Healthfirst Essential Plan |
$1,617.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$682.82
|
| Rate for Payer: Healthfirst QHP |
$718.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$503.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$718.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$610.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$503.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$718.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$539.07
|
| Rate for Payer: SOMOS Essential |
$539.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$718.76
|
|
|
PR OSTEOTOMY TIBIA
|
Professional
|
Both
|
$3,312.26
|
|
|
Service Code
|
HCPCS 27705
|
| Min. Negotiated Rate |
$614.22 |
| Max. Negotiated Rate |
$1,974.29 |
| Rate for Payer: Cash Price |
$890.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$877.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$789.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$789.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$833.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$877.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$833.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$877.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$877.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$658.10
|
| Rate for Payer: Healthfirst Commercial |
$877.46
|
| Rate for Payer: Healthfirst Essential Plan |
$1,974.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$833.59
|
| Rate for Payer: Healthfirst QHP |
$877.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$614.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$877.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$745.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$614.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$877.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$658.10
|
| Rate for Payer: SOMOS Essential |
$658.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$877.46
|
|
|
PR OSTEOTOMY TIBIA & FIBULA
|
Professional
|
Both
|
$4,969.86
|
|
|
Service Code
|
HCPCS 27709
|
| Min. Negotiated Rate |
$938.97 |
| Max. Negotiated Rate |
$3,018.11 |
| Rate for Payer: Cash Price |
$1,357.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,341.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,207.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,207.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,274.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,341.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,274.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,341.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,341.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,006.03
|
| Rate for Payer: Healthfirst Commercial |
$1,341.38
|
| Rate for Payer: Healthfirst Essential Plan |
$3,018.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,274.31
|
| Rate for Payer: Healthfirst QHP |
$1,341.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$938.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,341.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,140.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$938.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,341.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,006.03
|
| Rate for Payer: SOMOS Essential |
$1,006.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,341.38
|
|
|
PR OSTEOTOMY&TRANSFER GREATER TROCHANTER SPX
|
Professional
|
Both
|
$3,967.18
|
|
|
Service Code
|
HCPCS 27140
|
| Min. Negotiated Rate |
$747.60 |
| Max. Negotiated Rate |
$2,403.00 |
| Rate for Payer: Cash Price |
$1,072.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,068.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$961.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$961.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,014.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,068.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,014.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,068.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,068.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$801.00
|
| Rate for Payer: Healthfirst Commercial |
$1,068.00
|
| Rate for Payer: Healthfirst Essential Plan |
$2,403.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,014.60
|
| Rate for Payer: Healthfirst QHP |
$1,068.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$747.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,068.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$907.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$747.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,068.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$801.00
|
| Rate for Payer: SOMOS Essential |
$801.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,068.00
|
|
|
PR OSTEOTOMY ULNA
|
Professional
|
Both
|
$2,904.44
|
|
|
Service Code
|
HCPCS 25360
|
| Min. Negotiated Rate |
$549.78 |
| Max. Negotiated Rate |
$1,767.15 |
| Rate for Payer: Cash Price |
$788.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$785.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$706.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$706.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$746.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$785.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$746.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$785.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$785.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$589.05
|
| Rate for Payer: Healthfirst Commercial |
$785.40
|
| Rate for Payer: Healthfirst Essential Plan |
$1,767.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$746.13
|
| Rate for Payer: Healthfirst QHP |
$785.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$549.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$785.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$667.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$549.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$785.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$589.05
|
| Rate for Payer: SOMOS Essential |
$589.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$785.40
|
|
|
PR OSTEOT PROX TIBIA FIB EXC/OSTEOT AFTER EPIPHYSL
|
Professional
|
Both
|
$4,252.26
|
|
|
Service Code
|
HCPCS 27457
|
| Min. Negotiated Rate |
$793.51 |
| Max. Negotiated Rate |
$2,550.58 |
| Rate for Payer: Cash Price |
$1,123.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,133.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,020.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,020.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,076.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,133.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,076.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,133.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,133.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$850.19
|
| Rate for Payer: Healthfirst Commercial |
$1,133.59
|
| Rate for Payer: Healthfirst Essential Plan |
$2,550.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,076.91
|
| Rate for Payer: Healthfirst QHP |
$1,133.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$793.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,133.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$963.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$793.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,133.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$850.19
|
| Rate for Payer: SOMOS Essential |
$850.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,133.59
|
|
|
PR OSTEOT PROX TIBIA FIB EXC/OSTEOT BEFORE EPIPHYSL
|
Professional
|
Both
|
$4,256.53
|
|
|
Service Code
|
HCPCS 27455
|
| Min. Negotiated Rate |
$798.84 |
| Max. Negotiated Rate |
$2,567.70 |
| Rate for Payer: Cash Price |
$1,147.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,141.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,027.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,027.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,084.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,141.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,084.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,141.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,141.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$855.90
|
| Rate for Payer: Healthfirst Commercial |
$1,141.20
|
| Rate for Payer: Healthfirst Essential Plan |
$2,567.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,084.14
|
| Rate for Payer: Healthfirst QHP |
$1,141.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$798.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,141.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$970.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$798.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,141.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$855.90
|
| Rate for Payer: SOMOS Essential |
$855.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,141.20
|
|
|
PR OSTEOT SHRT CORRJ OTH PHALANGES ANY TOE
|
Professional
|
Both
|
$1,441.86
|
|
|
Service Code
|
HCPCS 28312
|
| Min. Negotiated Rate |
$292.07 |
| Max. Negotiated Rate |
$938.79 |
| Rate for Payer: Cash Price |
$405.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$417.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$375.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$375.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$396.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$417.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$396.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$417.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$417.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$312.93
|
| Rate for Payer: Healthfirst Commercial |
$417.24
|
| Rate for Payer: Healthfirst Essential Plan |
$938.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$396.38
|
| Rate for Payer: Healthfirst QHP |
$417.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$292.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$417.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$354.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$292.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$417.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$312.93
|
| Rate for Payer: SOMOS Essential |
$312.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$417.24
|
|
|
PR OSTEOT SHRT CORRJ PROX PHALANX 1ST TOE
|
Professional
|
Both
|
$1,524.50
|
|
|
Service Code
|
HCPCS 28310
|
| Min. Negotiated Rate |
$297.86 |
| Max. Negotiated Rate |
$957.42 |
| Rate for Payer: Cash Price |
$423.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$425.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$382.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$382.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$404.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$425.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$404.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$425.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$425.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$319.14
|
| Rate for Payer: Healthfirst Commercial |
$425.52
|
| Rate for Payer: Healthfirst Essential Plan |
$957.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$404.24
|
| Rate for Payer: Healthfirst QHP |
$425.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$297.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$425.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$361.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$297.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$425.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$319.14
|
| Rate for Payer: SOMOS Essential |
$319.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$425.52
|
|
|
PR OSTEOT SPI PST/PSTLAT APPR 1 VRT SGM EA VRT SGM
|
Professional
|
Both
|
$1,662.75
|
|
|
Service Code
|
HCPCS 22216
|
| Min. Negotiated Rate |
$306.39 |
| Max. Negotiated Rate |
$984.83 |
| Rate for Payer: Cash Price |
$439.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$437.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$393.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$393.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$415.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$437.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$415.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$437.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$437.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$328.27
|
| Rate for Payer: Healthfirst Commercial |
$437.70
|
| Rate for Payer: Healthfirst Essential Plan |
$984.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$415.81
|
| Rate for Payer: Healthfirst QHP |
$437.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$306.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$437.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$372.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$306.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$437.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$328.27
|
| Rate for Payer: SOMOS Essential |
$328.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$437.70
|
|
|
PR OSTEOT SPI W/DSKC ANT APPR 1 VRT SGM EA VRT SGM
|
Professional
|
Both
|
$1,632.51
|
|
|
Service Code
|
HCPCS 22226
|
| Min. Negotiated Rate |
$302.97 |
| Max. Negotiated Rate |
$973.85 |
| Rate for Payer: Cash Price |
$432.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$432.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$389.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$389.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$411.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$432.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$411.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$432.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$432.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$324.62
|
| Rate for Payer: Healthfirst Commercial |
$432.82
|
| Rate for Payer: Healthfirst Essential Plan |
$973.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$411.18
|
| Rate for Payer: Healthfirst QHP |
$432.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$302.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$432.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$367.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$302.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$432.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$324.62
|
| Rate for Payer: SOMOS Essential |
$324.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$432.82
|
|
|
PR OSTEOT TARSAL OTH/THN CALCANEUS/TALUS W/AGRFT
|
Professional
|
Both
|
$2,861.99
|
|
|
Service Code
|
HCPCS 28305
|
| Min. Negotiated Rate |
$547.20 |
| Max. Negotiated Rate |
$1,758.87 |
| Rate for Payer: Cash Price |
$788.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$781.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$703.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$703.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$742.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$781.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$742.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$781.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$781.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$586.29
|
| Rate for Payer: Healthfirst Commercial |
$781.72
|
| Rate for Payer: Healthfirst Essential Plan |
$1,758.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$742.63
|
| Rate for Payer: Healthfirst QHP |
$781.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$547.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$781.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$664.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$547.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$781.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$586.29
|
| Rate for Payer: SOMOS Essential |
$586.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$781.72
|
|
|
PR OSTEOT W/WO LNGTH SHRT/ANGULAR CORRJ METAR MLT
|
Professional
|
Both
|
$3,886.82
|
|
|
Service Code
|
HCPCS 28309
|
| Min. Negotiated Rate |
$739.94 |
| Max. Negotiated Rate |
$2,378.39 |
| Rate for Payer: Cash Price |
$1,063.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,057.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$951.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$951.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,004.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,057.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,004.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,057.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,057.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$792.79
|
| Rate for Payer: Healthfirst Commercial |
$1,057.06
|
| Rate for Payer: Healthfirst Essential Plan |
$2,378.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,004.21
|
| Rate for Payer: Healthfirst QHP |
$1,057.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$739.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,057.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$898.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$739.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,057.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$792.79
|
| Rate for Payer: SOMOS Essential |
$792.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,057.06
|
|
|
PR OSTEOT W/WO LNGTH SHRT/CORRJ 1ST METAR
|
Professional
|
Both
|
$1,732.54
|
|
|
Service Code
|
HCPCS 28306
|
| Min. Negotiated Rate |
$332.28 |
| Max. Negotiated Rate |
$1,068.03 |
| Rate for Payer: Cash Price |
$478.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$474.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$427.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$427.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$450.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$474.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$450.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$474.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$474.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$356.01
|
| Rate for Payer: Healthfirst Commercial |
$474.68
|
| Rate for Payer: Healthfirst Essential Plan |
$1,068.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$450.95
|
| Rate for Payer: Healthfirst QHP |
$474.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$332.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$474.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$403.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$332.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$474.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$356.01
|
| Rate for Payer: SOMOS Essential |
$356.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$474.68
|
|
|
PR OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA
|
Professional
|
Both
|
$1,641.89
|
|
|
Service Code
|
HCPCS 28308
|
| Min. Negotiated Rate |
$316.23 |
| Max. Negotiated Rate |
$1,016.46 |
| Rate for Payer: Cash Price |
$454.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$451.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$406.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$406.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$429.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$451.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$429.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$451.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$451.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$338.82
|
| Rate for Payer: Healthfirst Commercial |
$451.76
|
| Rate for Payer: Healthfirst Essential Plan |
$1,016.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$429.17
|
| Rate for Payer: Healthfirst QHP |
$451.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$316.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$451.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$384.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$316.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$451.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$338.82
|
| Rate for Payer: SOMOS Essential |
$338.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$451.76
|
|
|
PR OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST TOE
|
Professional
|
Both
|
$2,292.50
|
|
|
Service Code
|
HCPCS 28307
|
| Min. Negotiated Rate |
$435.35 |
| Max. Negotiated Rate |
$1,399.34 |
| Rate for Payer: Cash Price |
$622.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$621.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$559.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$559.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$590.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$621.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$590.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$621.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$621.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$466.45
|
| Rate for Payer: Healthfirst Commercial |
$621.93
|
| Rate for Payer: Healthfirst Essential Plan |
$1,399.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$590.83
|
| Rate for Payer: Healthfirst QHP |
$621.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$435.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$621.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$528.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$435.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$621.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$466.45
|
| Rate for Payer: SOMOS Essential |
$466.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$621.93
|
|
|
PR OSTPL FEMUR CMBN LNGTH&SHRT W/FEMORAL SGM TRNSFR
|
Professional
|
Both
|
$5,919.83
|
|
|
Service Code
|
HCPCS 27468
|
| Min. Negotiated Rate |
$1,110.93 |
| Max. Negotiated Rate |
$3,570.86 |
| Rate for Payer: Cash Price |
$1,594.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,587.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,428.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,428.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,507.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,587.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,507.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,587.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,587.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,190.29
|
| Rate for Payer: Healthfirst Commercial |
$1,587.05
|
| Rate for Payer: Healthfirst Essential Plan |
$3,570.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,507.70
|
| Rate for Payer: Healthfirst QHP |
$1,587.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,110.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,587.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,348.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,110.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,587.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,190.29
|
| Rate for Payer: SOMOS Essential |
$1,190.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,587.05
|
|
|
PR OSTPL RCNSTJ DORSAL SPI ELMNTS FLWG ISPI PX
|
Professional
|
Both
|
$1,597.30
|
|
|
Service Code
|
HCPCS 63295
|
| Min. Negotiated Rate |
$289.73 |
| Max. Negotiated Rate |
$931.27 |
| Rate for Payer: Cash Price |
$413.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$413.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$372.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$372.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$393.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$413.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$393.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$413.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$413.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$310.43
|
| Rate for Payer: Healthfirst Commercial |
$413.90
|
| Rate for Payer: Healthfirst Essential Plan |
$931.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$393.20
|
| Rate for Payer: Healthfirst QHP |
$413.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$289.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$413.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$351.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$289.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$413.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$310.43
|
| Rate for Payer: SOMOS Essential |
$310.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$413.90
|
|
