|
PR CLOSED TREATMENT SESAMOID FRACTURE
|
Professional
|
Both
|
$430.75
|
|
|
Service Code
|
HCPCS 28530
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$279.65 |
| Rate for Payer: Cash Price |
$122.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$124.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$111.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$111.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$118.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$124.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$118.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$93.22
|
| Rate for Payer: Healthfirst Commercial |
$124.29
|
| Rate for Payer: Healthfirst Essential Plan |
$279.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$118.08
|
| Rate for Payer: Healthfirst QHP |
$124.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$87.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$124.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$105.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$87.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$124.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$93.22
|
| Rate for Payer: SOMOS Essential |
$93.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$124.29
|
|
|
PR CLOSED TREATMENT STERNUM FRACTURE
|
Professional
|
Both
|
$659.65
|
|
|
Service Code
|
HCPCS 21820
|
| Min. Negotiated Rate |
$128.32 |
| Max. Negotiated Rate |
$412.47 |
| Rate for Payer: Cash Price |
$181.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$183.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$164.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$164.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$174.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$183.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$174.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$183.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$183.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$137.49
|
| Rate for Payer: Healthfirst Commercial |
$183.32
|
| Rate for Payer: Healthfirst Essential Plan |
$412.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$174.15
|
| Rate for Payer: Healthfirst QHP |
$183.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$128.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$183.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$155.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$128.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$183.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$137.49
|
| Rate for Payer: SOMOS Essential |
$137.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$183.32
|
|
|
PR CLOSED TREATMENT ULNAR STYLOID FRACTURE
|
Professional
|
Both
|
$1,383.24
|
|
|
Service Code
|
HCPCS 25650
|
| Min. Negotiated Rate |
$263.56 |
| Max. Negotiated Rate |
$847.15 |
| Rate for Payer: Cash Price |
$376.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$376.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$338.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$338.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$357.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$376.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$357.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$376.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$376.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$282.38
|
| Rate for Payer: Healthfirst Commercial |
$376.51
|
| Rate for Payer: Healthfirst Essential Plan |
$847.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$357.68
|
| Rate for Payer: Healthfirst QHP |
$376.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$263.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$376.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$320.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$263.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$376.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$282.38
|
| Rate for Payer: SOMOS Essential |
$282.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$376.51
|
|
|
PR CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA
|
Professional
|
Both
|
$1,734.25
|
|
|
Service Code
|
HCPCS 27840
|
| Min. Negotiated Rate |
$329.53 |
| Max. Negotiated Rate |
$1,059.21 |
| Rate for Payer: Cash Price |
$473.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$470.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$423.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$423.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$447.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$470.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$447.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$470.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$470.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$353.07
|
| Rate for Payer: Healthfirst Commercial |
$470.76
|
| Rate for Payer: Healthfirst Essential Plan |
$1,059.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$447.22
|
| Rate for Payer: Healthfirst QHP |
$470.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$329.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$470.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$400.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$329.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$470.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$353.07
|
| Rate for Payer: SOMOS Essential |
$353.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$470.76
|
|
|
PR CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ
|
Professional
|
Both
|
$1,918.04
|
|
|
Service Code
|
HCPCS 27810
|
| Min. Negotiated Rate |
$363.97 |
| Max. Negotiated Rate |
$1,169.91 |
| Rate for Payer: Cash Price |
$523.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$519.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$467.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$467.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$493.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$519.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$493.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$519.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$519.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$389.97
|
| Rate for Payer: Healthfirst Commercial |
$519.96
|
| Rate for Payer: Healthfirst Essential Plan |
$1,169.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$493.96
|
| Rate for Payer: Healthfirst QHP |
$519.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$363.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$519.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$441.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$363.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$519.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$389.97
|
| Rate for Payer: SOMOS Essential |
$389.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$519.96
|
|
|
PR CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ
|
Professional
|
Both
|
$1,367.91
|
|
|
Service Code
|
HCPCS 27808
|
| Min. Negotiated Rate |
$262.82 |
| Max. Negotiated Rate |
$844.78 |
| Rate for Payer: Cash Price |
$375.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$375.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$337.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$337.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$356.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$375.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$356.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$375.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$375.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$281.60
|
| Rate for Payer: Healthfirst Commercial |
$375.46
|
| Rate for Payer: Healthfirst Essential Plan |
$844.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$356.69
|
| Rate for Payer: Healthfirst QHP |
$375.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$262.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$375.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$319.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$262.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$375.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$281.60
|
| Rate for Payer: SOMOS Essential |
$281.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$375.46
|
|
|
PR CLOSED TX CALCANEAL FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$1,813.88
|
|
|
Service Code
|
HCPCS 28405
|
| Min. Negotiated Rate |
$346.91 |
| Max. Negotiated Rate |
$1,115.06 |
| Rate for Payer: Cash Price |
$495.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$495.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$446.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$446.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$470.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$495.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$470.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$495.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$495.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$371.69
|
| Rate for Payer: Healthfirst Commercial |
$495.58
|
| Rate for Payer: Healthfirst Essential Plan |
$1,115.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$470.80
|
| Rate for Payer: Healthfirst QHP |
$495.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$346.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$495.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$421.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$346.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$495.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$371.69
|
| Rate for Payer: SOMOS Essential |
$371.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$495.58
|
|
|
PR CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$1,011.71
|
|
|
Service Code
|
HCPCS 28400
|
| Min. Negotiated Rate |
$194.63 |
| Max. Negotiated Rate |
$625.61 |
| Rate for Payer: Cash Price |
$279.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$278.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$250.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$250.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$264.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$278.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$264.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$278.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$208.54
|
| Rate for Payer: Healthfirst Commercial |
$278.05
|
| Rate for Payer: Healthfirst Essential Plan |
$625.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$264.15
|
| Rate for Payer: Healthfirst QHP |
$278.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$194.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$278.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$236.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$194.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$278.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$208.54
|
| Rate for Payer: SOMOS Essential |
$208.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$278.05
|
|
|
PR CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ
|
Professional
|
Both
|
$1,997.17
|
|
|
Service Code
|
HCPCS 25624
|
| Min. Negotiated Rate |
$382.14 |
| Max. Negotiated Rate |
$1,228.30 |
| Rate for Payer: Cash Price |
$546.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$545.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$491.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$491.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$518.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$545.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$518.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$545.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$545.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$409.43
|
| Rate for Payer: Healthfirst Commercial |
$545.91
|
| Rate for Payer: Healthfirst Essential Plan |
$1,228.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$518.61
|
| Rate for Payer: Healthfirst QHP |
$545.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$382.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$545.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$464.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$382.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$545.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$409.43
|
| Rate for Payer: SOMOS Essential |
$409.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$545.91
|
|
|
PR CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ
|
Professional
|
Both
|
$1,277.89
|
|
|
Service Code
|
HCPCS 25622
|
| Min. Negotiated Rate |
$245.36 |
| Max. Negotiated Rate |
$788.65 |
| Rate for Payer: Cash Price |
$350.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$350.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$315.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$315.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$332.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$350.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$332.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$350.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$350.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$262.88
|
| Rate for Payer: Healthfirst Commercial |
$350.51
|
| Rate for Payer: Healthfirst Essential Plan |
$788.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$332.98
|
| Rate for Payer: Healthfirst QHP |
$350.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$245.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$350.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$297.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$245.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$350.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$262.88
|
| Rate for Payer: SOMOS Essential |
$262.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$350.51
|
|
|
PR CLOSED TX CRANIOFACIAL SEPARATION
|
Professional
|
Both
|
$2,938.50
|
|
|
Service Code
|
HCPCS 21431
|
| Min. Negotiated Rate |
$557.05 |
| Max. Negotiated Rate |
$1,790.51 |
| Rate for Payer: Cash Price |
$798.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$795.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$716.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$716.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$755.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$795.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$755.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$795.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$795.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$596.84
|
| Rate for Payer: Healthfirst Commercial |
$795.78
|
| Rate for Payer: Healthfirst Essential Plan |
$1,790.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$755.99
|
| Rate for Payer: Healthfirst QHP |
$795.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$557.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$795.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$676.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$557.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$795.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$596.84
|
| Rate for Payer: SOMOS Essential |
$596.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$795.78
|
|
|
PR CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ
|
Professional
|
Both
|
$1,852.34
|
|
|
Service Code
|
HCPCS 25675
|
| Min. Negotiated Rate |
$354.97 |
| Max. Negotiated Rate |
$1,140.97 |
| Rate for Payer: Cash Price |
$507.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$507.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$456.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$456.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$481.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$507.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$481.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$507.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$507.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$380.32
|
| Rate for Payer: Healthfirst Commercial |
$507.10
|
| Rate for Payer: Healthfirst Essential Plan |
$1,140.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$481.75
|
| Rate for Payer: Healthfirst QHP |
$507.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$354.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$507.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$431.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$354.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$507.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$380.32
|
| Rate for Payer: SOMOS Essential |
$380.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$507.10
|
|
|
PR CLOSED TX FEMORAL FRACTURE PROX HEAD W/MANJ
|
Professional
|
Both
|
$2,425.71
|
|
|
Service Code
|
HCPCS 27268
|
| Min. Negotiated Rate |
$458.92 |
| Max. Negotiated Rate |
$1,475.10 |
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$655.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$590.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$590.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$622.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$655.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$622.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$655.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$655.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$491.70
|
| Rate for Payer: Healthfirst Commercial |
$655.60
|
| Rate for Payer: Healthfirst Essential Plan |
$1,475.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$622.82
|
| Rate for Payer: Healthfirst QHP |
$655.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$458.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$655.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$557.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$458.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$655.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$491.70
|
| Rate for Payer: SOMOS Essential |
$491.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$655.60
|
|
|
PR CLOSED TX FEMORAL FRACTURE PROX HEAD W/O MANJ
|
Professional
|
Both
|
$1,959.27
|
|
|
Service Code
|
HCPCS 27267
|
| Min. Negotiated Rate |
$370.69 |
| Max. Negotiated Rate |
$1,191.51 |
| Rate for Payer: Cash Price |
$536.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$529.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$476.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$476.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$503.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$529.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$503.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$529.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$529.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$397.17
|
| Rate for Payer: Healthfirst Commercial |
$529.56
|
| Rate for Payer: Healthfirst Essential Plan |
$1,191.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$503.08
|
| Rate for Payer: Healthfirst QHP |
$529.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$370.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$529.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$450.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$370.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$529.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$397.17
|
| Rate for Payer: SOMOS Essential |
$397.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$529.56
|
|
|
PR CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION
|
Professional
|
Both
|
$2,148.69
|
|
|
Service Code
|
HCPCS 27500
|
| Min. Negotiated Rate |
$404.40 |
| Max. Negotiated Rate |
$1,299.87 |
| Rate for Payer: Cash Price |
$581.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$577.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$519.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$519.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$548.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$577.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$548.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$577.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$577.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$433.29
|
| Rate for Payer: Healthfirst Commercial |
$577.72
|
| Rate for Payer: Healthfirst Essential Plan |
$1,299.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$548.83
|
| Rate for Payer: Healthfirst QHP |
$577.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$404.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$577.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$491.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$404.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$577.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$433.29
|
| Rate for Payer: SOMOS Essential |
$433.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$577.72
|
|
|
PR CLOSED TX FX ORBIT EXCEPT BLOWOUT W/MANIPULATION
|
Professional
|
Both
|
$1,439.31
|
|
|
Service Code
|
HCPCS 21401
|
| Min. Negotiated Rate |
$275.05 |
| Max. Negotiated Rate |
$884.09 |
| Rate for Payer: Cash Price |
$393.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$392.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$353.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$353.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$373.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$392.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$373.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$392.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$392.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$294.70
|
| Rate for Payer: Healthfirst Commercial |
$392.93
|
| Rate for Payer: Healthfirst Essential Plan |
$884.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$373.28
|
| Rate for Payer: Healthfirst QHP |
$392.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$275.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$392.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$333.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$275.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$392.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$294.70
|
| Rate for Payer: SOMOS Essential |
$294.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$392.93
|
|
|
PR CLOSED TX KNEE DISLOCATION W/ANESTHESIA
|
Professional
|
Both
|
$2,813.30
|
|
|
Service Code
|
HCPCS 27552
|
| Min. Negotiated Rate |
$533.57 |
| Max. Negotiated Rate |
$1,715.04 |
| Rate for Payer: Cash Price |
$765.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$762.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$686.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$686.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$724.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$762.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$724.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$762.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$762.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$571.68
|
| Rate for Payer: Healthfirst Commercial |
$762.24
|
| Rate for Payer: Healthfirst Essential Plan |
$1,715.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$724.13
|
| Rate for Payer: Healthfirst QHP |
$762.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$533.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$762.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$647.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$533.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$762.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$571.68
|
| Rate for Payer: SOMOS Essential |
$571.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$762.24
|
|
|
PR CLOSED TX KNEE DISLOCATION W/O ANESTHESIA
|
Professional
|
Both
|
$2,116.77
|
|
|
Service Code
|
HCPCS 27550
|
| Min. Negotiated Rate |
$399.31 |
| Max. Negotiated Rate |
$1,283.49 |
| Rate for Payer: Cash Price |
$572.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$570.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$513.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$513.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$541.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$570.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$541.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$570.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$570.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$427.83
|
| Rate for Payer: Healthfirst Commercial |
$570.44
|
| Rate for Payer: Healthfirst Essential Plan |
$1,283.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$541.92
|
| Rate for Payer: Healthfirst QHP |
$570.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$399.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$570.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$484.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$399.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$570.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$427.83
|
| Rate for Payer: SOMOS Essential |
$427.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$570.44
|
|
|
PR CLOSED TX LUNATE DISLOCATION W/MANIPULATION
|
Professional
|
Both
|
$2,197.02
|
|
|
Service Code
|
HCPCS 25690
|
| Min. Negotiated Rate |
$417.99 |
| Max. Negotiated Rate |
$1,343.54 |
| Rate for Payer: Cash Price |
$600.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$597.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$537.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$537.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$567.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$597.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$567.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$597.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$597.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$447.85
|
| Rate for Payer: Healthfirst Commercial |
$597.13
|
| Rate for Payer: Healthfirst Essential Plan |
$1,343.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$567.27
|
| Rate for Payer: Healthfirst QHP |
$597.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$417.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$597.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$507.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$417.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$597.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$447.85
|
| Rate for Payer: SOMOS Essential |
$447.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$597.13
|
|
|
PR CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$2,739.98
|
|
|
Service Code
|
HCPCS 21451
|
| Min. Negotiated Rate |
$515.28 |
| Max. Negotiated Rate |
$1,656.27 |
| Rate for Payer: Cash Price |
$742.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$736.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$662.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$662.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$699.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$736.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$699.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$736.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$736.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$552.09
|
| Rate for Payer: Healthfirst Commercial |
$736.12
|
| Rate for Payer: Healthfirst Essential Plan |
$1,656.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$699.31
|
| Rate for Payer: Healthfirst QHP |
$736.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$515.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$736.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$625.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$515.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$736.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$552.09
|
| Rate for Payer: SOMOS Essential |
$552.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$736.12
|
|
|
PR CLOSED TX MANDIBULAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$2,055.45
|
|
|
Service Code
|
HCPCS 21450
|
| Min. Negotiated Rate |
$387.08 |
| Max. Negotiated Rate |
$1,244.18 |
| Rate for Payer: Cash Price |
$558.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$552.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$497.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$497.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$525.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$552.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$525.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$552.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$552.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$414.73
|
| Rate for Payer: Healthfirst Commercial |
$552.97
|
| Rate for Payer: Healthfirst Essential Plan |
$1,244.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$525.32
|
| Rate for Payer: Healthfirst QHP |
$552.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$387.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$552.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$470.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$387.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$552.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$414.73
|
| Rate for Payer: SOMOS Essential |
$414.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$552.97
|
|
|
PR CLOSED TX MANDIBULAR FX W/INTERDENTAL FIXATION
|
Professional
|
Both
|
$4,023.46
|
|
|
Service Code
|
HCPCS 21453
|
| Min. Negotiated Rate |
$743.25 |
| Max. Negotiated Rate |
$2,389.01 |
| Rate for Payer: Cash Price |
$1,089.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,061.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$955.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$955.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,008.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,061.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,008.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,061.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,061.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$796.34
|
| Rate for Payer: Healthfirst Commercial |
$1,061.78
|
| Rate for Payer: Healthfirst Essential Plan |
$2,389.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,008.69
|
| Rate for Payer: Healthfirst QHP |
$1,061.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$743.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,061.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$902.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$743.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,061.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$796.34
|
| Rate for Payer: SOMOS Essential |
$796.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,061.78
|
|
|
PR CLOSED TX METATARSAL FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$893.06
|
|
|
Service Code
|
HCPCS 28470
|
| Min. Negotiated Rate |
$173.01 |
| Max. Negotiated Rate |
$556.11 |
| Rate for Payer: Cash Price |
$248.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$247.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$222.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$222.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$234.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$247.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$234.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$247.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$247.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$185.37
|
| Rate for Payer: Healthfirst Commercial |
$247.16
|
| Rate for Payer: Healthfirst Essential Plan |
$556.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$234.80
|
| Rate for Payer: Healthfirst QHP |
$247.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$173.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$247.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$210.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$173.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$247.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$185.37
|
| Rate for Payer: SOMOS Essential |
$185.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$247.16
|
|
|
PR CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ
|
Professional
|
Both
|
$2,620.66
|
|
|
Service Code
|
HCPCS 24620
|
| Min. Negotiated Rate |
$497.74 |
| Max. Negotiated Rate |
$1,599.88 |
| Rate for Payer: Cash Price |
$713.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$711.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$639.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$639.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$675.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$711.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$675.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$711.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$711.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$533.29
|
| Rate for Payer: Healthfirst Commercial |
$711.06
|
| Rate for Payer: Healthfirst Essential Plan |
$1,599.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$675.51
|
| Rate for Payer: Healthfirst QHP |
$711.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$497.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$711.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$604.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$497.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$711.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$533.29
|
| Rate for Payer: SOMOS Essential |
$533.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$711.06
|
|
|
PR CLOSED TX NASAL BONE FX W/MNPJ W/O STABILIZATION
|
Professional
|
Both
|
$263.06
|
|
|
Service Code
|
HCPCS 21315
|
| Min. Negotiated Rate |
$48.82 |
| Max. Negotiated Rate |
$156.91 |
| Rate for Payer: Cash Price |
$69.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$69.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$66.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$69.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$66.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$69.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$69.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.30
|
| Rate for Payer: Healthfirst Commercial |
$69.74
|
| Rate for Payer: Healthfirst Essential Plan |
$156.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$66.25
|
| Rate for Payer: Healthfirst QHP |
$69.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$69.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$59.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$69.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$52.30
|
| Rate for Payer: SOMOS Essential |
$52.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69.74
|
|
