|
PR APPLICATION CAST SHOULDER SPICA
|
Professional
|
Both
|
$603.19
|
|
|
Service Code
|
HCPCS 29055
|
| Min. Negotiated Rate |
$115.61 |
| Max. Negotiated Rate |
$371.61 |
| Rate for Payer: Cash Price |
$164.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$165.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$148.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$148.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$156.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$165.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$156.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$123.87
|
| Rate for Payer: Healthfirst Commercial |
$165.16
|
| Rate for Payer: Healthfirst Essential Plan |
$371.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.90
|
| Rate for Payer: Healthfirst QHP |
$165.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$115.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$165.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$140.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$115.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$165.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$123.87
|
| Rate for Payer: SOMOS Essential |
$123.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$165.16
|
|
|
PR APPLICATION CYLINDER CAST THIGH ANKLE
|
Professional
|
Both
|
$381.78
|
|
|
Service Code
|
HCPCS 29365
|
| Min. Negotiated Rate |
$72.37 |
| Max. Negotiated Rate |
$232.63 |
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$103.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$93.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$93.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$98.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$98.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.54
|
| Rate for Payer: Healthfirst Commercial |
$103.39
|
| Rate for Payer: Healthfirst Essential Plan |
$232.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$98.22
|
| Rate for Payer: Healthfirst QHP |
$103.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$103.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$87.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.54
|
| Rate for Payer: SOMOS Essential |
$77.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.39
|
|
|
PR APPLICATION FINGER SPLINT DYNAMIC
|
Professional
|
Both
|
$152.32
|
|
|
Service Code
|
HCPCS 29131
|
| Min. Negotiated Rate |
$28.13 |
| Max. Negotiated Rate |
$90.43 |
| Rate for Payer: Cash Price |
$40.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.14
|
| Rate for Payer: Healthfirst Commercial |
$40.19
|
| Rate for Payer: Healthfirst Essential Plan |
$90.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.18
|
| Rate for Payer: Healthfirst QHP |
$40.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.14
|
| Rate for Payer: SOMOS Essential |
$30.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.19
|
|
|
PR APPLICATION FINGER SPLINT STATIC
|
Professional
|
Both
|
$130.24
|
|
|
Service Code
|
HCPCS 29130
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$75.22 |
| Rate for Payer: Cash Price |
$34.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.07
|
| Rate for Payer: Healthfirst Commercial |
$33.43
|
| Rate for Payer: Healthfirst Essential Plan |
$75.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.76
|
| Rate for Payer: Healthfirst QHP |
$33.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.07
|
| Rate for Payer: SOMOS Essential |
$25.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.43
|
|
|
PR APPLICATION HALO CRANIAL INCLUDING REMOVAL
|
Professional
|
Both
|
$2,384.69
|
|
|
Service Code
|
HCPCS 20661
|
| Min. Negotiated Rate |
$445.47 |
| Max. Negotiated Rate |
$1,431.86 |
| Rate for Payer: Cash Price |
$651.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$636.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$572.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$572.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$604.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$636.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$604.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$636.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$636.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$477.29
|
| Rate for Payer: Healthfirst Commercial |
$636.38
|
| Rate for Payer: Healthfirst Essential Plan |
$1,431.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$604.56
|
| Rate for Payer: Healthfirst QHP |
$636.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$445.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$636.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$540.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$445.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$636.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$477.29
|
| Rate for Payer: SOMOS Essential |
$477.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$636.38
|
|
|
PR APPLICATION HALO FEMORAL INCLUDING REMOVAL
|
Professional
|
Both
|
$2,126.08
|
|
|
Service Code
|
HCPCS 20663
|
| Min. Negotiated Rate |
$404.07 |
| Max. Negotiated Rate |
$1,298.81 |
| Rate for Payer: Cash Price |
$580.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$577.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$519.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$519.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$548.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$577.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$548.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$577.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$577.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$432.94
|
| Rate for Payer: Healthfirst Commercial |
$577.25
|
| Rate for Payer: Healthfirst Essential Plan |
$1,298.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$548.39
|
| Rate for Payer: Healthfirst QHP |
$577.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$404.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$577.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$490.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$404.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$577.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$432.94
|
| Rate for Payer: SOMOS Essential |
$432.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$577.25
|
|
|
PR APPLICATION HALO PELVIC INCLUDING REMOVAL
|
Professional
|
Both
|
$2,307.94
|
|
|
Service Code
|
HCPCS 20662
|
| Min. Negotiated Rate |
$438.61 |
| Max. Negotiated Rate |
$1,409.81 |
| Rate for Payer: Cash Price |
$627.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$626.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$563.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$563.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$595.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$626.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$595.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$626.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$626.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$469.94
|
| Rate for Payer: Healthfirst Commercial |
$626.58
|
| Rate for Payer: Healthfirst Essential Plan |
$1,409.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$595.25
|
| Rate for Payer: Healthfirst QHP |
$626.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$438.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$626.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$532.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$438.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$626.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$469.94
|
| Rate for Payer: SOMOS Essential |
$469.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$626.58
|
|
|
PR APPLICATION HALO TYPE BODY CAST
|
Professional
|
Both
|
$929.01
|
|
|
Service Code
|
HCPCS 29000
|
| Min. Negotiated Rate |
$173.52 |
| Max. Negotiated Rate |
$557.73 |
| Rate for Payer: Cash Price |
$249.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$247.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$223.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$223.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$235.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$247.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$235.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$247.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$247.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$185.91
|
| Rate for Payer: Healthfirst Commercial |
$247.88
|
| Rate for Payer: Healthfirst Essential Plan |
$557.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$235.49
|
| Rate for Payer: Healthfirst QHP |
$247.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$173.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$247.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$210.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$173.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$247.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$185.91
|
| Rate for Payer: SOMOS Essential |
$185.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$247.88
|
|
|
PR APPLICATION HIP SPICA CAST 1 LEG
|
Professional
|
Both
|
$694.19
|
|
|
Service Code
|
HCPCS 29305
|
| Min. Negotiated Rate |
$132.61 |
| Max. Negotiated Rate |
$426.24 |
| Rate for Payer: Cash Price |
$188.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$189.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$170.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$170.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$179.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$189.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$179.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$189.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$189.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$142.08
|
| Rate for Payer: Healthfirst Commercial |
$189.44
|
| Rate for Payer: Healthfirst Essential Plan |
$426.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$179.97
|
| Rate for Payer: Healthfirst QHP |
$189.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$132.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$189.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$161.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$132.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$189.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$142.08
|
| Rate for Payer: SOMOS Essential |
$142.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$189.44
|
|
|
PR APPLICATION LONG ARM SPLINT SHOULDER HAND
|
Professional
|
Both
|
$188.41
|
|
|
Service Code
|
HCPCS 29105
|
| Min. Negotiated Rate |
$34.10 |
| Max. Negotiated Rate |
$109.60 |
| Rate for Payer: Cash Price |
$49.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$48.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.53
|
| Rate for Payer: Healthfirst Commercial |
$48.71
|
| Rate for Payer: Healthfirst Essential Plan |
$109.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.27
|
| Rate for Payer: Healthfirst QHP |
$48.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.53
|
| Rate for Payer: SOMOS Essential |
$36.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.71
|
|
|
PR APPLICATION LONG LEG CAST BRACE
|
Professional
|
Both
|
$452.52
|
|
|
Service Code
|
HCPCS 29358
|
| Min. Negotiated Rate |
$85.62 |
| Max. Negotiated Rate |
$275.20 |
| Rate for Payer: Cash Price |
$122.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$122.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$110.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$116.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$122.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$116.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.73
|
| Rate for Payer: Healthfirst Commercial |
$122.31
|
| Rate for Payer: Healthfirst Essential Plan |
$275.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$116.19
|
| Rate for Payer: Healthfirst QHP |
$122.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$85.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$122.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$103.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$85.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$122.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$91.73
|
| Rate for Payer: SOMOS Essential |
$91.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.31
|
|
|
PR APPLICATION LONG LEG CAST THIGH-TOE
|
Professional
|
Both
|
$436.10
|
|
|
Service Code
|
HCPCS 29345
|
| Min. Negotiated Rate |
$82.12 |
| Max. Negotiated Rate |
$263.97 |
| Rate for Payer: Cash Price |
$116.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$117.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$105.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$105.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$111.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$117.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$111.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$117.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$117.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$87.99
|
| Rate for Payer: Healthfirst Commercial |
$117.32
|
| Rate for Payer: Healthfirst Essential Plan |
$263.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$111.45
|
| Rate for Payer: Healthfirst QHP |
$117.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$117.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$99.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$117.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$87.99
|
| Rate for Payer: SOMOS Essential |
$87.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$117.32
|
|
|
PR APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE
|
Professional
|
Both
|
$465.05
|
|
|
Service Code
|
HCPCS 29355
|
| Min. Negotiated Rate |
$87.05 |
| Max. Negotiated Rate |
$279.81 |
| Rate for Payer: Cash Price |
$125.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$124.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$111.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$111.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$118.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$124.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$118.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$93.27
|
| Rate for Payer: Healthfirst Commercial |
$124.36
|
| Rate for Payer: Healthfirst Essential Plan |
$279.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$118.14
|
| Rate for Payer: Healthfirst QHP |
$124.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$87.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$124.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$105.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$87.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$124.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$93.27
|
| Rate for Payer: SOMOS Essential |
$93.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$124.36
|
|
|
PR APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES
|
Professional
|
Both
|
$225.65
|
|
|
Service Code
|
HCPCS 29505
|
| Min. Negotiated Rate |
$43.73 |
| Max. Negotiated Rate |
$140.56 |
| Rate for Payer: Cash Price |
$61.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.85
|
| Rate for Payer: Healthfirst Commercial |
$62.47
|
| Rate for Payer: Healthfirst Essential Plan |
$140.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.35
|
| Rate for Payer: Healthfirst QHP |
$62.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$46.85
|
| Rate for Payer: SOMOS Essential |
$46.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.47
|
|
|
PR APPLICATION MODALITY 1/> AREAS DIATHERMY
|
Professional
|
Both
|
$31.82
|
|
|
Service Code
|
HCPCS 97024
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$19.15 |
| Rate for Payer: Cash Price |
$8.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.38
|
| Rate for Payer: Healthfirst Commercial |
$8.51
|
| Rate for Payer: Healthfirst Essential Plan |
$19.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.08
|
| Rate for Payer: Healthfirst QHP |
$8.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.38
|
| Rate for Payer: SOMOS Essential |
$6.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.51
|
|
|
PR APPLICATION MODALITY 1/> AREAS INFRARED
|
Professional
|
Both
|
$28.95
|
|
|
Service Code
|
HCPCS 97026
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$18.27 |
| Rate for Payer: Cash Price |
$7.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.09
|
| Rate for Payer: Healthfirst Commercial |
$8.12
|
| Rate for Payer: Healthfirst Essential Plan |
$18.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.71
|
| Rate for Payer: Healthfirst QHP |
$8.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$6.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.09
|
| Rate for Payer: SOMOS Essential |
$6.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.12
|
|
|
PR APPLICATION MODALITY 1/> AREAS WHIRLPOOL
|
Professional
|
Both
|
$71.47
|
|
|
Service Code
|
HCPCS 97022
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$40.77 |
| Rate for Payer: Cash Price |
$19.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.59
|
| Rate for Payer: Healthfirst Commercial |
$18.12
|
| Rate for Payer: Healthfirst Essential Plan |
$40.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.21
|
| Rate for Payer: Healthfirst QHP |
$18.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.59
|
| Rate for Payer: SOMOS Essential |
$13.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.12
|
|
|
PR APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM
|
Professional
|
Both
|
$4,899.51
|
|
|
Service Code
|
HCPCS 20692
|
| Min. Negotiated Rate |
$932.83 |
| Max. Negotiated Rate |
$2,998.39 |
| Rate for Payer: Cash Price |
$1,334.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,332.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,199.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,199.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,265.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,332.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,265.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,332.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,332.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$999.47
|
| Rate for Payer: Healthfirst Commercial |
$1,332.62
|
| Rate for Payer: Healthfirst Essential Plan |
$2,998.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,265.99
|
| Rate for Payer: Healthfirst QHP |
$1,332.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$932.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,332.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,132.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$932.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,332.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$999.47
|
| Rate for Payer: SOMOS Essential |
$999.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,332.62
|
|
|
PR APPLICATION PATELLAR TENDON BEARING CAST
|
Professional
|
Both
|
$350.60
|
|
|
Service Code
|
HCPCS 29435
|
| Min. Negotiated Rate |
$71.99 |
| Max. Negotiated Rate |
$231.39 |
| Rate for Payer: Cash Price |
$102.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$102.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$92.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$97.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$102.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$97.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.13
|
| Rate for Payer: Healthfirst Commercial |
$102.84
|
| Rate for Payer: Healthfirst Essential Plan |
$231.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$97.70
|
| Rate for Payer: Healthfirst QHP |
$102.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$71.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$102.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$87.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$71.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.13
|
| Rate for Payer: SOMOS Essential |
$77.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.84
|
|
|
PR APPLICATION RIGHT & LEFT PULMONARY ARTERY BAND
|
Professional
|
Both
|
$7,332.89
|
|
|
Service Code
|
HCPCS 33620
|
| Min. Negotiated Rate |
$1,348.88 |
| Max. Negotiated Rate |
$4,335.68 |
| Rate for Payer: Cash Price |
$1,947.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,926.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,734.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,734.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,830.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,926.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,830.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,926.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,926.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,445.23
|
| Rate for Payer: Healthfirst Commercial |
$1,926.97
|
| Rate for Payer: Healthfirst Essential Plan |
$4,335.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,830.62
|
| Rate for Payer: Healthfirst QHP |
$1,926.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,348.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,926.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,637.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,348.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,926.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,445.23
|
| Rate for Payer: SOMOS Essential |
$1,445.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,926.97
|
|
|
PR APPLICATION RIGID TOTAL CONTACT LEG CAST
|
Professional
|
Both
|
$410.06
|
|
|
Service Code
|
HCPCS 29445
|
| Min. Negotiated Rate |
$77.61 |
| Max. Negotiated Rate |
$249.46 |
| Rate for Payer: Cash Price |
$112.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$110.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$99.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$99.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$105.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$110.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$105.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.15
|
| Rate for Payer: Healthfirst Commercial |
$110.87
|
| Rate for Payer: Healthfirst Essential Plan |
$249.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$105.33
|
| Rate for Payer: Healthfirst QHP |
$110.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$77.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$110.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$94.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$77.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$110.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.15
|
| Rate for Payer: SOMOS Essential |
$83.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$110.87
|
|
|
PR APPLICATION RISSER JACKET LOCALIZER BODY ONLY
|
Professional
|
Both
|
$703.57
|
|
|
Service Code
|
HCPCS 29010
|
| Min. Negotiated Rate |
$134.31 |
| Max. Negotiated Rate |
$431.71 |
| Rate for Payer: Cash Price |
$190.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$191.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$172.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$182.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$191.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$182.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$143.90
|
| Rate for Payer: Healthfirst Commercial |
$191.87
|
| Rate for Payer: Healthfirst Essential Plan |
$431.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$182.28
|
| Rate for Payer: Healthfirst QHP |
$191.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$134.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$191.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$163.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$134.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$191.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$143.90
|
| Rate for Payer: SOMOS Essential |
$143.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.87
|
|
|
PR APPLICATION RISSER JACKET LOCALIZER BODY W/HEAD
|
Professional
|
Both
|
$792.44
|
|
|
Service Code
|
HCPCS 29015
|
| Min. Negotiated Rate |
$150.67 |
| Max. Negotiated Rate |
$484.29 |
| Rate for Payer: Cash Price |
$214.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$215.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$193.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$193.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$204.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$215.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$204.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$215.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$215.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$161.43
|
| Rate for Payer: Healthfirst Commercial |
$215.24
|
| Rate for Payer: Healthfirst Essential Plan |
$484.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$204.48
|
| Rate for Payer: Healthfirst QHP |
$215.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$150.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$215.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$182.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$150.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$215.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$161.43
|
| Rate for Payer: SOMOS Essential |
$161.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$215.24
|
|
|
PR APPLICATION SHORT ARM SPLINT DYNAMIC
|
Professional
|
Both
|
$211.72
|
|
|
Service Code
|
HCPCS 29126
|
| Min. Negotiated Rate |
$40.56 |
| Max. Negotiated Rate |
$130.37 |
| Rate for Payer: Cash Price |
$57.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$57.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$52.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$57.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.45
|
| Rate for Payer: Healthfirst Commercial |
$57.94
|
| Rate for Payer: Healthfirst Essential Plan |
$130.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$55.04
|
| Rate for Payer: Healthfirst QHP |
$57.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$57.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$49.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$43.45
|
| Rate for Payer: SOMOS Essential |
$43.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57.94
|
|
|
PR APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC
|
Professional
|
Both
|
$177.66
|
|
|
Service Code
|
HCPCS 29125
|
| Min. Negotiated Rate |
$33.18 |
| Max. Negotiated Rate |
$106.65 |
| Rate for Payer: Cash Price |
$47.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.55
|
| Rate for Payer: Healthfirst Commercial |
$47.40
|
| Rate for Payer: Healthfirst Essential Plan |
$106.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.03
|
| Rate for Payer: Healthfirst QHP |
$47.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.55
|
| Rate for Payer: SOMOS Essential |
$35.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.40
|
|
