|
PR ANT SGM IMAGING W/I&R W/FLUOROSCEIN ANGRPH
|
Professional
|
Both
|
$467.04
|
|
|
Service Code
|
HCPCS 92287 TC
|
| Min. Negotiated Rate |
$88.47 |
| Max. Negotiated Rate |
$284.36 |
| Rate for Payer: Cash Price |
$134.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$126.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$113.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$120.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$126.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$120.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.78
|
| Rate for Payer: Healthfirst Commercial |
$126.38
|
| Rate for Payer: Healthfirst Essential Plan |
$284.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$120.06
|
| Rate for Payer: Healthfirst QHP |
$126.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$88.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$126.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$107.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$88.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$126.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$94.78
|
| Rate for Payer: SOMOS Essential |
$94.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$126.38
|
|
|
PR ANT SGM IMAGING W/I&R W/FLUOROSCEIN ANGRPH
|
Professional
|
Both
|
$147.70
|
|
|
Service Code
|
HCPCS 92287 26
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$57.71 |
| Rate for Payer: Cash Price |
$32.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.24
|
| Rate for Payer: Healthfirst Commercial |
$25.65
|
| Rate for Payer: Healthfirst Essential Plan |
$57.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.37
|
| Rate for Payer: Healthfirst QHP |
$25.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$25.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.24
|
| Rate for Payer: SOMOS Essential |
$19.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.65
|
|
|
PR ANT VESICOURETHROPEXY/URETHROPEXY COMP
|
Professional
|
Both
|
$3,384.26
|
|
|
Service Code
|
HCPCS 51841
|
| Min. Negotiated Rate |
$640.93 |
| Max. Negotiated Rate |
$2,060.12 |
| Rate for Payer: Cash Price |
$924.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$915.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$824.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$824.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$869.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$915.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$869.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$915.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$915.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$686.71
|
| Rate for Payer: Healthfirst Commercial |
$915.61
|
| Rate for Payer: Healthfirst Essential Plan |
$2,060.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$869.83
|
| Rate for Payer: Healthfirst QHP |
$915.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$640.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$915.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$778.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$640.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$915.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$686.71
|
| Rate for Payer: SOMOS Essential |
$686.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$915.61
|
|
|
PR ANT VESICOURETHROPEXY/URETHROPEXY SMPL
|
Professional
|
Both
|
$2,957.36
|
|
|
Service Code
|
HCPCS 51840
|
| Min. Negotiated Rate |
$558.42 |
| Max. Negotiated Rate |
$1,794.94 |
| Rate for Payer: Cash Price |
$805.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$797.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$717.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$717.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$757.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$797.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$757.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$797.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$797.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$598.31
|
| Rate for Payer: Healthfirst Commercial |
$797.75
|
| Rate for Payer: Healthfirst Essential Plan |
$1,794.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$757.86
|
| Rate for Payer: Healthfirst QHP |
$797.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$558.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$797.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$678.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$558.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$797.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$598.31
|
| Rate for Payer: SOMOS Essential |
$598.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$797.75
|
|
|
PR AORTIC HEMIARCH GRAFT W/ISOL & CTRL ARCH VESSELS
|
Professional
|
Both
|
$4,077.43
|
|
|
Service Code
|
HCPCS 33866
|
| Min. Negotiated Rate |
$747.08 |
| Max. Negotiated Rate |
$2,401.31 |
| Rate for Payer: Cash Price |
$1,076.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,067.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$960.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$960.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,013.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,067.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,013.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,067.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,067.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$800.44
|
| Rate for Payer: Healthfirst Commercial |
$1,067.25
|
| Rate for Payer: Healthfirst Essential Plan |
$2,401.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,013.89
|
| Rate for Payer: Healthfirst QHP |
$1,067.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$747.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,067.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$907.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$747.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,067.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$800.44
|
| Rate for Payer: SOMOS Essential |
$800.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,067.25
|
|
|
PR AORTIC SUSPENSION TRACHEAL DECOMPRESSION SPX
|
Professional
|
Both
|
$4,387.99
|
|
|
Service Code
|
HCPCS 33800
|
| Min. Negotiated Rate |
$811.01 |
| Max. Negotiated Rate |
$2,606.80 |
| Rate for Payer: Cash Price |
$1,168.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,158.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,042.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,042.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,100.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,158.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,100.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,158.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,158.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$868.93
|
| Rate for Payer: Healthfirst Commercial |
$1,158.58
|
| Rate for Payer: Healthfirst Essential Plan |
$2,606.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,100.65
|
| Rate for Payer: Healthfirst QHP |
$1,158.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$811.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,158.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$984.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$811.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,158.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$868.93
|
| Rate for Payer: SOMOS Essential |
$868.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,158.58
|
|
|
PR AORTOPLASTY SUPRAVALVULAR STENOSIS
|
Professional
|
Both
|
$7,426.58
|
|
|
Service Code
|
HCPCS 33417
|
| Min. Negotiated Rate |
$1,370.20 |
| Max. Negotiated Rate |
$4,404.22 |
| Rate for Payer: Cash Price |
$1,977.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,957.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,761.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,761.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,859.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,957.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,859.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,957.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,957.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,468.07
|
| Rate for Payer: Healthfirst Commercial |
$1,957.43
|
| Rate for Payer: Healthfirst Essential Plan |
$4,404.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,859.56
|
| Rate for Payer: Healthfirst QHP |
$1,957.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,370.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,957.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,663.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,370.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,957.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,468.07
|
| Rate for Payer: SOMOS Essential |
$1,468.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,957.43
|
|
|
PR APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX
|
Professional
|
Both
|
$372.33
|
|
|
Service Code
|
HCPCS 44955
|
| Min. Negotiated Rate |
$68.45 |
| Max. Negotiated Rate |
$220.03 |
| Rate for Payer: Cash Price |
$98.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$97.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$88.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$88.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$92.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$97.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$92.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.34
|
| Rate for Payer: Healthfirst Commercial |
$97.79
|
| Rate for Payer: Healthfirst Essential Plan |
$220.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$92.90
|
| Rate for Payer: Healthfirst QHP |
$97.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$97.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$83.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$97.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$73.34
|
| Rate for Payer: SOMOS Essential |
$73.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$97.79
|
|
|
PR APPENDEC RPTD APPENDIX ABSC/PRITONITIS
|
Professional
|
Both
|
$3,959.27
|
|
|
Service Code
|
HCPCS 44960
|
| Min. Negotiated Rate |
$733.66 |
| Max. Negotiated Rate |
$2,358.20 |
| Rate for Payer: Cash Price |
$1,055.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$943.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$943.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$995.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$995.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,048.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$786.07
|
| Rate for Payer: Healthfirst Commercial |
$1,048.09
|
| Rate for Payer: Healthfirst Essential Plan |
$2,358.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$995.69
|
| Rate for Payer: Healthfirst QHP |
$1,048.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$733.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,048.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$890.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$733.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$786.07
|
| Rate for Payer: SOMOS Essential |
$786.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.09
|
|
|
PR APPENDECTOMY
|
Professional
|
Both
|
$2,896.50
|
|
|
Service Code
|
HCPCS 44950
|
| Min. Negotiated Rate |
$536.63 |
| Max. Negotiated Rate |
$1,724.89 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$766.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$689.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$689.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$728.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$766.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$728.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$766.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$766.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$574.97
|
| Rate for Payer: Healthfirst Commercial |
$766.62
|
| Rate for Payer: Healthfirst Essential Plan |
$1,724.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$728.29
|
| Rate for Payer: Healthfirst QHP |
$766.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$536.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$766.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$651.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$536.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$766.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$574.97
|
| Rate for Payer: SOMOS Essential |
$574.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$766.62
|
|
|
PR APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG
|
Professional
|
Both
|
$475.55
|
|
|
Service Code
|
HCPCS 29450
|
| Min. Negotiated Rate |
$88.32 |
| Max. Negotiated Rate |
$283.88 |
| Rate for Payer: Cash Price |
$128.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$126.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$113.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$119.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$126.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$119.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.63
|
| Rate for Payer: Healthfirst Commercial |
$126.17
|
| Rate for Payer: Healthfirst Essential Plan |
$283.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$119.86
|
| Rate for Payer: Healthfirst QHP |
$126.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$88.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$126.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$107.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$88.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$126.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$94.63
|
| Rate for Payer: SOMOS Essential |
$94.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$126.17
|
|
|
PR APPL CRANIAL TONG/STRTCTC FRAME W/REMOVAL SPX
|
Professional
|
Both
|
$1,131.41
|
|
|
Service Code
|
HCPCS 20660
|
| Min. Negotiated Rate |
$206.23 |
| Max. Negotiated Rate |
$662.89 |
| Rate for Payer: Cash Price |
$295.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$294.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$265.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$265.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$279.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$294.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$279.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$294.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$294.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$220.97
|
| Rate for Payer: Healthfirst Commercial |
$294.62
|
| Rate for Payer: Healthfirst Essential Plan |
$662.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$279.89
|
| Rate for Payer: Healthfirst QHP |
$294.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$206.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$294.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$250.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$206.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$294.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$220.97
|
| Rate for Payer: SOMOS Essential |
$220.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$294.62
|
|
|
PR APPL HALO APPLIANCE MAXILLOFACIAL FIXATION SPX
|
Professional
|
Both
|
$1,490.51
|
|
|
Service Code
|
HCPCS 21100
|
| Min. Negotiated Rate |
$291.88 |
| Max. Negotiated Rate |
$938.18 |
| Rate for Payer: Cash Price |
$410.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$416.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$375.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$375.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$396.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$416.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$396.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$416.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$416.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$312.73
|
| Rate for Payer: Healthfirst Commercial |
$416.97
|
| Rate for Payer: Healthfirst Essential Plan |
$938.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$396.12
|
| Rate for Payer: Healthfirst QHP |
$416.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$291.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$416.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$354.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$291.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$416.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$312.73
|
| Rate for Payer: SOMOS Essential |
$312.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$416.97
|
|
|
PR APPL HALO CRANIAL 6/> PINS THIN SKULL OSTEOLOGY
|
Professional
|
Both
|
$4,200.70
|
|
|
Service Code
|
HCPCS 20664
|
| Min. Negotiated Rate |
$781.75 |
| Max. Negotiated Rate |
$2,512.76 |
| Rate for Payer: Cash Price |
$1,122.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,116.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,005.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,005.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,060.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,116.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,060.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,116.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,116.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$837.59
|
| Rate for Payer: Healthfirst Commercial |
$1,116.78
|
| Rate for Payer: Healthfirst Essential Plan |
$2,512.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,060.94
|
| Rate for Payer: Healthfirst QHP |
$1,116.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$781.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,116.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$949.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$781.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,116.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$837.59
|
| Rate for Payer: SOMOS Essential |
$837.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,116.78
|
|
|
PR APPL HIP SPICA CAST ONE&ONE-HALF SPICA/BOTH LEGS
|
Professional
|
Both
|
$775.81
|
|
|
Service Code
|
HCPCS 29325
|
| Min. Negotiated Rate |
$148.88 |
| Max. Negotiated Rate |
$478.53 |
| Rate for Payer: Cash Price |
$210.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$212.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$191.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$191.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$202.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$212.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$202.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$212.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$159.51
|
| Rate for Payer: Healthfirst Commercial |
$212.68
|
| Rate for Payer: Healthfirst Essential Plan |
$478.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$202.05
|
| Rate for Payer: Healthfirst QHP |
$212.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$148.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$212.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$180.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$148.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$212.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$159.51
|
| Rate for Payer: SOMOS Essential |
$159.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$212.68
|
|
|
PR APPLICATION BODY CAST SHOULDER HIPS
|
Professional
|
Both
|
$629.27
|
|
|
Service Code
|
HCPCS 29035
|
| Min. Negotiated Rate |
$120.81 |
| Max. Negotiated Rate |
$388.31 |
| Rate for Payer: Cash Price |
$171.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$172.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$155.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$155.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$163.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$172.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$163.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$172.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$172.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$129.44
|
| Rate for Payer: Healthfirst Commercial |
$172.58
|
| Rate for Payer: Healthfirst Essential Plan |
$388.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$163.95
|
| Rate for Payer: Healthfirst QHP |
$172.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$120.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$172.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$146.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$120.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$172.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$129.44
|
| Rate for Payer: SOMOS Essential |
$129.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$172.58
|
|
|
PR APPLICATION BODY CAST SHOULDER HIPS BOTH THIGHS
|
Professional
|
Both
|
$824.04
|
|
|
Service Code
|
HCPCS 29046
|
| Min. Negotiated Rate |
$157.19 |
| Max. Negotiated Rate |
$505.24 |
| Rate for Payer: Cash Price |
$223.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$224.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$202.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$202.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$213.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$224.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$213.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$224.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$224.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$168.41
|
| Rate for Payer: Healthfirst Commercial |
$224.55
|
| Rate for Payer: Healthfirst Essential Plan |
$505.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$213.32
|
| Rate for Payer: Healthfirst QHP |
$224.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$157.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$224.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$190.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$157.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$224.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$168.41
|
| Rate for Payer: SOMOS Essential |
$168.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$224.55
|
|
|
PR APPLICATION BODY CAST SHOULDER HIPS HEAD MINERVA
|
Professional
|
Both
|
$756.39
|
|
|
Service Code
|
HCPCS 29040
|
| Min. Negotiated Rate |
$145.76 |
| Max. Negotiated Rate |
$468.52 |
| Rate for Payer: Cash Price |
$206.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$208.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$187.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$187.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$197.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$208.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$197.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$208.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$208.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$156.17
|
| Rate for Payer: Healthfirst Commercial |
$208.23
|
| Rate for Payer: Healthfirst Essential Plan |
$468.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$197.82
|
| Rate for Payer: Healthfirst QHP |
$208.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$145.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$208.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$177.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$145.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$208.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$156.17
|
| Rate for Payer: SOMOS Essential |
$156.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$208.23
|
|
|
PR APPLICATION BODY CAST SHOULDER HIPS W/ONE THIGH
|
Professional
|
Both
|
$733.92
|
|
|
Service Code
|
HCPCS 29044
|
| Min. Negotiated Rate |
$140.26 |
| Max. Negotiated Rate |
$450.83 |
| Rate for Payer: Cash Price |
$199.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$200.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$180.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$180.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$190.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$200.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$190.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$150.28
|
| Rate for Payer: Healthfirst Commercial |
$200.37
|
| Rate for Payer: Healthfirst Essential Plan |
$450.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$190.35
|
| Rate for Payer: Healthfirst QHP |
$200.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$140.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$200.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$170.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$140.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$200.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$150.28
|
| Rate for Payer: SOMOS Essential |
$150.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$200.37
|
|
|
PR APPLICATION CAST ELBOW FINGER SHORT ARM
|
Professional
|
Both
|
$278.08
|
|
|
Service Code
|
HCPCS 29075
|
| Min. Negotiated Rate |
$52.66 |
| Max. Negotiated Rate |
$169.27 |
| Rate for Payer: Cash Price |
$74.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$75.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$75.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$71.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.42
|
| Rate for Payer: Healthfirst Commercial |
$75.23
|
| Rate for Payer: Healthfirst Essential Plan |
$169.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$71.47
|
| Rate for Payer: Healthfirst QHP |
$75.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$75.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$75.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56.42
|
| Rate for Payer: SOMOS Essential |
$56.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.23
|
|
|
PR APPLICATION CAST FIGURE-OF-8
|
Professional
|
Both
|
$304.47
|
|
|
Service Code
|
HCPCS 29049
|
| Min. Negotiated Rate |
$58.32 |
| Max. Negotiated Rate |
$187.47 |
| Rate for Payer: Cash Price |
$83.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$83.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$79.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$83.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$79.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.49
|
| Rate for Payer: Healthfirst Commercial |
$83.32
|
| Rate for Payer: Healthfirst Essential Plan |
$187.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$79.15
|
| Rate for Payer: Healthfirst QHP |
$83.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$83.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$83.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62.49
|
| Rate for Payer: SOMOS Essential |
$62.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$83.32
|
|
|
PR APPLICATION CAST FINGER
|
Professional
|
Both
|
$208.92
|
|
|
Service Code
|
HCPCS 29086
|
| Min. Negotiated Rate |
$39.67 |
| Max. Negotiated Rate |
$127.51 |
| Rate for Payer: Cash Price |
$57.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$51.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$53.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.50
|
| Rate for Payer: Healthfirst Commercial |
$56.67
|
| Rate for Payer: Healthfirst Essential Plan |
$127.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$53.84
|
| Rate for Payer: Healthfirst QHP |
$56.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$56.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.50
|
| Rate for Payer: SOMOS Essential |
$42.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.67
|
|
|
PR APPLICATION CAST HAND & LOWER FOREARM GAUNTLET
|
Professional
|
Both
|
$294.91
|
|
|
Service Code
|
HCPCS 29085
|
| Min. Negotiated Rate |
$56.16 |
| Max. Negotiated Rate |
$180.52 |
| Rate for Payer: Cash Price |
$80.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$80.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.17
|
| Rate for Payer: Healthfirst Commercial |
$80.23
|
| Rate for Payer: Healthfirst Essential Plan |
$180.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.22
|
| Rate for Payer: Healthfirst QHP |
$80.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.17
|
| Rate for Payer: SOMOS Essential |
$60.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.23
|
|
|
PR APPLICATION CAST PLASTER VELPEAU
|
Professional
|
Both
|
$410.59
|
|
|
Service Code
|
HCPCS 29058
|
| Min. Negotiated Rate |
$78.32 |
| Max. Negotiated Rate |
$251.75 |
| Rate for Payer: Cash Price |
$111.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$111.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$100.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$100.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$106.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$111.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$106.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.92
|
| Rate for Payer: Healthfirst Commercial |
$111.89
|
| Rate for Payer: Healthfirst Essential Plan |
$251.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$106.30
|
| Rate for Payer: Healthfirst QHP |
$111.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$111.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$95.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$111.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.92
|
| Rate for Payer: SOMOS Essential |
$83.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.89
|
|
|
PR APPLICATION CAST SHOULDER HAND LONG ARM
|
Professional
|
Both
|
$300.55
|
|
|
Service Code
|
HCPCS 29065
|
| Min. Negotiated Rate |
$56.43 |
| Max. Negotiated Rate |
$181.40 |
| Rate for Payer: Cash Price |
$81.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$80.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.47
|
| Rate for Payer: Healthfirst Commercial |
$80.62
|
| Rate for Payer: Healthfirst Essential Plan |
$181.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.59
|
| Rate for Payer: Healthfirst QHP |
$80.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.47
|
| Rate for Payer: SOMOS Essential |
$60.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.62
|
|
