|
PR CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ
|
Professional
|
Both
|
$1,365.04
|
|
|
Service Code
|
HCPCS 27824
|
| Min. Negotiated Rate |
$261.95 |
| Max. Negotiated Rate |
$842.00 |
| Rate for Payer: Cash Price |
$373.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$374.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$336.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$336.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$355.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$374.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$355.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$374.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$374.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$280.67
|
| Rate for Payer: Healthfirst Commercial |
$374.22
|
| Rate for Payer: Healthfirst Essential Plan |
$842.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$355.51
|
| Rate for Payer: Healthfirst QHP |
$374.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$261.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$374.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$318.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$261.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$374.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$280.67
|
| Rate for Payer: SOMOS Essential |
$280.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$374.22
|
|
|
PR CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ
|
Professional
|
Both
|
$2,196.99
|
|
|
Service Code
|
HCPCS 27825
|
| Min. Negotiated Rate |
$417.65 |
| Max. Negotiated Rate |
$1,342.46 |
| Rate for Payer: Cash Price |
$595.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$596.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$536.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$536.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$566.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$596.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$566.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$596.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$596.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$447.49
|
| Rate for Payer: Healthfirst Commercial |
$596.65
|
| Rate for Payer: Healthfirst Essential Plan |
$1,342.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$566.82
|
| Rate for Payer: Healthfirst QHP |
$596.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$417.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$596.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$507.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$417.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$596.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$447.49
|
| Rate for Payer: SOMOS Essential |
$447.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$596.65
|
|
|
PR CLTX GREATER HUMERAL TUBEROSITY FX W/O MANJ
|
Professional
|
Both
|
$1,170.61
|
|
|
Service Code
|
HCPCS 23620
|
| Min. Negotiated Rate |
$224.41 |
| Max. Negotiated Rate |
$721.33 |
| Rate for Payer: Cash Price |
$320.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$320.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$288.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$288.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$320.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$320.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$320.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$240.44
|
| Rate for Payer: Healthfirst Commercial |
$320.59
|
| Rate for Payer: Healthfirst Essential Plan |
$721.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$304.56
|
| Rate for Payer: Healthfirst QHP |
$320.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$224.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$320.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$272.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$224.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$320.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$240.44
|
| Rate for Payer: SOMOS Essential |
$240.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$320.59
|
|
|
PR CLTX GREATER TROCHANTERIC FX W/O MANJ
|
Professional
|
Both
|
$1,727.25
|
|
|
Service Code
|
HCPCS 27246
|
| Min. Negotiated Rate |
$328.15 |
| Max. Negotiated Rate |
$1,054.78 |
| Rate for Payer: Cash Price |
$470.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$468.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$421.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$421.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$445.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$468.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$445.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$468.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$468.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$351.59
|
| Rate for Payer: Healthfirst Commercial |
$468.79
|
| Rate for Payer: Healthfirst Essential Plan |
$1,054.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$445.35
|
| Rate for Payer: Healthfirst QHP |
$468.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$328.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$468.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$398.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$328.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$468.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$351.59
|
| Rate for Payer: SOMOS Essential |
$351.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$468.79
|
|
|
PR CLTX GRTER HUMERAL TUBEROSITY FX W/MANIPULATION
|
Professional
|
Both
|
$1,598.94
|
|
|
Service Code
|
HCPCS 23625
|
| Min. Negotiated Rate |
$298.84 |
| Max. Negotiated Rate |
$960.57 |
| Rate for Payer: Cash Price |
$434.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$426.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$384.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$384.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$405.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$426.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$405.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$426.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$426.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$320.19
|
| Rate for Payer: Healthfirst Commercial |
$426.92
|
| Rate for Payer: Healthfirst Essential Plan |
$960.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$405.57
|
| Rate for Payer: Healthfirst QHP |
$426.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$298.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$426.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$362.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$298.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$426.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$320.19
|
| Rate for Payer: SOMOS Essential |
$320.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$426.92
|
|
|
PR CLTX HIP DISLOCATION TRAUMATIC REQ ANESTHESIA
|
Professional
|
Both
|
$3,344.32
|
|
|
Service Code
|
HCPCS 27252
|
| Min. Negotiated Rate |
$621.30 |
| Max. Negotiated Rate |
$1,997.03 |
| Rate for Payer: Cash Price |
$895.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$887.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$798.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$798.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$843.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$887.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$843.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$887.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$887.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$665.68
|
| Rate for Payer: Healthfirst Commercial |
$887.57
|
| Rate for Payer: Healthfirst Essential Plan |
$1,997.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$843.19
|
| Rate for Payer: Healthfirst QHP |
$887.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$621.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$887.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$754.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$621.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$887.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$665.68
|
| Rate for Payer: SOMOS Essential |
$665.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$887.57
|
|
|
PR CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA
|
Professional
|
Both
|
$802.55
|
|
|
Service Code
|
HCPCS 27250
|
| Min. Negotiated Rate |
$147.65 |
| Max. Negotiated Rate |
$474.59 |
| Rate for Payer: Cash Price |
$212.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$210.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$189.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$189.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$200.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$200.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$210.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$210.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$158.20
|
| Rate for Payer: Healthfirst Commercial |
$210.93
|
| Rate for Payer: Healthfirst Essential Plan |
$474.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$200.38
|
| Rate for Payer: Healthfirst QHP |
$210.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$147.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$210.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$179.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$147.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$210.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$158.20
|
| Rate for Payer: SOMOS Essential |
$158.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$210.93
|
|
|
PR CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ
|
Professional
|
Both
|
$2,272.76
|
|
|
Service Code
|
HCPCS 24577
|
| Min. Negotiated Rate |
$433.61 |
| Max. Negotiated Rate |
$1,393.74 |
| Rate for Payer: Cash Price |
$619.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$619.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$557.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$557.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$588.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$619.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$588.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$619.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$619.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$464.58
|
| Rate for Payer: Healthfirst Commercial |
$619.44
|
| Rate for Payer: Healthfirst Essential Plan |
$1,393.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$588.47
|
| Rate for Payer: Healthfirst QHP |
$619.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$433.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$619.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$526.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$433.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$619.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$464.58
|
| Rate for Payer: SOMOS Essential |
$464.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$619.44
|
|
|
PR CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ
|
Professional
|
Both
|
$1,407.18
|
|
|
Service Code
|
HCPCS 24576
|
| Min. Negotiated Rate |
$270.55 |
| Max. Negotiated Rate |
$869.62 |
| Rate for Payer: Cash Price |
$387.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$386.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$347.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$347.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$367.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$386.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$367.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$386.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$386.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$289.88
|
| Rate for Payer: Healthfirst Commercial |
$386.50
|
| Rate for Payer: Healthfirst Essential Plan |
$869.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$367.18
|
| Rate for Payer: Healthfirst QHP |
$386.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$270.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$386.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$328.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$270.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$386.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$289.88
|
| Rate for Payer: SOMOS Essential |
$289.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$386.50
|
|
|
PR CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ
|
Professional
|
Both
|
$2,218.51
|
|
|
Service Code
|
HCPCS 24565
|
| Min. Negotiated Rate |
$421.78 |
| Max. Negotiated Rate |
$1,355.71 |
| Rate for Payer: Cash Price |
$605.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$602.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$542.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$542.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$572.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$602.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$572.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$602.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$602.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$451.90
|
| Rate for Payer: Healthfirst Commercial |
$602.54
|
| Rate for Payer: Healthfirst Essential Plan |
$1,355.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$572.41
|
| Rate for Payer: Healthfirst QHP |
$602.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$421.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$602.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$512.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$421.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$602.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$451.90
|
| Rate for Payer: SOMOS Essential |
$451.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$602.54
|
|
|
PR CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ
|
Professional
|
Both
|
$1,328.32
|
|
|
Service Code
|
HCPCS 24560
|
| Min. Negotiated Rate |
$254.33 |
| Max. Negotiated Rate |
$817.49 |
| Rate for Payer: Cash Price |
$363.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$363.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$327.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$327.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$345.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$363.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$345.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$363.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$363.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$272.50
|
| Rate for Payer: Healthfirst Commercial |
$363.33
|
| Rate for Payer: Healthfirst Essential Plan |
$817.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$345.16
|
| Rate for Payer: Healthfirst QHP |
$363.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$254.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$363.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$308.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$254.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$363.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$272.50
|
| Rate for Payer: SOMOS Essential |
$272.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$363.33
|
|
|
PR CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ
|
Professional
|
Both
|
$2,026.01
|
|
|
Service Code
|
HCPCS 24505
|
| Min. Negotiated Rate |
$384.89 |
| Max. Negotiated Rate |
$1,237.14 |
| Rate for Payer: Cash Price |
$553.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$549.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$494.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$494.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$522.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$549.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$522.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$549.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$549.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$412.38
|
| Rate for Payer: Healthfirst Commercial |
$549.84
|
| Rate for Payer: Healthfirst Essential Plan |
$1,237.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$522.35
|
| Rate for Payer: Healthfirst QHP |
$549.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$384.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$549.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$467.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$384.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$549.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$412.38
|
| Rate for Payer: SOMOS Essential |
$412.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$549.84
|
|
|
PR CLTX INTERCONDYLAR SPI&/TUBRST FX KNE W/WO MAN
|
Professional
|
Both
|
$2,012.26
|
|
|
Service Code
|
HCPCS 27538
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$1,231.07 |
| Rate for Payer: Cash Price |
$549.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$547.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$492.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$492.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$519.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$547.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$519.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$547.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$547.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$410.36
|
| Rate for Payer: Healthfirst Commercial |
$547.14
|
| Rate for Payer: Healthfirst Essential Plan |
$1,231.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$519.78
|
| Rate for Payer: Healthfirst QHP |
$547.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$383.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$547.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$465.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$383.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$547.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$410.36
|
| Rate for Payer: SOMOS Essential |
$410.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$547.14
|
|
|
PR CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ
|
Professional
|
Both
|
$2,082.92
|
|
|
Service Code
|
HCPCS 27238
|
| Min. Negotiated Rate |
$395.35 |
| Max. Negotiated Rate |
$1,270.78 |
| Rate for Payer: Cash Price |
$567.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$564.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$508.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$508.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$536.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$564.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$536.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$564.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$564.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$423.59
|
| Rate for Payer: Healthfirst Commercial |
$564.79
|
| Rate for Payer: Healthfirst Essential Plan |
$1,270.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$536.55
|
| Rate for Payer: Healthfirst QHP |
$564.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$395.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$564.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$480.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$395.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$564.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$423.59
|
| Rate for Payer: SOMOS Essential |
$423.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$564.79
|
|
|
PR CLTX INTERPHALANGEAL JOINT DISLOCATION REQ ANES
|
Professional
|
Both
|
$521.68
|
|
|
Service Code
|
HCPCS 28665
|
| Min. Negotiated Rate |
$101.05 |
| Max. Negotiated Rate |
$324.81 |
| Rate for Payer: Cash Price |
$146.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$144.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$129.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$129.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$137.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$144.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$137.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$108.27
|
| Rate for Payer: Healthfirst Commercial |
$144.36
|
| Rate for Payer: Healthfirst Essential Plan |
$324.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$137.14
|
| Rate for Payer: Healthfirst QHP |
$144.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$101.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$144.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$122.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$101.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$144.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$108.27
|
| Rate for Payer: SOMOS Essential |
$108.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$144.36
|
|
|
PR CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES
|
Professional
|
Both
|
$407.40
|
|
|
Service Code
|
HCPCS 28660
|
| Min. Negotiated Rate |
$78.32 |
| Max. Negotiated Rate |
$251.73 |
| Rate for Payer: Cash Price |
$113.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$111.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$100.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$100.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$106.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$111.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$106.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.91
|
| Rate for Payer: Healthfirst Commercial |
$111.88
|
| Rate for Payer: Healthfirst Essential Plan |
$251.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$106.29
|
| Rate for Payer: Healthfirst QHP |
$111.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$111.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$95.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$111.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.91
|
| Rate for Payer: SOMOS Essential |
$83.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.88
|
|
|
PR CLTX INTR/PERI/SBTRCHNTC FEMORAL FX W/MANJ
|
Professional
|
Both
|
$4,234.16
|
|
|
Service Code
|
HCPCS 27240
|
| Min. Negotiated Rate |
$795.70 |
| Max. Negotiated Rate |
$2,557.62 |
| Rate for Payer: Cash Price |
$1,136.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,136.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,023.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,023.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,079.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,136.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,079.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,136.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,136.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$852.54
|
| Rate for Payer: Healthfirst Commercial |
$1,136.72
|
| Rate for Payer: Healthfirst Essential Plan |
$2,557.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,079.88
|
| Rate for Payer: Healthfirst QHP |
$1,136.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$795.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,136.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$966.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$795.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,136.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$852.54
|
| Rate for Payer: SOMOS Essential |
$852.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,136.72
|
|
|
PR CLTX IPHAL JT DISLC W/MANJ REQ ANES
|
Professional
|
Both
|
$1,590.96
|
|
|
Service Code
|
HCPCS 26775
|
| Min. Negotiated Rate |
$303.60 |
| Max. Negotiated Rate |
$975.87 |
| Rate for Payer: Cash Price |
$435.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$433.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$390.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$390.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$412.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$433.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$412.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$433.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$433.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$325.29
|
| Rate for Payer: Healthfirst Commercial |
$433.72
|
| Rate for Payer: Healthfirst Essential Plan |
$975.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$412.03
|
| Rate for Payer: Healthfirst QHP |
$433.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$303.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$433.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$368.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$303.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$433.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$325.29
|
| Rate for Payer: SOMOS Essential |
$325.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$433.72
|
|
|
PR CLTX IPHAL JT DISLC W/MANJ W/O ANES
|
Professional
|
Both
|
$1,179.71
|
|
|
Service Code
|
HCPCS 26770
|
| Min. Negotiated Rate |
$227.66 |
| Max. Negotiated Rate |
$731.77 |
| Rate for Payer: Cash Price |
$324.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$325.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$292.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$292.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$308.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$325.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$308.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$325.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$325.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$243.92
|
| Rate for Payer: Healthfirst Commercial |
$325.23
|
| Rate for Payer: Healthfirst Essential Plan |
$731.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$308.97
|
| Rate for Payer: Healthfirst QHP |
$325.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$227.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$325.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$276.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$227.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$325.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$243.92
|
| Rate for Payer: SOMOS Essential |
$243.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$325.23
|
|
|
PR CLTX MANDIBULAR/MAXILLARY ALVEOLAR RIDGE FX SPX
|
Professional
|
Both
|
$2,374.96
|
|
|
Service Code
|
HCPCS 21440
|
| Min. Negotiated Rate |
$483.55 |
| Max. Negotiated Rate |
$1,554.26 |
| Rate for Payer: Cash Price |
$709.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$690.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$621.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$621.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$656.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$690.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$656.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$690.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$690.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$518.09
|
| Rate for Payer: Healthfirst Commercial |
$690.78
|
| Rate for Payer: Healthfirst Essential Plan |
$1,554.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$656.24
|
| Rate for Payer: Healthfirst QHP |
$690.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$483.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$690.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$587.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$483.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$690.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$518.09
|
| Rate for Payer: SOMOS Essential |
$518.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$690.78
|
|
|
PR CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION
|
Professional
|
Both
|
$1,364.72
|
|
|
Service Code
|
HCPCS 27760
|
| Min. Negotiated Rate |
$264.17 |
| Max. Negotiated Rate |
$849.13 |
| Rate for Payer: Cash Price |
$377.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$377.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$339.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$339.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$358.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$377.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$358.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$377.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$377.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$283.04
|
| Rate for Payer: Healthfirst Commercial |
$377.39
|
| Rate for Payer: Healthfirst Essential Plan |
$849.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$358.52
|
| Rate for Payer: Healthfirst QHP |
$377.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$264.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$377.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$320.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$264.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$377.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$283.04
|
| Rate for Payer: SOMOS Essential |
$283.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$377.39
|
|
|
PR CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ
|
Professional
|
Both
|
$1,955.52
|
|
|
Service Code
|
HCPCS 27762
|
| Min. Negotiated Rate |
$372.15 |
| Max. Negotiated Rate |
$1,196.19 |
| Rate for Payer: Cash Price |
$538.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$531.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$478.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$478.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$505.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$531.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$505.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$531.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$531.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$398.73
|
| Rate for Payer: Healthfirst Commercial |
$531.64
|
| Rate for Payer: Healthfirst Essential Plan |
$1,196.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$505.06
|
| Rate for Payer: Healthfirst QHP |
$531.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$372.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$531.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$451.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$372.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$531.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$398.73
|
| Rate for Payer: SOMOS Essential |
$398.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$531.64
|
|
|
PR CLTX METACARPAL FX W/MANIPULATION EACH BONE
|
Professional
|
Both
|
$1,337.46
|
|
|
Service Code
|
HCPCS 26605
|
| Min. Negotiated Rate |
$256.07 |
| Max. Negotiated Rate |
$823.10 |
| Rate for Payer: Cash Price |
$366.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$365.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$329.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$329.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$347.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$365.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$347.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$365.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$365.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$274.37
|
| Rate for Payer: Healthfirst Commercial |
$365.82
|
| Rate for Payer: Healthfirst Essential Plan |
$823.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$347.53
|
| Rate for Payer: Healthfirst QHP |
$365.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$256.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$365.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$310.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$256.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$365.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$274.37
|
| Rate for Payer: SOMOS Essential |
$274.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$365.82
|
|
|
PR CLTX METACARPAL FX W/MANJ W/XTRNL FIXJ EA BONE
|
Professional
|
Both
|
$2,270.87
|
|
|
Service Code
|
HCPCS 26607
|
| Min. Negotiated Rate |
$425.04 |
| Max. Negotiated Rate |
$1,366.20 |
| Rate for Payer: Cash Price |
$614.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$607.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$546.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$546.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$576.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$607.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$576.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$607.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$607.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$455.40
|
| Rate for Payer: Healthfirst Commercial |
$607.20
|
| Rate for Payer: Healthfirst Essential Plan |
$1,366.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$576.84
|
| Rate for Payer: Healthfirst QHP |
$607.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$425.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$607.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$516.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$425.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$607.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$455.40
|
| Rate for Payer: SOMOS Essential |
$455.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$607.20
|
|
|
PR CLTX METACARPAL FX W/O MANIPULATION EACH BONE
|
Professional
|
Both
|
$1,286.29
|
|
|
Service Code
|
HCPCS 26600
|
| Min. Negotiated Rate |
$248.72 |
| Max. Negotiated Rate |
$799.45 |
| Rate for Payer: Cash Price |
$354.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$355.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$319.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$319.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$337.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$355.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$337.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$355.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$266.48
|
| Rate for Payer: Healthfirst Commercial |
$355.31
|
| Rate for Payer: Healthfirst Essential Plan |
$799.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$337.54
|
| Rate for Payer: Healthfirst QHP |
$355.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$248.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$355.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$302.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$248.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$355.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$266.48
|
| Rate for Payer: SOMOS Essential |
$266.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$355.31
|
|
