|
PR CLOSED TX NASAL BONE FX W/MNPJ W/STABILIZATION
|
Professional
|
Both
|
$407.26
|
|
|
Service Code
|
HCPCS 21320
|
| Min. Negotiated Rate |
$76.55 |
| Max. Negotiated Rate |
$246.06 |
| Rate for Payer: Cash Price |
$110.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$109.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$98.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$98.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$103.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$109.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$103.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.02
|
| Rate for Payer: Healthfirst Commercial |
$109.36
|
| Rate for Payer: Healthfirst Essential Plan |
$246.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$103.89
|
| Rate for Payer: Healthfirst QHP |
$109.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$76.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$109.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$92.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$76.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$109.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.02
|
| Rate for Payer: SOMOS Essential |
$82.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$109.36
|
|
|
PR CLOSED TX NASAL SEPTAL FRACT W/WO STABILIZATION
|
Professional
|
Both
|
$1,304.45
|
|
|
Service Code
|
HCPCS 21337
|
| Min. Negotiated Rate |
$248.80 |
| Max. Negotiated Rate |
$799.72 |
| Rate for Payer: Cash Price |
$356.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$355.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$319.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$319.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$337.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$355.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$337.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$355.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$266.57
|
| Rate for Payer: Healthfirst Commercial |
$355.43
|
| Rate for Payer: Healthfirst Essential Plan |
$799.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$337.66
|
| Rate for Payer: Healthfirst QHP |
$355.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$248.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$355.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$302.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$248.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$355.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$266.57
|
| Rate for Payer: SOMOS Essential |
$266.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$355.43
|
|
|
PR CLOSED TX NASOMAXILLARY COMPLEX FRACTURE
|
Professional
|
Both
|
$2,762.90
|
|
|
Service Code
|
HCPCS 21345
|
| Min. Negotiated Rate |
$521.98 |
| Max. Negotiated Rate |
$1,677.80 |
| Rate for Payer: Cash Price |
$752.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$745.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$671.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$671.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$708.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$745.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$708.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$745.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$745.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$559.27
|
| Rate for Payer: Healthfirst Commercial |
$745.69
|
| Rate for Payer: Healthfirst Essential Plan |
$1,677.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$708.41
|
| Rate for Payer: Healthfirst QHP |
$745.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$521.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$745.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$633.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$521.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$745.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$559.27
|
| Rate for Payer: SOMOS Essential |
$559.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$745.69
|
|
|
PR CLOSED TX PALATAL/MAXILLARY FX W/FIXATION/SPLINT
|
Professional
|
Both
|
$2,305.91
|
|
|
Service Code
|
HCPCS 21421
|
| Min. Negotiated Rate |
$441.32 |
| Max. Negotiated Rate |
$1,418.54 |
| Rate for Payer: Cash Price |
$629.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$630.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$567.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$567.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$598.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$630.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$598.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$630.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$630.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$472.85
|
| Rate for Payer: Healthfirst Commercial |
$630.46
|
| Rate for Payer: Healthfirst Essential Plan |
$1,418.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$598.94
|
| Rate for Payer: Healthfirst QHP |
$630.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$441.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$630.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$535.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$441.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$630.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$472.85
|
| Rate for Payer: SOMOS Essential |
$472.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$630.46
|
|
|
PR CLOSED TX PATELLAR DISLOCATION W/ANESTHESIA
|
Professional
|
Both
|
$2,188.52
|
|
|
Service Code
|
HCPCS 27562
|
| Min. Negotiated Rate |
$416.42 |
| Max. Negotiated Rate |
$1,338.50 |
| Rate for Payer: Cash Price |
$595.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$594.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$535.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$535.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$565.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$594.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$565.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$594.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$594.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$446.17
|
| Rate for Payer: Healthfirst Commercial |
$594.89
|
| Rate for Payer: Healthfirst Essential Plan |
$1,338.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$565.15
|
| Rate for Payer: Healthfirst QHP |
$594.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$416.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$594.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$505.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$416.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$594.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$446.17
|
| Rate for Payer: SOMOS Essential |
$446.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$594.89
|
|
|
PR CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA
|
Professional
|
Both
|
$1,539.58
|
|
|
Service Code
|
HCPCS 27560
|
| Min. Negotiated Rate |
$292.00 |
| Max. Negotiated Rate |
$938.59 |
| Rate for Payer: Cash Price |
$419.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$417.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$375.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$375.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$396.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$417.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$396.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$417.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$417.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$312.86
|
| Rate for Payer: Healthfirst Commercial |
$417.15
|
| Rate for Payer: Healthfirst Essential Plan |
$938.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$396.29
|
| Rate for Payer: Healthfirst QHP |
$417.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$292.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$417.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$354.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$292.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$417.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$312.86
|
| Rate for Payer: SOMOS Essential |
$312.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$417.15
|
|
|
PR CLOSED TX PATELLAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$1,352.93
|
|
|
Service Code
|
HCPCS 27520
|
| Min. Negotiated Rate |
$259.31 |
| Max. Negotiated Rate |
$833.49 |
| Rate for Payer: Cash Price |
$370.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$370.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$333.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$333.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$351.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$370.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$351.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$370.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$370.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$277.83
|
| Rate for Payer: Healthfirst Commercial |
$370.44
|
| Rate for Payer: Healthfirst Essential Plan |
$833.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$351.92
|
| Rate for Payer: Healthfirst QHP |
$370.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$259.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$370.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$314.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$259.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$370.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$277.83
|
| Rate for Payer: SOMOS Essential |
$277.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$370.44
|
|
|
PR CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION
|
Professional
|
Both
|
$1,813.77
|
|
|
Service Code
|
HCPCS 24655
|
| Min. Negotiated Rate |
$346.30 |
| Max. Negotiated Rate |
$1,113.12 |
| Rate for Payer: Cash Price |
$499.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$494.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$445.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$445.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$469.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$494.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$469.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$494.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$494.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$371.04
|
| Rate for Payer: Healthfirst Commercial |
$494.72
|
| Rate for Payer: Healthfirst Essential Plan |
$1,113.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$469.98
|
| Rate for Payer: Healthfirst QHP |
$494.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$346.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$494.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$420.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$346.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$494.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$371.04
|
| Rate for Payer: SOMOS Essential |
$371.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$494.72
|
|
|
PR CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION
|
Professional
|
Both
|
$1,104.04
|
|
|
Service Code
|
HCPCS 24650
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$689.47 |
| Rate for Payer: Cash Price |
$304.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$306.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$275.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$275.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$291.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$306.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$291.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$306.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$306.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$229.82
|
| Rate for Payer: Healthfirst Commercial |
$306.43
|
| Rate for Payer: Healthfirst Essential Plan |
$689.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$291.11
|
| Rate for Payer: Healthfirst QHP |
$306.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$214.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$306.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$260.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$214.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$306.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$229.82
|
| Rate for Payer: SOMOS Essential |
$229.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$306.43
|
|
|
PR CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$2,065.14
|
|
|
Service Code
|
HCPCS 25505
|
| Min. Negotiated Rate |
$393.01 |
| Max. Negotiated Rate |
$1,263.26 |
| Rate for Payer: Cash Price |
$565.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$561.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$505.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$505.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$533.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$561.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$533.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$561.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$561.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$421.09
|
| Rate for Payer: Healthfirst Commercial |
$561.45
|
| Rate for Payer: Healthfirst Essential Plan |
$1,263.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$533.38
|
| Rate for Payer: Healthfirst QHP |
$561.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$393.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$561.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$477.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$393.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$561.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$421.09
|
| Rate for Payer: SOMOS Essential |
$421.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$561.45
|
|
|
PR CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$1,156.89
|
|
|
Service Code
|
HCPCS 25500
|
| Min. Negotiated Rate |
$223.45 |
| Max. Negotiated Rate |
$718.22 |
| Rate for Payer: Cash Price |
$318.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$319.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$287.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$287.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$303.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$319.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$303.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$319.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$319.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$239.41
|
| Rate for Payer: Healthfirst Commercial |
$319.21
|
| Rate for Payer: Healthfirst Essential Plan |
$718.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$303.25
|
| Rate for Payer: Healthfirst QHP |
$319.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$223.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$319.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$271.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$223.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$319.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$239.41
|
| Rate for Payer: SOMOS Essential |
$239.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$319.21
|
|
|
PR CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ
|
Professional
|
Both
|
$2,096.33
|
|
|
Service Code
|
HCPCS 25565
|
| Min. Negotiated Rate |
$394.39 |
| Max. Negotiated Rate |
$1,267.69 |
| Rate for Payer: Cash Price |
$568.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$563.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$507.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$507.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$535.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$563.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$535.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$563.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$563.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$422.56
|
| Rate for Payer: Healthfirst Commercial |
$563.42
|
| Rate for Payer: Healthfirst Essential Plan |
$1,267.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$535.25
|
| Rate for Payer: Healthfirst QHP |
$563.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$394.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$563.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$478.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$394.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$563.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$422.56
|
| Rate for Payer: SOMOS Essential |
$422.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$563.42
|
|
|
PR CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN
|
Professional
|
Both
|
$1,165.57
|
|
|
Service Code
|
HCPCS 25560
|
| Min. Negotiated Rate |
$224.73 |
| Max. Negotiated Rate |
$722.34 |
| Rate for Payer: Cash Price |
$320.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$321.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$288.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$288.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$321.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$321.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$321.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$240.78
|
| Rate for Payer: Healthfirst Commercial |
$321.04
|
| Rate for Payer: Healthfirst Essential Plan |
$722.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$304.99
|
| Rate for Payer: Healthfirst QHP |
$321.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$224.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$321.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$272.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$224.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$321.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$240.78
|
| Rate for Payer: SOMOS Essential |
$240.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$321.04
|
|
|
PR CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$1,085.84
|
|
|
Service Code
|
HCPCS 23570
|
| Min. Negotiated Rate |
$210.98 |
| Max. Negotiated Rate |
$678.15 |
| Rate for Payer: Cash Price |
$299.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$301.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$271.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$271.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$286.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$301.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$286.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$301.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$301.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$226.05
|
| Rate for Payer: Healthfirst Commercial |
$301.40
|
| Rate for Payer: Healthfirst Essential Plan |
$678.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$286.33
|
| Rate for Payer: Healthfirst QHP |
$301.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$210.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$301.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$256.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$210.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$301.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$226.05
|
| Rate for Payer: SOMOS Essential |
$226.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$301.40
|
|
|
PR CLOSED TX STERNOCLAVICULAR DISLC W/MANIPULATION
|
Professional
|
Both
|
$1,628.66
|
|
|
Service Code
|
HCPCS 23525
|
| Min. Negotiated Rate |
$313.05 |
| Max. Negotiated Rate |
$1,006.25 |
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$447.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$402.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$402.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$424.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$447.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$424.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$447.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$447.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$335.42
|
| Rate for Payer: Healthfirst Commercial |
$447.22
|
| Rate for Payer: Healthfirst Essential Plan |
$1,006.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$424.86
|
| Rate for Payer: Healthfirst QHP |
$447.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$313.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$447.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$380.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$313.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$447.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$335.42
|
| Rate for Payer: SOMOS Essential |
$335.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$447.22
|
|
|
PR CLOSED TX TALOTARSAL JOINT DISLC W/O ANES
|
Professional
|
Both
|
$878.26
|
|
|
Service Code
|
HCPCS 28570
|
| Min. Negotiated Rate |
$171.10 |
| Max. Negotiated Rate |
$549.97 |
| Rate for Payer: Cash Price |
$243.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$244.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$219.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$219.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$232.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$244.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$232.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$244.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$244.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$183.32
|
| Rate for Payer: Healthfirst Commercial |
$244.43
|
| Rate for Payer: Healthfirst Essential Plan |
$549.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$232.21
|
| Rate for Payer: Healthfirst QHP |
$244.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$171.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$244.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$207.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$171.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$244.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$183.32
|
| Rate for Payer: SOMOS Essential |
$183.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$244.43
|
|
|
PR CLOSED TX TALOTARSAL JOINT DISLOCATION W/ANES
|
Professional
|
Both
|
$1,518.34
|
|
|
Service Code
|
HCPCS 28575
|
| Min. Negotiated Rate |
$290.68 |
| Max. Negotiated Rate |
$934.31 |
| Rate for Payer: Cash Price |
$415.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$415.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$373.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$373.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$394.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$415.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$394.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$415.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$415.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$311.44
|
| Rate for Payer: Healthfirst Commercial |
$415.25
|
| Rate for Payer: Healthfirst Essential Plan |
$934.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$394.49
|
| Rate for Payer: Healthfirst QHP |
$415.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$290.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$415.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$352.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$290.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$415.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$311.44
|
| Rate for Payer: SOMOS Essential |
$311.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$415.25
|
|
|
PR CLOSED TX TALUS FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$1,469.83
|
|
|
Service Code
|
HCPCS 28435
|
| Min. Negotiated Rate |
$281.18 |
| Max. Negotiated Rate |
$903.78 |
| Rate for Payer: Cash Price |
$402.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$401.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$361.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$361.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$381.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$401.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$381.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$401.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$401.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$301.26
|
| Rate for Payer: Healthfirst Commercial |
$401.68
|
| Rate for Payer: Healthfirst Essential Plan |
$903.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$381.60
|
| Rate for Payer: Healthfirst QHP |
$401.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$281.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$401.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$341.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$281.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$401.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$301.26
|
| Rate for Payer: SOMOS Essential |
$301.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$401.68
|
|
|
PR CLOSED TX TALUS FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$928.69
|
|
|
Service Code
|
HCPCS 28430
|
| Min. Negotiated Rate |
$178.88 |
| Max. Negotiated Rate |
$574.99 |
| Rate for Payer: Cash Price |
$255.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$255.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$230.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$230.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$242.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$255.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$242.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$255.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$255.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.66
|
| Rate for Payer: Healthfirst Commercial |
$255.55
|
| Rate for Payer: Healthfirst Essential Plan |
$574.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$242.77
|
| Rate for Payer: Healthfirst QHP |
$255.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$178.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$255.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$217.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$178.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$255.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$191.66
|
| Rate for Payer: SOMOS Essential |
$191.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$255.55
|
|
|
PR CLOSED TX TARSOMETATARSAL DISLOCATION W/ANES
|
Professional
|
Both
|
$1,361.61
|
|
|
Service Code
|
HCPCS 28605
|
| Min. Negotiated Rate |
$262.75 |
| Max. Negotiated Rate |
$844.56 |
| Rate for Payer: Cash Price |
$374.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$375.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$337.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$337.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$356.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$375.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$356.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$375.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$375.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$281.52
|
| Rate for Payer: Healthfirst Commercial |
$375.36
|
| Rate for Payer: Healthfirst Essential Plan |
$844.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$356.59
|
| Rate for Payer: Healthfirst QHP |
$375.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$262.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$375.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$319.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$262.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$375.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$281.52
|
| Rate for Payer: SOMOS Essential |
$281.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$375.36
|
|
|
PR CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES
|
Professional
|
Both
|
$808.57
|
|
|
Service Code
|
HCPCS 28600
|
| Min. Negotiated Rate |
$156.85 |
| Max. Negotiated Rate |
$504.16 |
| Rate for Payer: Cash Price |
$189.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$224.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$201.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$201.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$212.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$224.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$212.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$224.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$224.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$168.05
|
| Rate for Payer: Healthfirst Commercial |
$224.07
|
| Rate for Payer: Healthfirst Essential Plan |
$504.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$212.87
|
| Rate for Payer: Healthfirst QHP |
$224.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$156.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$224.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$190.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$156.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$224.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$168.05
|
| Rate for Payer: SOMOS Essential |
$168.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$224.07
|
|
|
PR CLOSED TX TEMPOROMANDIBULAR DISLC COMP 1ST/SBSQ
|
Professional
|
Both
|
$3,402.63
|
|
|
Service Code
|
HCPCS 21485
|
| Min. Negotiated Rate |
$622.21 |
| Max. Negotiated Rate |
$1,999.96 |
| Rate for Payer: Cash Price |
$912.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$888.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$799.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$799.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$844.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$888.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$844.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$888.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$888.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$666.65
|
| Rate for Payer: Healthfirst Commercial |
$888.87
|
| Rate for Payer: Healthfirst Essential Plan |
$1,999.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$844.43
|
| Rate for Payer: Healthfirst QHP |
$888.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$622.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$888.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$755.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$622.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$888.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$666.65
|
| Rate for Payer: SOMOS Essential |
$666.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$888.87
|
|
|
PR CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ
|
Professional
|
Both
|
$137.97
|
|
|
Service Code
|
HCPCS 21480
|
| Min. Negotiated Rate |
$26.04 |
| Max. Negotiated Rate |
$83.70 |
| Rate for Payer: Cash Price |
$36.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.90
|
| Rate for Payer: Healthfirst Commercial |
$37.20
|
| Rate for Payer: Healthfirst Essential Plan |
$83.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.34
|
| Rate for Payer: Healthfirst QHP |
$37.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.90
|
| Rate for Payer: SOMOS Essential |
$27.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.20
|
|
|
PR CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ
|
Professional
|
Both
|
$1,868.34
|
|
|
Service Code
|
HCPCS 24675
|
| Min. Negotiated Rate |
$355.35 |
| Max. Negotiated Rate |
$1,142.19 |
| Rate for Payer: Cash Price |
$510.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$507.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$456.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$456.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$482.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$507.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$482.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$507.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$507.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$380.73
|
| Rate for Payer: Healthfirst Commercial |
$507.64
|
| Rate for Payer: Healthfirst Essential Plan |
$1,142.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$482.26
|
| Rate for Payer: Healthfirst QHP |
$507.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$355.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$507.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$431.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$355.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$507.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$380.73
|
| Rate for Payer: SOMOS Essential |
$380.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$507.64
|
|
|
PR CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ
|
Professional
|
Both
|
$1,206.42
|
|
|
Service Code
|
HCPCS 24670
|
| Min. Negotiated Rate |
$231.27 |
| Max. Negotiated Rate |
$743.36 |
| Rate for Payer: Cash Price |
$330.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$330.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$297.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$297.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$313.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$330.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$313.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$330.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$330.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$247.78
|
| Rate for Payer: Healthfirst Commercial |
$330.38
|
| Rate for Payer: Healthfirst Essential Plan |
$743.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$313.86
|
| Rate for Payer: Healthfirst QHP |
$330.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$231.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$330.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$280.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$231.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$330.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$247.78
|
| Rate for Payer: SOMOS Essential |
$247.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$330.38
|
|
