|
PR CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ
|
Professional
|
Both
|
$987.25
|
|
|
Service Code
|
HCPCS 26740
|
| Min. Negotiated Rate |
$191.51 |
| Max. Negotiated Rate |
$615.55 |
| Rate for Payer: Cash Price |
$272.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$273.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$246.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$246.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$259.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$273.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$259.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$273.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$273.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$205.19
|
| Rate for Payer: Healthfirst Commercial |
$273.58
|
| Rate for Payer: Healthfirst Essential Plan |
$615.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$259.90
|
| Rate for Payer: Healthfirst QHP |
$273.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$191.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$273.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$232.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$191.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$273.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$205.19
|
| Rate for Payer: SOMOS Essential |
$205.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$273.58
|
|
|
PR CLTX CARPAL BONE FX W/MANJ EACH BONE
|
Professional
|
Both
|
$1,894.45
|
|
|
Service Code
|
HCPCS 25635
|
| Min. Negotiated Rate |
$362.96 |
| Max. Negotiated Rate |
$1,166.65 |
| Rate for Payer: Cash Price |
$519.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$518.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$466.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$466.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$492.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$518.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$492.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$518.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$518.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$388.88
|
| Rate for Payer: Healthfirst Commercial |
$518.51
|
| Rate for Payer: Healthfirst Essential Plan |
$1,166.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$492.58
|
| Rate for Payer: Healthfirst QHP |
$518.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$362.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$518.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$440.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$362.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$518.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$388.88
|
| Rate for Payer: SOMOS Essential |
$388.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$518.51
|
|
|
PR CLTX CARPAL BONE FX W/O MANJ EACH BONE
|
Professional
|
Both
|
$1,279.95
|
|
|
Service Code
|
HCPCS 25630
|
| Min. Negotiated Rate |
$245.86 |
| Max. Negotiated Rate |
$790.27 |
| Rate for Payer: Cash Price |
$350.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$351.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$316.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$316.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$333.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$351.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$333.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$351.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$351.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$263.42
|
| Rate for Payer: Healthfirst Commercial |
$351.23
|
| Rate for Payer: Healthfirst Essential Plan |
$790.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$333.67
|
| Rate for Payer: Healthfirst QHP |
$351.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$245.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$351.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$298.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$245.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$351.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$263.42
|
| Rate for Payer: SOMOS Essential |
$263.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$351.23
|
|
|
PR CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ
|
Professional
|
Both
|
$1,713.39
|
|
|
Service Code
|
HCPCS 26641
|
| Min. Negotiated Rate |
$328.31 |
| Max. Negotiated Rate |
$1,055.27 |
| Rate for Payer: Cash Price |
$470.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$469.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$422.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$422.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$445.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$469.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$445.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$469.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$469.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$351.76
|
| Rate for Payer: Healthfirst Commercial |
$469.01
|
| Rate for Payer: Healthfirst Essential Plan |
$1,055.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$445.56
|
| Rate for Payer: Healthfirst QHP |
$469.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$328.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$469.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$398.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$328.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$469.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$351.76
|
| Rate for Payer: SOMOS Essential |
$351.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$469.01
|
|
|
PR CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ
|
Professional
|
Both
|
$1,772.82
|
|
|
Service Code
|
HCPCS 26645
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$1,086.43 |
| Rate for Payer: Cash Price |
$484.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$482.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$434.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$434.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$458.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$482.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$458.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$482.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$482.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$362.14
|
| Rate for Payer: Healthfirst Commercial |
$482.86
|
| Rate for Payer: Healthfirst Essential Plan |
$1,086.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$458.72
|
| Rate for Payer: Healthfirst QHP |
$482.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$338.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$482.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$410.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$338.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$482.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$362.14
|
| Rate for Payer: SOMOS Essential |
$362.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$482.86
|
|
|
PR CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES
|
Professional
|
Both
|
$1,403.68
|
|
|
Service Code
|
HCPCS 26670
|
| Min. Negotiated Rate |
$272.18 |
| Max. Negotiated Rate |
$874.87 |
| Rate for Payer: Cash Price |
$386.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$388.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$349.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$349.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$369.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$388.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$369.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$388.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$388.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$291.62
|
| Rate for Payer: Healthfirst Commercial |
$388.83
|
| Rate for Payer: Healthfirst Essential Plan |
$874.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$369.39
|
| Rate for Payer: Healthfirst QHP |
$388.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$272.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$388.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$330.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$272.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$388.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$291.62
|
| Rate for Payer: SOMOS Essential |
$291.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$388.83
|
|
|
PR CLTX CARPO/MTCRPL DISLC THUMB MANJ EA JT W/ANES
|
Professional
|
Both
|
$1,895.29
|
|
|
Service Code
|
HCPCS 26675
|
| Min. Negotiated Rate |
$361.73 |
| Max. Negotiated Rate |
$1,162.71 |
| Rate for Payer: Cash Price |
$518.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$516.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$465.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$465.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$490.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$516.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$490.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$516.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$516.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$387.57
|
| Rate for Payer: Healthfirst Commercial |
$516.76
|
| Rate for Payer: Healthfirst Essential Plan |
$1,162.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$490.92
|
| Rate for Payer: Healthfirst QHP |
$516.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$361.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$516.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$439.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$361.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$516.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$387.57
|
| Rate for Payer: SOMOS Essential |
$387.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$516.76
|
|
|
PR CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ
|
Professional
|
Both
|
$2,169.37
|
|
|
Service Code
|
HCPCS 27516
|
| Min. Negotiated Rate |
$413.34 |
| Max. Negotiated Rate |
$1,328.60 |
| Rate for Payer: Cash Price |
$592.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$590.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$531.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$531.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$560.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$590.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$560.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$590.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$590.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$442.87
|
| Rate for Payer: Healthfirst Commercial |
$590.49
|
| Rate for Payer: Healthfirst Essential Plan |
$1,328.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$560.97
|
| Rate for Payer: Healthfirst QHP |
$590.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$413.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$590.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$501.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$413.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$590.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$442.87
|
| Rate for Payer: SOMOS Essential |
$442.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$590.49
|
|
|
PR CLTX DSTL FEM EPIPHYSL SEP W/MANJ W/WO SKIN/SKEL
|
Professional
|
Both
|
$3,071.57
|
|
|
Service Code
|
HCPCS 27517
|
| Min. Negotiated Rate |
$581.29 |
| Max. Negotiated Rate |
$1,868.44 |
| Rate for Payer: Cash Price |
$830.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$830.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$747.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$747.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$788.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$830.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$788.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$830.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$830.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$622.82
|
| Rate for Payer: Healthfirst Commercial |
$830.42
|
| Rate for Payer: Healthfirst Essential Plan |
$1,868.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$788.90
|
| Rate for Payer: Healthfirst QHP |
$830.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$581.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$830.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$705.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$581.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$830.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$622.82
|
| Rate for Payer: SOMOS Essential |
$622.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$830.42
|
|
|
PR CLTX DSTL FIBULAR FX LAT MALLS W/MANJ
|
Professional
|
Both
|
$1,724.56
|
|
|
Service Code
|
HCPCS 27788
|
| Min. Negotiated Rate |
$327.29 |
| Max. Negotiated Rate |
$1,051.99 |
| Rate for Payer: Cash Price |
$470.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$467.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$420.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$420.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$444.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$467.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$444.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$467.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$467.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$350.66
|
| Rate for Payer: Healthfirst Commercial |
$467.55
|
| Rate for Payer: Healthfirst Essential Plan |
$1,051.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$444.17
|
| Rate for Payer: Healthfirst QHP |
$467.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$327.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$467.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$397.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$327.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$467.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$350.66
|
| Rate for Payer: SOMOS Essential |
$350.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$467.55
|
|
|
PR CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ
|
Professional
|
Both
|
$1,283.56
|
|
|
Service Code
|
HCPCS 27786
|
| Min. Negotiated Rate |
$244.66 |
| Max. Negotiated Rate |
$786.40 |
| Rate for Payer: Cash Price |
$351.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$349.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$314.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$314.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$332.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$349.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$332.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$349.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$349.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$262.13
|
| Rate for Payer: Healthfirst Commercial |
$349.51
|
| Rate for Payer: Healthfirst Essential Plan |
$786.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$332.03
|
| Rate for Payer: Healthfirst QHP |
$349.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$244.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$349.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$297.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$244.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$349.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$262.13
|
| Rate for Payer: SOMOS Essential |
$262.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$349.51
|
|
|
PR CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA
|
Professional
|
Both
|
$1,240.93
|
|
|
Service Code
|
HCPCS 26755
|
| Min. Negotiated Rate |
$237.64 |
| Max. Negotiated Rate |
$763.83 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$339.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$305.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$305.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$322.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$339.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$322.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$339.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$339.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$254.61
|
| Rate for Payer: Healthfirst Commercial |
$339.48
|
| Rate for Payer: Healthfirst Essential Plan |
$763.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$322.51
|
| Rate for Payer: Healthfirst QHP |
$339.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$237.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$339.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$288.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$237.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$339.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$254.61
|
| Rate for Payer: SOMOS Essential |
$254.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$339.48
|
|
|
PR CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA
|
Professional
|
Both
|
$854.53
|
|
|
Service Code
|
HCPCS 26750
|
| Min. Negotiated Rate |
$166.04 |
| Max. Negotiated Rate |
$533.70 |
| Rate for Payer: Cash Price |
$235.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$237.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$213.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$213.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$225.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$237.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$225.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$237.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$237.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$177.90
|
| Rate for Payer: Healthfirst Commercial |
$237.20
|
| Rate for Payer: Healthfirst Essential Plan |
$533.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.34
|
| Rate for Payer: Healthfirst QHP |
$237.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$166.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$237.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$201.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$166.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$237.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$177.90
|
| Rate for Payer: SOMOS Essential |
$177.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$237.20
|
|
|
PR CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ
|
Professional
|
Both
|
$1,454.74
|
|
|
Service Code
|
HCPCS 25600
|
| Min. Negotiated Rate |
$280.88 |
| Max. Negotiated Rate |
$902.81 |
| Rate for Payer: Cash Price |
$400.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$401.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$361.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$361.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$381.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$401.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$381.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$401.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$401.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$300.94
|
| Rate for Payer: Healthfirst Commercial |
$401.25
|
| Rate for Payer: Healthfirst Essential Plan |
$902.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$381.19
|
| Rate for Payer: Healthfirst QHP |
$401.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$280.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$401.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$341.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$280.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$401.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$300.94
|
| Rate for Payer: SOMOS Essential |
$300.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$401.25
|
|
|
PR CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF
|
Professional
|
Both
|
$2,293.52
|
|
|
Service Code
|
HCPCS 25605
|
| Min. Negotiated Rate |
$434.18 |
| Max. Negotiated Rate |
$1,395.56 |
| Rate for Payer: Cash Price |
$623.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$620.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$558.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$558.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$589.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$620.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$589.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$620.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$620.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$465.19
|
| Rate for Payer: Healthfirst Commercial |
$620.25
|
| Rate for Payer: Healthfirst Essential Plan |
$1,395.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$589.24
|
| Rate for Payer: Healthfirst QHP |
$620.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$434.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$620.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$527.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$434.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$620.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$465.19
|
| Rate for Payer: SOMOS Essential |
$465.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$620.25
|
|
|
PR CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING
|
Professional
|
Both
|
$2,413.60
|
|
|
Service Code
|
HCPCS 26432
|
| Min. Negotiated Rate |
$449.03 |
| Max. Negotiated Rate |
$1,443.31 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$641.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$577.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$577.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$609.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$641.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$609.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$641.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$641.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$481.10
|
| Rate for Payer: Healthfirst Commercial |
$641.47
|
| Rate for Payer: Healthfirst Essential Plan |
$1,443.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$609.40
|
| Rate for Payer: Healthfirst QHP |
$641.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$449.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$641.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$545.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$449.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$641.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$481.10
|
| Rate for Payer: SOMOS Essential |
$481.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$641.47
|
|
|
PR CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/MANJ
|
Professional
|
Both
|
$3,032.89
|
|
|
Service Code
|
HCPCS 27510
|
| Min. Negotiated Rate |
$569.08 |
| Max. Negotiated Rate |
$1,829.18 |
| Rate for Payer: Cash Price |
$819.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$812.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$731.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$731.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$772.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$812.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$772.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$812.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$812.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$609.73
|
| Rate for Payer: Healthfirst Commercial |
$812.97
|
| Rate for Payer: Healthfirst Essential Plan |
$1,829.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$772.32
|
| Rate for Payer: Healthfirst QHP |
$812.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$569.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$812.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$691.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$569.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$812.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$609.73
|
| Rate for Payer: SOMOS Essential |
$609.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$812.97
|
|
|
PR CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ
|
Professional
|
Both
|
$2,220.23
|
|
|
Service Code
|
HCPCS 27508
|
| Min. Negotiated Rate |
$421.50 |
| Max. Negotiated Rate |
$1,354.84 |
| Rate for Payer: Cash Price |
$604.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$602.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$541.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$541.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$572.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$602.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$572.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$602.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$602.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$451.61
|
| Rate for Payer: Healthfirst Commercial |
$602.15
|
| Rate for Payer: Healthfirst Essential Plan |
$1,354.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$572.04
|
| Rate for Payer: Healthfirst QHP |
$602.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$421.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$602.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$511.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$421.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$602.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$451.61
|
| Rate for Payer: SOMOS Essential |
$451.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$602.15
|
|
|
PR CLTX FEM FX PROX END NCK W/MANJ W/WO SKEL TRACJ
|
Professional
|
Both
|
$3,223.54
|
|
|
Service Code
|
HCPCS 27232
|
| Min. Negotiated Rate |
$606.98 |
| Max. Negotiated Rate |
$1,951.02 |
| Rate for Payer: Cash Price |
$866.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$867.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$780.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$780.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$823.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$867.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$823.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$867.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$867.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$650.34
|
| Rate for Payer: Healthfirst Commercial |
$867.12
|
| Rate for Payer: Healthfirst Essential Plan |
$1,951.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$823.76
|
| Rate for Payer: Healthfirst QHP |
$867.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$606.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$867.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$737.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$606.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$867.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$650.34
|
| Rate for Payer: SOMOS Essential |
$650.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$867.12
|
|
|
PR CLTX FEM FX PROX END NCK W/O MANJ
|
Professional
|
Both
|
$2,129.09
|
|
|
Service Code
|
HCPCS 27230
|
| Min. Negotiated Rate |
$403.75 |
| Max. Negotiated Rate |
$1,297.78 |
| Rate for Payer: Cash Price |
$581.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$576.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$519.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$519.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$547.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$576.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$547.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$576.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$576.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$432.59
|
| Rate for Payer: Healthfirst Commercial |
$576.79
|
| Rate for Payer: Healthfirst Essential Plan |
$1,297.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$547.95
|
| Rate for Payer: Healthfirst QHP |
$576.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$403.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$576.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$490.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$403.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$576.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$432.59
|
| Rate for Payer: SOMOS Essential |
$432.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$576.79
|
|
|
PR CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ
|
Professional
|
Both
|
$3,357.52
|
|
|
Service Code
|
HCPCS 27502
|
| Min. Negotiated Rate |
$628.54 |
| Max. Negotiated Rate |
$2,020.30 |
| Rate for Payer: Cash Price |
$902.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$897.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$808.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$808.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$853.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$897.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$853.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$897.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$897.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$673.43
|
| Rate for Payer: Healthfirst Commercial |
$897.91
|
| Rate for Payer: Healthfirst Essential Plan |
$2,020.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$853.01
|
| Rate for Payer: Healthfirst QHP |
$897.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$628.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$897.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$763.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$628.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$897.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$673.43
|
| Rate for Payer: SOMOS Essential |
$673.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$897.91
|
|
|
PR CLTX FX GRT TOE PHLX/PHLG W/MANJ
|
Professional
|
Both
|
$640.47
|
|
|
Service Code
|
HCPCS 28495
|
| Min. Negotiated Rate |
$125.47 |
| Max. Negotiated Rate |
$403.29 |
| Rate for Payer: Cash Price |
$178.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$179.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$161.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$161.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$170.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$179.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$170.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$134.43
|
| Rate for Payer: Healthfirst Commercial |
$179.24
|
| Rate for Payer: Healthfirst Essential Plan |
$403.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$170.28
|
| Rate for Payer: Healthfirst QHP |
$179.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$125.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$179.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$152.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$125.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$179.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$134.43
|
| Rate for Payer: SOMOS Essential |
$134.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$179.24
|
|
|
PR CLTX FX GRT TOE PHLX/PHLG W/O MANJ
|
Professional
|
Both
|
$546.67
|
|
|
Service Code
|
HCPCS 28490
|
| Min. Negotiated Rate |
$105.78 |
| Max. Negotiated Rate |
$340.02 |
| Rate for Payer: Cash Price |
$150.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$151.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$136.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$136.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$143.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$151.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$143.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$151.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$151.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.34
|
| Rate for Payer: Healthfirst Commercial |
$151.12
|
| Rate for Payer: Healthfirst Essential Plan |
$340.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$143.56
|
| Rate for Payer: Healthfirst QHP |
$151.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$151.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$128.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$151.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$113.34
|
| Rate for Payer: SOMOS Essential |
$113.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$151.12
|
|
|
PR CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ
|
Professional
|
Both
|
$618.38
|
|
|
Service Code
|
HCPCS 28515
|
| Min. Negotiated Rate |
$119.53 |
| Max. Negotiated Rate |
$384.21 |
| Rate for Payer: Cash Price |
$171.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$170.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$153.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$170.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$170.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$128.07
|
| Rate for Payer: Healthfirst Commercial |
$170.76
|
| Rate for Payer: Healthfirst Essential Plan |
$384.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$162.22
|
| Rate for Payer: Healthfirst QHP |
$170.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$119.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$170.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$145.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$119.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$170.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$128.07
|
| Rate for Payer: SOMOS Essential |
$128.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$170.76
|
|
|
PR CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ
|
Professional
|
Both
|
$521.22
|
|
|
Service Code
|
HCPCS 28510
|
| Min. Negotiated Rate |
$102.09 |
| Max. Negotiated Rate |
$328.14 |
| Rate for Payer: Cash Price |
$145.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$145.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$131.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$131.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$138.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$145.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$138.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$145.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$145.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$109.38
|
| Rate for Payer: Healthfirst Commercial |
$145.84
|
| Rate for Payer: Healthfirst Essential Plan |
$328.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$138.55
|
| Rate for Payer: Healthfirst QHP |
$145.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$102.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$145.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$123.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$102.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$145.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$109.38
|
| Rate for Payer: SOMOS Essential |
$109.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$145.84
|
|
