|
PR RPR LAC CJNC MOBLJ & REARGMT W/HOSPIZATION
|
Professional
|
Both
|
$1,563.59
|
|
|
Service Code
|
HCPCS 65273
|
| Min. Negotiated Rate |
$296.07 |
| Max. Negotiated Rate |
$951.66 |
| Rate for Payer: Cash Price |
$429.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$422.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$380.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$380.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$401.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$422.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$401.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$422.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$422.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$317.22
|
| Rate for Payer: Healthfirst Commercial |
$422.96
|
| Rate for Payer: Healthfirst Essential Plan |
$951.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$401.81
|
| Rate for Payer: Healthfirst QHP |
$422.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$296.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$422.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$359.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$296.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$422.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$317.22
|
| Rate for Payer: SOMOS Essential |
$317.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$422.96
|
|
|
PR RPR LAC CJNC MOBLJ& REARGMT W/O HOSPITALIZATION
|
Professional
|
Both
|
$1,453.52
|
|
|
Service Code
|
HCPCS 65272
|
| Min. Negotiated Rate |
$276.48 |
| Max. Negotiated Rate |
$888.68 |
| Rate for Payer: Cash Price |
$400.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$394.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$355.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$355.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$375.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$394.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$375.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$394.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$394.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$296.23
|
| Rate for Payer: Healthfirst Commercial |
$394.97
|
| Rate for Payer: Healthfirst Essential Plan |
$888.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$375.22
|
| Rate for Payer: Healthfirst QHP |
$394.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$276.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$394.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$335.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$276.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$394.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$296.23
|
| Rate for Payer: SOMOS Essential |
$296.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$394.97
|
|
|
PR RPR LAC CJNC W/WO NONPERFOR LAC SCLERA DIR CLSR
|
Professional
|
Both
|
$585.45
|
|
|
Service Code
|
HCPCS 65270
|
| Min. Negotiated Rate |
$109.92 |
| Max. Negotiated Rate |
$353.32 |
| Rate for Payer: Cash Price |
$158.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$141.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$149.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$149.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$117.77
|
| Rate for Payer: Healthfirst Commercial |
$157.03
|
| Rate for Payer: Healthfirst Essential Plan |
$353.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$149.18
|
| Rate for Payer: Healthfirst QHP |
$157.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$109.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$157.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$133.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$109.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$117.77
|
| Rate for Payer: SOMOS Essential |
$117.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.03
|
|
|
PR RPR LAC CORNEA NONPERFOR W/WO RMVL FOREIGN BODY
|
Professional
|
Both
|
$1,896.51
|
|
|
Service Code
|
HCPCS 65275
|
| Min. Negotiated Rate |
$359.98 |
| Max. Negotiated Rate |
$1,157.09 |
| Rate for Payer: Cash Price |
$520.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$514.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$462.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$462.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$488.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$514.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$488.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$514.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$514.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$385.69
|
| Rate for Payer: Healthfirst Commercial |
$514.26
|
| Rate for Payer: Healthfirst Essential Plan |
$1,157.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$488.55
|
| Rate for Payer: Healthfirst QHP |
$514.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$359.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$514.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$437.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$359.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$514.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$385.69
|
| Rate for Payer: SOMOS Essential |
$385.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$514.26
|
|
|
PR RPR LAC CORNEA&/SCLERA PERFOR X INVG UVEAL TIS
|
Professional
|
Both
|
$2,760.03
|
|
|
Service Code
|
HCPCS 65280
|
| Min. Negotiated Rate |
$521.87 |
| Max. Negotiated Rate |
$1,677.44 |
| Rate for Payer: Cash Price |
$758.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$745.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$670.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$670.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$708.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$745.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$708.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$745.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$745.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$559.15
|
| Rate for Payer: Healthfirst Commercial |
$745.53
|
| Rate for Payer: Healthfirst Essential Plan |
$1,677.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$708.25
|
| Rate for Payer: Healthfirst QHP |
$745.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$521.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$745.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$633.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$521.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$745.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$559.15
|
| Rate for Payer: SOMOS Essential |
$559.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$745.53
|
|
|
PR RPR LAC CORN&/SCLRA PERF W/REPOS/RESCJ UVEAL T
|
Professional
|
Both
|
$4,540.76
|
|
|
Service Code
|
HCPCS 65285
|
| Min. Negotiated Rate |
$860.48 |
| Max. Negotiated Rate |
$2,765.81 |
| Rate for Payer: Cash Price |
$1,248.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,229.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,106.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,106.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,167.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,229.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,167.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,229.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,229.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$921.94
|
| Rate for Payer: Healthfirst Commercial |
$1,229.25
|
| Rate for Payer: Healthfirst Essential Plan |
$2,765.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,167.79
|
| Rate for Payer: Healthfirst QHP |
$1,229.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$860.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,229.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,044.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$860.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,229.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$921.94
|
| Rate for Payer: SOMOS Essential |
$921.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,229.25
|
|
|
PR RPR LAC TONGUE FLOOR MOUTH > 2.6 CM/CPLX
|
Professional
|
Both
|
$910.49
|
|
|
Service Code
|
HCPCS 41252
|
| Min. Negotiated Rate |
$170.97 |
| Max. Negotiated Rate |
$549.56 |
| Rate for Payer: Cash Price |
$245.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$244.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$219.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$219.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$232.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$244.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$232.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$244.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$244.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$183.19
|
| Rate for Payer: Healthfirst Commercial |
$244.25
|
| Rate for Payer: Healthfirst Essential Plan |
$549.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$232.04
|
| Rate for Payer: Healthfirst QHP |
$244.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$170.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$244.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$207.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$170.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$244.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$183.19
|
| Rate for Payer: SOMOS Essential |
$183.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$244.25
|
|
|
PR RPR LG OMPHALOCELE/GASTROSCHISIS RMVL PROSTH
|
Professional
|
Both
|
$5,146.96
|
|
|
Service Code
|
HCPCS 49606
|
| Min. Negotiated Rate |
$952.51 |
| Max. Negotiated Rate |
$3,061.64 |
| Rate for Payer: Cash Price |
$1,369.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,360.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,224.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,224.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,292.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,360.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,292.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,360.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,360.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,020.55
|
| Rate for Payer: Healthfirst Commercial |
$1,360.73
|
| Rate for Payer: Healthfirst Essential Plan |
$3,061.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,292.69
|
| Rate for Payer: Healthfirst QHP |
$1,360.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$952.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,360.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,156.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$952.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,360.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,020.55
|
| Rate for Payer: SOMOS Essential |
$1,020.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,360.73
|
|
|
PR RPR LG OMPHALOCELE/GASTROSCHISIS W/WO PROSTH
|
Professional
|
Both
|
$22,242.40
|
|
|
Service Code
|
HCPCS 49605
|
| Min. Negotiated Rate |
$4,093.86 |
| Max. Negotiated Rate |
$13,158.83 |
| Rate for Payer: Cash Price |
$5,900.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,848.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5,263.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,263.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,555.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,848.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,555.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,848.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,848.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4,386.28
|
| Rate for Payer: Healthfirst Commercial |
$5,848.37
|
| Rate for Payer: Healthfirst Essential Plan |
$13,158.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,555.95
|
| Rate for Payer: Healthfirst QHP |
$5,848.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$4,093.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5,848.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4,971.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$4,093.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,848.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,386.28
|
| Rate for Payer: SOMOS Essential |
$4,386.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,848.37
|
|
|
PR RPR LIP FTH OVER ONE-HALF VERT HEIGHT/COMPLEX
|
Professional
|
Both
|
$1,842.23
|
|
|
Service Code
|
HCPCS 40654
|
| Min. Negotiated Rate |
$350.97 |
| Max. Negotiated Rate |
$1,128.13 |
| Rate for Payer: Cash Price |
$503.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$501.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$451.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$451.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$476.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$501.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$476.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$501.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$501.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$376.04
|
| Rate for Payer: Healthfirst Commercial |
$501.39
|
| Rate for Payer: Healthfirst Essential Plan |
$1,128.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$476.32
|
| Rate for Payer: Healthfirst QHP |
$501.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$350.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$501.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$426.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$350.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$501.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$376.04
|
| Rate for Payer: SOMOS Essential |
$376.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$501.39
|
|
|
PR RPR LW IMPERFORATE ANUS W/ANOPRNL FSTL CUT-BK
|
Professional
|
Both
|
$2,510.41
|
|
|
Service Code
|
HCPCS 46715
|
| Min. Negotiated Rate |
$468.65 |
| Max. Negotiated Rate |
$1,506.38 |
| Rate for Payer: Cash Price |
$671.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$669.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$602.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$602.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$636.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$669.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$636.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$669.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$669.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$502.12
|
| Rate for Payer: Healthfirst Commercial |
$669.50
|
| Rate for Payer: Healthfirst Essential Plan |
$1,506.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$636.02
|
| Rate for Payer: Healthfirst QHP |
$669.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$468.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$669.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$569.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$468.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$669.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$502.12
|
| Rate for Payer: SOMOS Essential |
$502.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$669.50
|
|
|
PR RPR LW IMPERFORATE ANUS W/TRPOS FISTULA
|
Professional
|
Both
|
$5,562.90
|
|
|
Service Code
|
HCPCS 46716
|
| Min. Negotiated Rate |
$1,040.68 |
| Max. Negotiated Rate |
$3,345.05 |
| Rate for Payer: Cash Price |
$1,491.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,486.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,338.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,338.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,412.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,486.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,412.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,486.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,486.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,115.02
|
| Rate for Payer: Healthfirst Commercial |
$1,486.69
|
| Rate for Payer: Healthfirst Essential Plan |
$3,345.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,412.36
|
| Rate for Payer: Healthfirst QHP |
$1,486.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,040.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,486.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,263.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,040.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,486.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,115.02
|
| Rate for Payer: SOMOS Essential |
$1,115.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,486.69
|
|
|
PR RPR NEONATAL DIPHRG HERNIA W/WO CHEST TUBE INSJ
|
Professional
|
Both
|
$25,911.10
|
|
|
Service Code
|
HCPCS 39503
|
| Min. Negotiated Rate |
$4,749.66 |
| Max. Negotiated Rate |
$15,266.77 |
| Rate for Payer: Cash Price |
$6,865.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,785.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6,106.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6,106.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,445.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,785.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,445.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,785.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,785.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5,088.92
|
| Rate for Payer: Healthfirst Commercial |
$6,785.23
|
| Rate for Payer: Healthfirst Essential Plan |
$15,266.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6,445.97
|
| Rate for Payer: Healthfirst QHP |
$6,785.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$4,749.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$6,785.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$5,767.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$4,749.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,785.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5,088.92
|
| Rate for Payer: SOMOS Essential |
$5,088.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,785.23
|
|
|
PR RPR NFLTBL URETHRAL/BLADDER NECK SPHINCTER
|
Professional
|
Both
|
$2,581.36
|
|
|
Service Code
|
HCPCS 53449
|
| Min. Negotiated Rate |
$490.99 |
| Max. Negotiated Rate |
$1,578.19 |
| Rate for Payer: Cash Price |
$704.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$701.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$631.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$631.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$666.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$701.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$666.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$701.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$701.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$526.07
|
| Rate for Payer: Healthfirst Commercial |
$701.42
|
| Rate for Payer: Healthfirst Essential Plan |
$1,578.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$666.35
|
| Rate for Payer: Healthfirst QHP |
$701.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$490.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$701.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$596.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$490.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$701.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$526.07
|
| Rate for Payer: SOMOS Essential |
$526.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$701.42
|
|
|
PR RPR NON/MAL FEMUR DSTL H/N W/ILIAC/AUTOG BONE
|
Professional
|
Both
|
$5,584.46
|
|
|
Service Code
|
HCPCS 27472
|
| Min. Negotiated Rate |
$1,048.03 |
| Max. Negotiated Rate |
$3,368.66 |
| Rate for Payer: Cash Price |
$1,505.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,497.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,347.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,347.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,422.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,497.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,422.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,497.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,497.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,122.88
|
| Rate for Payer: Healthfirst Commercial |
$1,497.18
|
| Rate for Payer: Healthfirst Essential Plan |
$3,368.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,422.32
|
| Rate for Payer: Healthfirst QHP |
$1,497.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,048.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,497.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,272.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,048.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,497.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,122.88
|
| Rate for Payer: SOMOS Essential |
$1,122.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,497.18
|
|
|
PR RPR NON/MAL FEMUR DSTL H/N W/O GRF
|
Professional
|
Both
|
$5,215.49
|
|
|
Service Code
|
HCPCS 27470
|
| Min. Negotiated Rate |
$978.96 |
| Max. Negotiated Rate |
$3,146.67 |
| Rate for Payer: Cash Price |
$1,407.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,398.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,258.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,258.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,328.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,398.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,328.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,398.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,398.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,048.89
|
| Rate for Payer: Healthfirst Commercial |
$1,398.52
|
| Rate for Payer: Healthfirst Essential Plan |
$3,146.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,328.59
|
| Rate for Payer: Healthfirst QHP |
$1,398.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$978.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,398.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,188.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$978.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,398.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,048.89
|
| Rate for Payer: SOMOS Essential |
$1,048.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,398.52
|
|
|
PR RPR NON/MAL TIBIA SYNOSTOSIS W/FIBULA ANY METH
|
Professional
|
Both
|
$5,366.48
|
|
|
Service Code
|
HCPCS 27725
|
| Min. Negotiated Rate |
$1,010.46 |
| Max. Negotiated Rate |
$3,247.90 |
| Rate for Payer: Cash Price |
$1,450.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,443.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,299.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,299.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,371.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,443.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,371.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,443.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,443.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,082.63
|
| Rate for Payer: Healthfirst Commercial |
$1,443.51
|
| Rate for Payer: Healthfirst Essential Plan |
$3,247.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,371.33
|
| Rate for Payer: Healthfirst QHP |
$1,443.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,010.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,443.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,226.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,010.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,443.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,082.63
|
| Rate for Payer: SOMOS Essential |
$1,082.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,443.51
|
|
|
PR RPR NON/MAL TIBIA W/ILIAC/OTH AGRFT
|
Professional
|
Both
|
$5,541.69
|
|
|
Service Code
|
HCPCS 27724
|
| Min. Negotiated Rate |
$1,036.10 |
| Max. Negotiated Rate |
$3,330.32 |
| Rate for Payer: Cash Price |
$1,489.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,480.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,332.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,332.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,406.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,480.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,406.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,480.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,480.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,110.11
|
| Rate for Payer: Healthfirst Commercial |
$1,480.14
|
| Rate for Payer: Healthfirst Essential Plan |
$3,330.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,406.13
|
| Rate for Payer: Healthfirst QHP |
$1,480.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,036.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,480.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,258.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,036.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,480.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,110.11
|
| Rate for Payer: SOMOS Essential |
$1,110.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,480.14
|
|
|
PR RPR NON/MALUNION METARSAL W/WO BONE GRAFT
|
Professional
|
Both
|
$2,501.03
|
|
|
Service Code
|
HCPCS 28322
|
| Min. Negotiated Rate |
$473.28 |
| Max. Negotiated Rate |
$1,521.27 |
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$676.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$608.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$608.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$642.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$676.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$642.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$676.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$676.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$507.09
|
| Rate for Payer: Healthfirst Commercial |
$676.12
|
| Rate for Payer: Healthfirst Essential Plan |
$1,521.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$642.31
|
| Rate for Payer: Healthfirst QHP |
$676.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$473.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$676.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$574.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$473.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$676.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$507.09
|
| Rate for Payer: SOMOS Essential |
$507.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$676.12
|
|
|
PR RPR NON-STRUCT PROSTC VALVE DYSFUNCTION W/BYPASS
|
Professional
|
Both
|
$7,331.45
|
|
|
Service Code
|
HCPCS 33496
|
| Min. Negotiated Rate |
$1,353.49 |
| Max. Negotiated Rate |
$4,350.51 |
| Rate for Payer: Cash Price |
$1,948.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,933.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,740.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,740.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,836.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,933.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,836.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,933.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,933.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,450.17
|
| Rate for Payer: Healthfirst Commercial |
$1,933.56
|
| Rate for Payer: Healthfirst Essential Plan |
$4,350.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,836.88
|
| Rate for Payer: Healthfirst QHP |
$1,933.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,353.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,933.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,643.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,353.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,933.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,450.17
|
| Rate for Payer: SOMOS Essential |
$1,450.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,933.56
|
|
|
PR RPR NONUNION/MALUNION RADIUS&ULNA W/AUTOGRAFT
|
Professional
|
Both
|
$5,150.18
|
|
|
Service Code
|
HCPCS 25420
|
| Min. Negotiated Rate |
$968.24 |
| Max. Negotiated Rate |
$3,112.20 |
| Rate for Payer: Cash Price |
$1,390.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,383.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,244.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,244.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,314.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,383.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,314.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,383.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,383.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,037.40
|
| Rate for Payer: Healthfirst Commercial |
$1,383.20
|
| Rate for Payer: Healthfirst Essential Plan |
$3,112.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,314.04
|
| Rate for Payer: Healthfirst QHP |
$1,383.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$968.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,383.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,175.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$968.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,383.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,037.40
|
| Rate for Payer: SOMOS Essential |
$1,037.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,383.20
|
|
|
PR RPR NONUNION/MALUNION RADIUS/ULNA W/AUTOGRAFT
|
Professional
|
Both
|
$4,563.30
|
|
|
Service Code
|
HCPCS 25405
|
| Min. Negotiated Rate |
$860.83 |
| Max. Negotiated Rate |
$2,766.96 |
| Rate for Payer: Cash Price |
$1,232.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,229.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,106.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,106.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,168.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,229.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,168.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,229.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,229.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$922.32
|
| Rate for Payer: Healthfirst Commercial |
$1,229.76
|
| Rate for Payer: Healthfirst Essential Plan |
$2,766.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,168.27
|
| Rate for Payer: Healthfirst QHP |
$1,229.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$860.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,229.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,045.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$860.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,229.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$922.32
|
| Rate for Payer: SOMOS Essential |
$922.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,229.76
|
|
|
PR RPR NONUNION/MALUNION RADIUS&ULNA W/O AUTOGRAF
|
Professional
|
Both
|
$4,287.54
|
|
|
Service Code
|
HCPCS 25415
|
| Min. Negotiated Rate |
$805.52 |
| Max. Negotiated Rate |
$2,589.19 |
| Rate for Payer: Cash Price |
$1,156.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,150.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,035.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,035.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,093.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,150.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,093.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,150.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,150.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$863.06
|
| Rate for Payer: Healthfirst Commercial |
$1,150.75
|
| Rate for Payer: Healthfirst Essential Plan |
$2,589.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,093.21
|
| Rate for Payer: Healthfirst QHP |
$1,150.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$805.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,150.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$978.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$805.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,150.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$863.06
|
| Rate for Payer: SOMOS Essential |
$863.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,150.75
|
|
|
PR RPR NONUNION/MALUNION RADIUS/ULNA W/O AUTOGRAFT
|
Professional
|
Both
|
$3,549.25
|
|
|
Service Code
|
HCPCS 25400
|
| Min. Negotiated Rate |
$667.56 |
| Max. Negotiated Rate |
$2,145.74 |
| Rate for Payer: Cash Price |
$957.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$953.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$858.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$858.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$905.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$953.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$905.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$953.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$953.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$715.25
|
| Rate for Payer: Healthfirst Commercial |
$953.66
|
| Rate for Payer: Healthfirst Essential Plan |
$2,145.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$905.98
|
| Rate for Payer: Healthfirst QHP |
$953.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$667.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$953.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$810.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$667.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$953.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$715.25
|
| Rate for Payer: SOMOS Essential |
$715.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$953.66
|
|
|
PR RPR NON-UNION MTCRPL/PHALANX
|
Professional
|
Both
|
$4,587.35
|
|
|
Service Code
|
HCPCS 26546
|
| Min. Negotiated Rate |
$861.88 |
| Max. Negotiated Rate |
$2,770.31 |
| Rate for Payer: Cash Price |
$1,238.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,231.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,108.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,108.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,169.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,231.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,169.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,231.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,231.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$923.44
|
| Rate for Payer: Healthfirst Commercial |
$1,231.25
|
| Rate for Payer: Healthfirst Essential Plan |
$2,770.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,169.69
|
| Rate for Payer: Healthfirst QHP |
$1,231.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$861.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,231.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,046.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$861.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,231.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$923.44
|
| Rate for Payer: SOMOS Essential |
$923.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,231.25
|
|
