|
PR PRQ LYSIS EPIDURAL ADHESIONS MULT SESSIONS 1 DAY
|
Professional
|
Both
|
$1,013.25
|
|
|
Service Code
|
HCPCS 62264
|
| Min. Negotiated Rate |
$193.76 |
| Max. Negotiated Rate |
$622.80 |
| Rate for Payer: Cash Price |
$277.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$276.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$249.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$249.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$262.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$276.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$262.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$276.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$276.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$207.60
|
| Rate for Payer: Healthfirst Commercial |
$276.80
|
| Rate for Payer: Healthfirst Essential Plan |
$622.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$262.96
|
| Rate for Payer: Healthfirst QHP |
$276.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$193.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$276.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$235.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$193.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$276.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$207.60
|
| Rate for Payer: SOMOS Essential |
$207.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$276.80
|
|
|
PR PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL
|
Professional
|
Both
|
$1,078.77
|
|
|
Service Code
|
HCPCS 47533
|
| Min. Negotiated Rate |
$201.90 |
| Max. Negotiated Rate |
$648.97 |
| Rate for Payer: Cash Price |
$289.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$288.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$259.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$259.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$274.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$288.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$274.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$288.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$288.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$216.32
|
| Rate for Payer: Healthfirst Commercial |
$288.43
|
| Rate for Payer: Healthfirst Essential Plan |
$648.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$274.01
|
| Rate for Payer: Healthfirst QHP |
$288.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$201.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$288.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$245.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$201.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$288.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$216.32
|
| Rate for Payer: SOMOS Essential |
$216.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$288.43
|
|
|
PR PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I INT-EXT
|
Professional
|
Both
|
$1,503.53
|
|
|
Service Code
|
HCPCS 47534
|
| Min. Negotiated Rate |
$282.93 |
| Max. Negotiated Rate |
$909.43 |
| Rate for Payer: Cash Price |
$404.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$404.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$363.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$363.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$383.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$404.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$383.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$404.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$404.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$303.14
|
| Rate for Payer: Healthfirst Commercial |
$404.19
|
| Rate for Payer: Healthfirst Essential Plan |
$909.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$383.98
|
| Rate for Payer: Healthfirst QHP |
$404.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$282.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$404.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$343.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$282.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$404.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$303.14
|
| Rate for Payer: SOMOS Essential |
$303.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$404.19
|
|
|
PR PRQ PORTAL VEIN CATHETERIZATION ANY METHOD
|
Professional
|
Both
|
$1,338.93
|
|
|
Service Code
|
HCPCS 36481
|
| Min. Negotiated Rate |
$249.53 |
| Max. Negotiated Rate |
$802.06 |
| Rate for Payer: Cash Price |
$359.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$356.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$320.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$320.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$338.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$356.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$338.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$356.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$356.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$267.35
|
| Rate for Payer: Healthfirst Commercial |
$356.47
|
| Rate for Payer: Healthfirst Essential Plan |
$802.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$338.65
|
| Rate for Payer: Healthfirst QHP |
$356.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$249.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$356.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$303.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$249.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$356.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$267.35
|
| Rate for Payer: SOMOS Essential |
$267.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$356.47
|
|
|
PR PRQ SKELETAL FIXATION TALUS FRACTURE W/MANJ
|
Professional
|
Both
|
$2,204.37
|
|
|
Service Code
|
HCPCS 28436
|
| Min. Negotiated Rate |
$417.00 |
| Max. Negotiated Rate |
$1,340.35 |
| Rate for Payer: Cash Price |
$601.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$595.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$536.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$536.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$565.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$595.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$565.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$595.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$595.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$446.78
|
| Rate for Payer: Healthfirst Commercial |
$595.71
|
| Rate for Payer: Healthfirst Essential Plan |
$1,340.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$565.92
|
| Rate for Payer: Healthfirst QHP |
$595.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$417.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$595.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$506.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$417.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$595.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$446.78
|
| Rate for Payer: SOMOS Essential |
$446.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$595.71
|
|
|
PR PRQ SKELETAL FIXATION TIBIAL SHAFT FRACTURE
|
Professional
|
Both
|
$2,560.36
|
|
|
Service Code
|
HCPCS 27756
|
| Min. Negotiated Rate |
$495.01 |
| Max. Negotiated Rate |
$1,591.11 |
| Rate for Payer: Cash Price |
$694.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$707.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$636.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$636.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$671.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$707.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$671.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$707.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$707.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$530.37
|
| Rate for Payer: Healthfirst Commercial |
$707.16
|
| Rate for Payer: Healthfirst Essential Plan |
$1,591.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$671.80
|
| Rate for Payer: Healthfirst QHP |
$707.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$495.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$707.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$601.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$495.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$707.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$530.37
|
| Rate for Payer: SOMOS Essential |
$530.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$707.16
|
|
|
PR PRQ SKELETAL FIXATION ULNAR STYLOID FRACTURE
|
Professional
|
Both
|
$2,176.90
|
|
|
Service Code
|
HCPCS 25651
|
| Min. Negotiated Rate |
$414.22 |
| Max. Negotiated Rate |
$1,331.41 |
| Rate for Payer: Cash Price |
$594.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$591.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$532.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$532.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$562.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$591.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$562.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$591.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$591.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$443.81
|
| Rate for Payer: Healthfirst Commercial |
$591.74
|
| Rate for Payer: Healthfirst Essential Plan |
$1,331.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$562.15
|
| Rate for Payer: Healthfirst QHP |
$591.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$414.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$591.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$502.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$414.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$591.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$443.81
|
| Rate for Payer: SOMOS Essential |
$443.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$591.74
|
|
|
PR PRQ SKELETAL FIX CARPO/METACARPAL FX DISLC THUMB
|
Professional
|
Both
|
$2,138.54
|
|
|
Service Code
|
HCPCS 26650
|
| Min. Negotiated Rate |
$407.90 |
| Max. Negotiated Rate |
$1,311.12 |
| Rate for Payer: Cash Price |
$583.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$582.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$524.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$524.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$553.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$582.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$553.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$582.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$582.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$437.04
|
| Rate for Payer: Healthfirst Commercial |
$582.72
|
| Rate for Payer: Healthfirst Essential Plan |
$1,311.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$553.58
|
| Rate for Payer: Healthfirst QHP |
$582.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$407.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$582.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$495.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$407.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$582.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$437.04
|
| Rate for Payer: SOMOS Essential |
$437.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$582.72
|
|
|
PR PRQ SKELETAL FIXJ CALCANEAL FRACTURE W/MANJ
|
Professional
|
Both
|
$2,485.53
|
|
|
Service Code
|
HCPCS 28406
|
| Min. Negotiated Rate |
$495.38 |
| Max. Negotiated Rate |
$1,592.28 |
| Rate for Payer: Cash Price |
$712.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$707.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$636.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$636.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$672.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$707.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$672.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$707.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$707.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$530.76
|
| Rate for Payer: Healthfirst Commercial |
$707.68
|
| Rate for Payer: Healthfirst Essential Plan |
$1,592.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$672.30
|
| Rate for Payer: Healthfirst QHP |
$707.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$495.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$707.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$601.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$495.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$707.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$530.76
|
| Rate for Payer: SOMOS Essential |
$530.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$707.68
|
|
|
PR PRQ SKELETAL FIXJ DISTAL RADIOULNAR DISLOCATION
|
Professional
|
Both
|
$2,361.49
|
|
|
Service Code
|
HCPCS 25671
|
| Min. Negotiated Rate |
$452.93 |
| Max. Negotiated Rate |
$1,455.84 |
| Rate for Payer: Cash Price |
$649.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$647.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$582.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$582.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$614.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$647.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$614.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$647.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$647.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$485.28
|
| Rate for Payer: Healthfirst Commercial |
$647.04
|
| Rate for Payer: Healthfirst Essential Plan |
$1,455.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$614.69
|
| Rate for Payer: Healthfirst QHP |
$647.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$452.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$647.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$549.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$452.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$647.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$485.28
|
| Rate for Payer: SOMOS Essential |
$485.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$647.04
|
|
|
PR PRQ SKELETAL FIXJ FEMORAL FX DISTAL END
|
Professional
|
Both
|
$2,999.75
|
|
|
Service Code
|
HCPCS 27509
|
| Min. Negotiated Rate |
$564.07 |
| Max. Negotiated Rate |
$1,813.10 |
| Rate for Payer: Cash Price |
$810.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$805.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$725.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$725.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$765.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$805.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$765.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$805.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$805.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$604.37
|
| Rate for Payer: Healthfirst Commercial |
$805.82
|
| Rate for Payer: Healthfirst Essential Plan |
$1,813.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$765.53
|
| Rate for Payer: Healthfirst QHP |
$805.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$564.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$805.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$684.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$564.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$805.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$604.37
|
| Rate for Payer: SOMOS Essential |
$604.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$805.82
|
|
|
PR PRQ SKELETAL FIXJ METACARPAL FX EACH BONE
|
Professional
|
Both
|
$2,143.79
|
|
|
Service Code
|
HCPCS 26608
|
| Min. Negotiated Rate |
$405.71 |
| Max. Negotiated Rate |
$1,304.08 |
| Rate for Payer: Cash Price |
$583.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$579.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$521.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$521.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$550.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$579.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$550.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$579.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$579.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$434.69
|
| Rate for Payer: Healthfirst Commercial |
$579.59
|
| Rate for Payer: Healthfirst Essential Plan |
$1,304.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$550.61
|
| Rate for Payer: Healthfirst QHP |
$579.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$405.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$579.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$492.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$405.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$579.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$434.69
|
| Rate for Payer: SOMOS Essential |
$434.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$579.59
|
|
|
PR PRQ SKEL FIXJ CARPO/MTCRPL DISLC THMB MANJ EA JT
|
Professional
|
Both
|
$2,263.91
|
|
|
Service Code
|
HCPCS 26676
|
| Min. Negotiated Rate |
$431.10 |
| Max. Negotiated Rate |
$1,385.66 |
| Rate for Payer: Cash Price |
$617.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$615.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$554.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$554.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$585.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$615.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$585.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$615.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$615.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$461.89
|
| Rate for Payer: Healthfirst Commercial |
$615.85
|
| Rate for Payer: Healthfirst Essential Plan |
$1,385.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$585.06
|
| Rate for Payer: Healthfirst QHP |
$615.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$431.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$615.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$523.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$431.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$615.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$461.89
|
| Rate for Payer: SOMOS Essential |
$461.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$615.85
|
|
|
PR PRQ SKEL FIXJ DSTL PHLNGL FX FNGR/THMB EA
|
Professional
|
Both
|
$1,888.64
|
|
|
Service Code
|
HCPCS 26756
|
| Min. Negotiated Rate |
$358.23 |
| Max. Negotiated Rate |
$1,151.46 |
| Rate for Payer: Cash Price |
$514.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$511.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$460.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$460.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$486.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$511.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$486.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$511.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$511.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$383.82
|
| Rate for Payer: Healthfirst Commercial |
$511.76
|
| Rate for Payer: Healthfirst Essential Plan |
$1,151.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$486.17
|
| Rate for Payer: Healthfirst QHP |
$511.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$358.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$511.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$435.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$358.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$511.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$383.82
|
| Rate for Payer: SOMOS Essential |
$383.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$511.76
|
|
|
PR PRQ SKEL FIXJ FEMORAL FX PROX END NECK
|
Professional
|
Both
|
$4,001.94
|
|
|
Service Code
|
HCPCS 27235
|
| Min. Negotiated Rate |
$753.72 |
| Max. Negotiated Rate |
$2,422.66 |
| Rate for Payer: Cash Price |
$1,081.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,076.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$969.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$969.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,022.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,076.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,022.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,076.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,076.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$807.55
|
| Rate for Payer: Healthfirst Commercial |
$1,076.74
|
| Rate for Payer: Healthfirst Essential Plan |
$2,422.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,022.90
|
| Rate for Payer: Healthfirst QHP |
$1,076.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$753.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,076.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$915.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$753.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,076.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$807.55
|
| Rate for Payer: SOMOS Essential |
$807.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,076.74
|
|
|
PR PRQ SKEL FIXJ FX GRT TOE PHLX/PHLG W/MANJ
|
Professional
|
Both
|
$1,082.76
|
|
|
Service Code
|
HCPCS 28496
|
| Min. Negotiated Rate |
$232.67 |
| Max. Negotiated Rate |
$747.88 |
| Rate for Payer: Cash Price |
$331.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$332.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$299.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$299.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$315.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$332.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$315.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$332.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$332.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$249.29
|
| Rate for Payer: Healthfirst Commercial |
$332.39
|
| Rate for Payer: Healthfirst Essential Plan |
$747.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$315.77
|
| Rate for Payer: Healthfirst QHP |
$332.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$232.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$332.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$282.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$232.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$332.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$249.29
|
| Rate for Payer: SOMOS Essential |
$249.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$332.39
|
|
|
PR PRQ SKEL FIXJ HUMRL CNDYLR FX MEDIAL/LAT W/MANJ
|
Professional
|
Both
|
$3,623.62
|
|
|
Service Code
|
HCPCS 24582
|
| Min. Negotiated Rate |
$686.55 |
| Max. Negotiated Rate |
$2,206.76 |
| Rate for Payer: Cash Price |
$983.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$980.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$882.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$882.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$931.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$980.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$931.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$980.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$980.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$735.59
|
| Rate for Payer: Healthfirst Commercial |
$980.78
|
| Rate for Payer: Healthfirst Essential Plan |
$2,206.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$931.74
|
| Rate for Payer: Healthfirst QHP |
$980.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$686.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$980.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$833.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$686.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$980.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$735.59
|
| Rate for Payer: SOMOS Essential |
$735.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$980.78
|
|
|
PR PRQ SKEL FIXJ HUMRL EPCNDYLR FX MEDIAL/LAT MANJ
|
Professional
|
Both
|
$3,199.74
|
|
|
Service Code
|
HCPCS 24566
|
| Min. Negotiated Rate |
$606.97 |
| Max. Negotiated Rate |
$1,950.97 |
| Rate for Payer: Cash Price |
$868.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$867.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$780.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$780.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$823.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$867.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$823.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$867.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$867.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$650.33
|
| Rate for Payer: Healthfirst Commercial |
$867.10
|
| Rate for Payer: Healthfirst Essential Plan |
$1,950.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$823.75
|
| Rate for Payer: Healthfirst QHP |
$867.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$606.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$867.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$737.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$606.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$867.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$650.33
|
| Rate for Payer: SOMOS Essential |
$650.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$867.10
|
|
|
PR PRQ SKEL FIXJ INTERPHALANGEAL JOINT DISLC W/MANJ
|
Professional
|
Both
|
$734.34
|
|
|
Service Code
|
HCPCS 28666
|
| Min. Negotiated Rate |
$138.71 |
| Max. Negotiated Rate |
$445.86 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$198.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$178.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$178.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$188.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$198.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$188.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$198.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$148.62
|
| Rate for Payer: Healthfirst Commercial |
$198.16
|
| Rate for Payer: Healthfirst Essential Plan |
$445.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$188.25
|
| Rate for Payer: Healthfirst QHP |
$198.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$138.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$198.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$168.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$138.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$198.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$148.62
|
| Rate for Payer: SOMOS Essential |
$148.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$198.16
|
|
|
PR PRQ SKEL FIXJ IPHAL JT DISLC W/MANJ
|
Professional
|
Both
|
$2,000.57
|
|
|
Service Code
|
HCPCS 26776
|
| Min. Negotiated Rate |
$380.44 |
| Max. Negotiated Rate |
$1,222.83 |
| Rate for Payer: Cash Price |
$545.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$543.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$489.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$489.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$516.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$543.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$516.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$543.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$543.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$407.61
|
| Rate for Payer: Healthfirst Commercial |
$543.48
|
| Rate for Payer: Healthfirst Essential Plan |
$1,222.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$516.31
|
| Rate for Payer: Healthfirst QHP |
$543.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$380.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$543.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$461.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$380.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$543.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$407.61
|
| Rate for Payer: SOMOS Essential |
$407.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$543.48
|
|
|
PR PRQ SKEL FIXJ METACARPOPHALANGEAL DISLC W/MANJ
|
Professional
|
Both
|
$1,973.62
|
|
|
Service Code
|
HCPCS 26706
|
| Min. Negotiated Rate |
$376.86 |
| Max. Negotiated Rate |
$1,211.33 |
| Rate for Payer: Cash Price |
$539.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$538.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$484.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$484.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$511.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$538.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$511.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$538.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$538.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$403.78
|
| Rate for Payer: Healthfirst Commercial |
$538.37
|
| Rate for Payer: Healthfirst Essential Plan |
$1,211.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$511.45
|
| Rate for Payer: Healthfirst QHP |
$538.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$376.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$538.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$457.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$376.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$538.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$403.78
|
| Rate for Payer: SOMOS Essential |
$403.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$538.37
|
|
|
PR PRQ SKEL FIXJ METAR FX W/MANJ
|
Professional
|
Both
|
$1,698.20
|
|
|
Service Code
|
HCPCS 28476
|
| Min. Negotiated Rate |
$325.47 |
| Max. Negotiated Rate |
$1,046.16 |
| Rate for Payer: Cash Price |
$462.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$464.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$418.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$418.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$441.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$464.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$441.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$464.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$464.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$348.72
|
| Rate for Payer: Healthfirst Commercial |
$464.96
|
| Rate for Payer: Healthfirst Essential Plan |
$1,046.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$441.71
|
| Rate for Payer: Healthfirst QHP |
$464.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$325.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$464.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$395.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$325.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$464.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$348.72
|
| Rate for Payer: SOMOS Essential |
$348.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$464.96
|
|
|
PR PRQ SKEL FIXJ METATARSOPHLNGL JT DISLC W/MANJ
|
Professional
|
Both
|
$856.00
|
|
|
Service Code
|
HCPCS 28636
|
| Min. Negotiated Rate |
$188.08 |
| Max. Negotiated Rate |
$604.53 |
| Rate for Payer: Cash Price |
$267.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$268.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$241.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$241.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$255.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$268.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$255.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$268.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$268.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$201.51
|
| Rate for Payer: Healthfirst Commercial |
$268.68
|
| Rate for Payer: Healthfirst Essential Plan |
$604.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$255.25
|
| Rate for Payer: Healthfirst QHP |
$268.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$188.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$268.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$228.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$188.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$268.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$201.51
|
| Rate for Payer: SOMOS Essential |
$201.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$268.68
|
|
|
PR PRQ SKEL FIXJ PHLNGL SHFT FX PROX/MIDDLE PX/F/T
|
Professional
|
Both
|
$2,108.09
|
|
|
Service Code
|
HCPCS 26727
|
| Min. Negotiated Rate |
$400.79 |
| Max. Negotiated Rate |
$1,288.24 |
| Rate for Payer: Cash Price |
$575.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$572.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$515.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$515.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$543.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$572.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$543.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$572.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$572.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$429.41
|
| Rate for Payer: Healthfirst Commercial |
$572.55
|
| Rate for Payer: Healthfirst Essential Plan |
$1,288.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$543.92
|
| Rate for Payer: Healthfirst QHP |
$572.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$400.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$572.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$486.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$400.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$572.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$429.41
|
| Rate for Payer: SOMOS Essential |
$429.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$572.55
|
|
|
PR PRQ SKEL FIXJ SPRCNDYLR/TRANSCNDYLR HUMERAL FX
|
Professional
|
Both
|
$3,509.24
|
|
|
Service Code
|
HCPCS 24538
|
| Min. Negotiated Rate |
$658.62 |
| Max. Negotiated Rate |
$2,117.00 |
| Rate for Payer: Cash Price |
$948.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$940.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$846.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$846.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$893.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$940.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$893.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$940.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$940.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$705.67
|
| Rate for Payer: Healthfirst Commercial |
$940.89
|
| Rate for Payer: Healthfirst Essential Plan |
$2,117.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$893.85
|
| Rate for Payer: Healthfirst QHP |
$940.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$658.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$940.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$799.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$658.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$940.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$705.67
|
| Rate for Payer: SOMOS Essential |
$705.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$940.89
|
|
