|
PR REPAIR NON/MALUNION HUMERUS W/ILIAC/OTH AGRFT
|
Professional
|
Both
|
$4,763.40
|
|
|
Service Code
|
HCPCS 24435
|
| Min. Negotiated Rate |
$898.69 |
| Max. Negotiated Rate |
$2,888.64 |
| Rate for Payer: Cash Price |
$1,290.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,283.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,155.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,155.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,219.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,283.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,219.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,283.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,283.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$962.88
|
| Rate for Payer: Healthfirst Commercial |
$1,283.84
|
| Rate for Payer: Healthfirst Essential Plan |
$2,888.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,219.65
|
| Rate for Payer: Healthfirst QHP |
$1,283.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$898.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,283.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,091.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$898.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,283.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$962.88
|
| Rate for Payer: SOMOS Essential |
$962.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,283.84
|
|
|
PR REPAIR NON/MALUNION HUMERUS W/O GRAFT
|
Professional
|
Both
|
$4,660.15
|
|
|
Service Code
|
HCPCS 24430
|
| Min. Negotiated Rate |
$877.39 |
| Max. Negotiated Rate |
$2,820.20 |
| Rate for Payer: Cash Price |
$1,257.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,253.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,128.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,128.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,190.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,253.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,190.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,253.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,253.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$940.07
|
| Rate for Payer: Healthfirst Commercial |
$1,253.42
|
| Rate for Payer: Healthfirst Essential Plan |
$2,820.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,190.75
|
| Rate for Payer: Healthfirst QHP |
$1,253.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$877.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,253.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,065.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$877.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,253.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$940.07
|
| Rate for Payer: SOMOS Essential |
$940.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,253.42
|
|
|
PR REPAIR NONUNION CARPAL BONE EACH BONE
|
Professional
|
Both
|
$3,496.99
|
|
|
Service Code
|
HCPCS 25431
|
| Min. Negotiated Rate |
$659.61 |
| Max. Negotiated Rate |
$2,120.18 |
| Rate for Payer: Cash Price |
$945.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$942.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$848.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$848.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$895.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$942.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$895.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$942.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$942.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$706.73
|
| Rate for Payer: Healthfirst Commercial |
$942.30
|
| Rate for Payer: Healthfirst Essential Plan |
$2,120.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$895.18
|
| Rate for Payer: Healthfirst QHP |
$942.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$659.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$942.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$800.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$659.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$942.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$706.73
|
| Rate for Payer: SOMOS Essential |
$706.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$942.30
|
|
|
PR REPAIR NONUNION/MALUNION TARSAL BONES
|
Professional
|
Both
|
$2,634.17
|
|
|
Service Code
|
HCPCS 28320
|
| Min. Negotiated Rate |
$504.01 |
| Max. Negotiated Rate |
$1,620.02 |
| Rate for Payer: Cash Price |
$725.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$720.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$648.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$648.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$684.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$720.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$684.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$720.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$720.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$540.01
|
| Rate for Payer: Healthfirst Commercial |
$720.01
|
| Rate for Payer: Healthfirst Essential Plan |
$1,620.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$684.01
|
| Rate for Payer: Healthfirst QHP |
$720.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$504.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$720.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$612.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$504.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$720.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$540.01
|
| Rate for Payer: SOMOS Essential |
$540.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$720.01
|
|
|
PR REPAIR NONUNION/MALUNION TIBIA W/O GRAFT
|
Professional
|
Both
|
$3,848.36
|
|
|
Service Code
|
HCPCS 27720
|
| Min. Negotiated Rate |
$725.07 |
| Max. Negotiated Rate |
$2,330.59 |
| Rate for Payer: Cash Price |
$1,039.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,035.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$932.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$932.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$984.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,035.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$984.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,035.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,035.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$776.87
|
| Rate for Payer: Healthfirst Commercial |
$1,035.82
|
| Rate for Payer: Healthfirst Essential Plan |
$2,330.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$984.03
|
| Rate for Payer: Healthfirst QHP |
$1,035.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$725.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,035.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$880.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$725.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,035.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$776.87
|
| Rate for Payer: SOMOS Essential |
$776.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,035.82
|
|
|
PR REPAIR NONUNION/MALUNION TIBIA W/SLIDING GRAFT
|
Professional
|
Both
|
$3,957.17
|
|
|
Service Code
|
HCPCS 27722
|
| Min. Negotiated Rate |
$746.67 |
| Max. Negotiated Rate |
$2,400.01 |
| Rate for Payer: Cash Price |
$1,071.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,066.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$960.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$960.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,013.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,066.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,013.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,066.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,066.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$800.00
|
| Rate for Payer: Healthfirst Commercial |
$1,066.67
|
| Rate for Payer: Healthfirst Essential Plan |
$2,400.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,013.34
|
| Rate for Payer: Healthfirst QHP |
$1,066.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$746.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,066.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$906.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$746.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,066.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$800.00
|
| Rate for Payer: SOMOS Essential |
$800.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,066.67
|
|
|
PR REPAIR OF TRAUMATIC CORPOREAL TEAR(S)
|
Professional
|
Both
|
$2,846.03
|
|
|
Service Code
|
HCPCS 54437
|
| Min. Negotiated Rate |
$544.50 |
| Max. Negotiated Rate |
$1,750.18 |
| Rate for Payer: Cash Price |
$781.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$777.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$700.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$700.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$738.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$777.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$738.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$777.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$777.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$583.39
|
| Rate for Payer: Healthfirst Commercial |
$777.86
|
| Rate for Payer: Healthfirst Essential Plan |
$1,750.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$738.97
|
| Rate for Payer: Healthfirst QHP |
$777.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$544.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$777.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$661.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$544.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$777.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$583.39
|
| Rate for Payer: SOMOS Essential |
$583.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$777.86
|
|
|
PR REPAIR OVAL WINDOW FISTULA
|
Professional
|
Both
|
$3,509.35
|
|
|
Service Code
|
HCPCS 69666
|
| Min. Negotiated Rate |
$650.87 |
| Max. Negotiated Rate |
$2,092.09 |
| Rate for Payer: Cash Price |
$949.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$929.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$836.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$836.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$883.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$929.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$883.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$929.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$929.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$697.37
|
| Rate for Payer: Healthfirst Commercial |
$929.82
|
| Rate for Payer: Healthfirst Essential Plan |
$2,092.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$883.33
|
| Rate for Payer: Healthfirst QHP |
$929.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$650.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$929.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$790.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$650.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$929.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$697.37
|
| Rate for Payer: SOMOS Essential |
$697.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$929.82
|
|
|
PR REPAIR PATENT DUCTUS ARTERIOSUS LIGATION
|
Professional
|
Both
|
$4,310.15
|
|
|
Service Code
|
HCPCS 33820
|
| Min. Negotiated Rate |
$797.08 |
| Max. Negotiated Rate |
$2,562.05 |
| Rate for Payer: Cash Price |
$1,148.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,138.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,024.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,024.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,081.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,138.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,081.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,138.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,138.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$854.02
|
| Rate for Payer: Healthfirst Commercial |
$1,138.69
|
| Rate for Payer: Healthfirst Essential Plan |
$2,562.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,081.76
|
| Rate for Payer: Healthfirst QHP |
$1,138.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$797.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,138.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$967.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$797.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,138.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$854.02
|
| Rate for Payer: SOMOS Essential |
$854.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,138.69
|
|
|
PR REPAIR PECTUS EXCAVATUM/CARINATUM OPEN
|
Professional
|
Both
|
$4,591.51
|
|
|
Service Code
|
HCPCS 21740
|
| Min. Negotiated Rate |
$850.65 |
| Max. Negotiated Rate |
$2,734.22 |
| Rate for Payer: Cash Price |
$1,225.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,215.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,093.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,093.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,154.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,215.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,154.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,215.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,215.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$911.41
|
| Rate for Payer: Healthfirst Commercial |
$1,215.21
|
| Rate for Payer: Healthfirst Essential Plan |
$2,734.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,154.45
|
| Rate for Payer: Healthfirst QHP |
$1,215.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$850.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,215.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,032.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$850.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,215.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$911.41
|
| Rate for Payer: SOMOS Essential |
$911.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,215.21
|
|
|
PR REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON
|
Professional
|
Both
|
$2,852.05
|
|
|
Service Code
|
HCPCS 27650
|
| Min. Negotiated Rate |
$542.48 |
| Max. Negotiated Rate |
$1,743.68 |
| Rate for Payer: Cash Price |
$776.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$774.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$697.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$697.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$736.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$774.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$736.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$774.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$774.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$581.23
|
| Rate for Payer: Healthfirst Commercial |
$774.97
|
| Rate for Payer: Healthfirst Essential Plan |
$1,743.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$736.22
|
| Rate for Payer: Healthfirst QHP |
$774.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$542.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$774.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$658.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$542.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$774.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$581.23
|
| Rate for Payer: SOMOS Essential |
$581.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$774.97
|
|
|
PR REPAIR PRIMARY TORN LIGM&/CAPSULE KNEE CRUCIAT
|
Professional
|
Both
|
$3,531.19
|
|
|
Service Code
|
HCPCS 27407
|
| Min. Negotiated Rate |
$667.34 |
| Max. Negotiated Rate |
$2,145.01 |
| Rate for Payer: Cash Price |
$956.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$953.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$858.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$858.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$905.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$953.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$905.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$953.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$953.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$715.00
|
| Rate for Payer: Healthfirst Commercial |
$953.34
|
| Rate for Payer: Healthfirst Essential Plan |
$2,145.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$905.67
|
| Rate for Payer: Healthfirst QHP |
$953.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$667.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$953.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$810.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$667.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$953.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$715.00
|
| Rate for Payer: SOMOS Essential |
$715.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$953.34
|
|
|
PR REPAIR PULMONARY VENOUS STENOSIS
|
Professional
|
Both
|
$9,030.49
|
|
|
Service Code
|
HCPCS 33726
|
| Min. Negotiated Rate |
$1,660.64 |
| Max. Negotiated Rate |
$5,337.77 |
| Rate for Payer: Cash Price |
$2,398.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,372.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,135.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,135.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,253.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,372.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,253.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,372.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,372.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,779.26
|
| Rate for Payer: Healthfirst Commercial |
$2,372.34
|
| Rate for Payer: Healthfirst Essential Plan |
$5,337.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,253.72
|
| Rate for Payer: Healthfirst QHP |
$2,372.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,660.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,372.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,016.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,660.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,372.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,779.26
|
| Rate for Payer: SOMOS Essential |
$1,779.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,372.34
|
|
|
PR REPAIR RECTOCELE SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,990.72
|
|
|
Service Code
|
HCPCS 45560
|
| Min. Negotiated Rate |
$560.99 |
| Max. Negotiated Rate |
$1,803.17 |
| Rate for Payer: Cash Price |
$808.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$801.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$721.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$721.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$761.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$801.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$761.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$801.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$801.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$601.06
|
| Rate for Payer: Healthfirst Commercial |
$801.41
|
| Rate for Payer: Healthfirst Essential Plan |
$1,803.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$761.34
|
| Rate for Payer: Healthfirst QHP |
$801.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$560.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$801.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$681.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$560.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$801.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$601.06
|
| Rate for Payer: SOMOS Essential |
$601.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$801.41
|
|
|
PR REPAIR RETINAL DETACHMENT SCLERAL BUCKLING
|
Professional
|
Both
|
$4,596.20
|
|
|
Service Code
|
HCPCS 67107
|
| Min. Negotiated Rate |
$874.27 |
| Max. Negotiated Rate |
$2,810.16 |
| Rate for Payer: Cash Price |
$1,264.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,248.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,124.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,124.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,186.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,248.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,186.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,248.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,248.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$936.72
|
| Rate for Payer: Healthfirst Commercial |
$1,248.96
|
| Rate for Payer: Healthfirst Essential Plan |
$2,810.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,186.51
|
| Rate for Payer: Healthfirst QHP |
$1,248.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$874.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,248.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,061.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$874.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,248.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$936.72
|
| Rate for Payer: SOMOS Essential |
$936.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,248.96
|
|
|
PR REPAIR ROUND WINDOW FISTULA
|
Professional
|
Both
|
$3,510.57
|
|
|
Service Code
|
HCPCS 69667
|
| Min. Negotiated Rate |
$651.11 |
| Max. Negotiated Rate |
$2,092.86 |
| Rate for Payer: Cash Price |
$953.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$930.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$837.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$837.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$883.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$930.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$883.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$930.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$930.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$697.62
|
| Rate for Payer: Healthfirst Commercial |
$930.16
|
| Rate for Payer: Healthfirst Essential Plan |
$2,092.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$883.65
|
| Rate for Payer: Healthfirst QHP |
$930.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$651.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$930.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$790.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$651.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$930.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$697.62
|
| Rate for Payer: SOMOS Essential |
$697.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$930.16
|
|
|
PR REPAIR SCLERAL STAPHYLOMA W/GRAFT
|
Professional
|
Both
|
$3,845.56
|
|
|
Service Code
|
HCPCS 66225
|
| Min. Negotiated Rate |
$730.51 |
| Max. Negotiated Rate |
$2,348.08 |
| Rate for Payer: Cash Price |
$1,059.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,043.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$939.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$939.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$991.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,043.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$991.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,043.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,043.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$782.69
|
| Rate for Payer: Healthfirst Commercial |
$1,043.59
|
| Rate for Payer: Healthfirst Essential Plan |
$2,348.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$991.41
|
| Rate for Payer: Healthfirst QHP |
$1,043.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$730.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,043.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$887.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$730.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,043.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$782.69
|
| Rate for Payer: SOMOS Essential |
$782.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,043.59
|
|
|
PR REPAIR SECONDARY ACHILLES TENDON W/WO GRAFT
|
Professional
|
Both
|
$3,087.18
|
|
|
Service Code
|
HCPCS 27654
|
| Min. Negotiated Rate |
$588.79 |
| Max. Negotiated Rate |
$1,892.54 |
| Rate for Payer: Cash Price |
$842.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$841.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$757.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$757.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$799.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$841.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$799.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$841.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$841.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$630.85
|
| Rate for Payer: Healthfirst Commercial |
$841.13
|
| Rate for Payer: Healthfirst Essential Plan |
$1,892.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$799.07
|
| Rate for Payer: Healthfirst QHP |
$841.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$588.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$841.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$714.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$588.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$841.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$630.85
|
| Rate for Payer: SOMOS Essential |
$630.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$841.13
|
|
|
PR REPAIR SECONDARY DISRUPTED LIGAMENT ANKLE COLTRL
|
Professional
|
Both
|
$2,777.15
|
|
|
Service Code
|
HCPCS 27698
|
| Min. Negotiated Rate |
$523.58 |
| Max. Negotiated Rate |
$1,682.93 |
| Rate for Payer: Cash Price |
$750.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$747.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$673.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$673.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$710.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$747.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$710.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$747.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$747.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$560.98
|
| Rate for Payer: Healthfirst Commercial |
$747.97
|
| Rate for Payer: Healthfirst Essential Plan |
$1,682.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$710.57
|
| Rate for Payer: Healthfirst QHP |
$747.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$523.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$747.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$635.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$523.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$747.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$560.98
|
| Rate for Payer: SOMOS Essential |
$560.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$747.97
|
|
|
PR REPAIR SPICA BODY CAST/JACKET
|
Professional
|
Both
|
$192.47
|
|
|
Service Code
|
HCPCS 29720
|
| Min. Negotiated Rate |
$36.48 |
| Max. Negotiated Rate |
$117.25 |
| Rate for Payer: Cash Price |
$51.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.08
|
| Rate for Payer: Healthfirst Commercial |
$52.11
|
| Rate for Payer: Healthfirst Essential Plan |
$117.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.50
|
| Rate for Payer: Healthfirst QHP |
$52.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.08
|
| Rate for Payer: SOMOS Essential |
$39.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.11
|
|
|
PR REPAIR SYNDACTYLY EACH SPACE COMPLEX
|
Professional
|
Both
|
$6,103.41
|
|
|
Service Code
|
HCPCS 26562
|
| Min. Negotiated Rate |
$1,138.73 |
| Max. Negotiated Rate |
$3,660.21 |
| Rate for Payer: Cash Price |
$1,644.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,626.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,464.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,464.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,545.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,626.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,545.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,626.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,626.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,220.07
|
| Rate for Payer: Healthfirst Commercial |
$1,626.76
|
| Rate for Payer: Healthfirst Essential Plan |
$3,660.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,545.42
|
| Rate for Payer: Healthfirst QHP |
$1,626.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,138.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,626.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,382.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,138.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,626.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,220.07
|
| Rate for Payer: SOMOS Essential |
$1,220.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,626.76
|
|
|
PR REPAIR SYNDACTYLY EACH SPACE W/SKIN FLAPS
|
Professional
|
Both
|
$2,833.50
|
|
|
Service Code
|
HCPCS 26560
|
| Min. Negotiated Rate |
$525.22 |
| Max. Negotiated Rate |
$1,688.22 |
| Rate for Payer: Cash Price |
$764.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$750.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$675.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$675.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$712.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$750.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$712.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$750.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$750.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$562.74
|
| Rate for Payer: Healthfirst Commercial |
$750.32
|
| Rate for Payer: Healthfirst Essential Plan |
$1,688.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$712.80
|
| Rate for Payer: Healthfirst QHP |
$750.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$525.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$750.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$637.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$525.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$750.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$562.74
|
| Rate for Payer: SOMOS Essential |
$562.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$750.32
|
|
|
PR REPAIR SYNDACTYLY EACH SPACE W/SKIN FLAPS&GRAFT
|
Professional
|
Both
|
$4,373.46
|
|
|
Service Code
|
HCPCS 26561
|
| Min. Negotiated Rate |
$811.22 |
| Max. Negotiated Rate |
$2,607.50 |
| Rate for Payer: Cash Price |
$1,175.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,158.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,043.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,043.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,100.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,158.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,100.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,158.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,158.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$869.17
|
| Rate for Payer: Healthfirst Commercial |
$1,158.89
|
| Rate for Payer: Healthfirst Essential Plan |
$2,607.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,100.95
|
| Rate for Payer: Healthfirst QHP |
$1,158.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$811.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,158.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$985.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$811.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,158.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$869.17
|
| Rate for Payer: SOMOS Essential |
$869.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,158.89
|
|
|
PR REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON
|
Professional
|
Both
|
$1,373.72
|
|
|
Service Code
|
HCPCS 28208
|
| Min. Negotiated Rate |
$261.18 |
| Max. Negotiated Rate |
$839.52 |
| Rate for Payer: Cash Price |
$375.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$373.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$335.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$335.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$354.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$373.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$354.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$373.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$373.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$279.84
|
| Rate for Payer: Healthfirst Commercial |
$373.12
|
| Rate for Payer: Healthfirst Essential Plan |
$839.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$354.46
|
| Rate for Payer: Healthfirst QHP |
$373.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$261.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$373.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$317.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$261.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$373.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$279.84
|
| Rate for Payer: SOMOS Essential |
$279.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$373.12
|
|
|
PR REPAIR TENDON/MUSCLE UPPER ARM/ELBOW EA
|
Professional
|
Both
|
$3,303.90
|
|
|
Service Code
|
HCPCS 24341
|
| Min. Negotiated Rate |
$627.66 |
| Max. Negotiated Rate |
$2,017.48 |
| Rate for Payer: Cash Price |
$900.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$896.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$806.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$806.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$851.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$896.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$851.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$896.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$896.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$672.50
|
| Rate for Payer: Healthfirst Commercial |
$896.66
|
| Rate for Payer: Healthfirst Essential Plan |
$2,017.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$851.83
|
| Rate for Payer: Healthfirst QHP |
$896.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$627.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$896.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$762.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$627.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$896.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$672.50
|
| Rate for Payer: SOMOS Essential |
$672.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$896.66
|
|
