|
PR CLTX METACARPOPHALANGEAL DISLC W/MANJ W/ANES
|
Professional
|
Both
|
$1,782.55
|
|
|
Service Code
|
HCPCS 26705
|
| Min. Negotiated Rate |
$339.61 |
| Max. Negotiated Rate |
$1,091.59 |
| Rate for Payer: Cash Price |
$487.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$485.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$436.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$436.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$460.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$485.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$460.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$485.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$485.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$363.86
|
| Rate for Payer: Healthfirst Commercial |
$485.15
|
| Rate for Payer: Healthfirst Essential Plan |
$1,091.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$460.89
|
| Rate for Payer: Healthfirst QHP |
$485.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$339.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$485.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$412.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$339.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$485.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$363.86
|
| Rate for Payer: SOMOS Essential |
$363.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$485.15
|
|
|
PR CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES
|
Professional
|
Both
|
$1,412.29
|
|
|
Service Code
|
HCPCS 26700
|
| Min. Negotiated Rate |
$270.07 |
| Max. Negotiated Rate |
$868.07 |
| Rate for Payer: Cash Price |
$385.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$385.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$347.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$347.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$366.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$385.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$366.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$385.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$385.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$289.36
|
| Rate for Payer: Healthfirst Commercial |
$385.81
|
| Rate for Payer: Healthfirst Essential Plan |
$868.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$366.52
|
| Rate for Payer: Healthfirst QHP |
$385.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$270.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$385.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$327.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$270.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$385.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$289.36
|
| Rate for Payer: SOMOS Essential |
$289.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$385.81
|
|
|
PR CLTX METAR FX W/MANJ
|
Professional
|
Both
|
$978.78
|
|
|
Service Code
|
HCPCS 28475
|
| Min. Negotiated Rate |
$190.92 |
| Max. Negotiated Rate |
$613.66 |
| Rate for Payer: Cash Price |
$273.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$272.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$245.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$245.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$259.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$272.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$259.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$272.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$272.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$204.56
|
| Rate for Payer: Healthfirst Commercial |
$272.74
|
| Rate for Payer: Healthfirst Essential Plan |
$613.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$259.10
|
| Rate for Payer: Healthfirst QHP |
$272.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$190.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$272.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$231.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$190.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$272.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$204.56
|
| Rate for Payer: SOMOS Essential |
$204.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$272.74
|
|
|
PR CLTX METATARSOPHLNGL JT DISLC REQ ANES
|
Professional
|
Both
|
$571.48
|
|
|
Service Code
|
HCPCS 28635
|
| Min. Negotiated Rate |
$106.07 |
| Max. Negotiated Rate |
$340.94 |
| Rate for Payer: Cash Price |
$152.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$151.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$136.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$136.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$143.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$151.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$143.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$151.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$151.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.65
|
| Rate for Payer: Healthfirst Commercial |
$151.53
|
| Rate for Payer: Healthfirst Essential Plan |
$340.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$143.95
|
| Rate for Payer: Healthfirst QHP |
$151.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$106.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$151.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$128.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$106.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$151.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$113.65
|
| Rate for Payer: SOMOS Essential |
$113.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$151.53
|
|
|
PR CLTX METATARSOPHLNGL JT DISLC W/O ANES
|
Professional
|
Both
|
$478.63
|
|
|
Service Code
|
HCPCS 28630
|
| Min. Negotiated Rate |
$91.38 |
| Max. Negotiated Rate |
$293.71 |
| Rate for Payer: Cash Price |
$130.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$130.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$117.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$117.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$124.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$130.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$124.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.91
|
| Rate for Payer: Healthfirst Commercial |
$130.54
|
| Rate for Payer: Healthfirst Essential Plan |
$293.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$124.01
|
| Rate for Payer: Healthfirst QHP |
$130.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$91.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$130.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$110.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$91.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$130.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$97.91
|
| Rate for Payer: SOMOS Essential |
$97.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.54
|
|
|
PR CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA
|
Professional
|
Both
|
$1,369.55
|
|
|
Service Code
|
HCPCS 26725
|
| Min. Negotiated Rate |
$261.81 |
| Max. Negotiated Rate |
$841.52 |
| Rate for Payer: Cash Price |
$375.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$374.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$336.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$336.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$355.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$374.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$355.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$374.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$374.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$280.51
|
| Rate for Payer: Healthfirst Commercial |
$374.01
|
| Rate for Payer: Healthfirst Essential Plan |
$841.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$355.31
|
| Rate for Payer: Healthfirst QHP |
$374.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$261.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$374.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$317.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$261.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$374.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$280.51
|
| Rate for Payer: SOMOS Essential |
$280.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$374.01
|
|
|
PR CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA
|
Professional
|
Both
|
$849.66
|
|
|
Service Code
|
HCPCS 26720
|
| Min. Negotiated Rate |
$164.64 |
| Max. Negotiated Rate |
$529.20 |
| Rate for Payer: Cash Price |
$234.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$235.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$211.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$211.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$223.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$235.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$223.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$235.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$235.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$176.40
|
| Rate for Payer: Healthfirst Commercial |
$235.20
|
| Rate for Payer: Healthfirst Essential Plan |
$529.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$223.44
|
| Rate for Payer: Healthfirst QHP |
$235.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$164.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$235.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$199.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$164.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$235.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$176.40
|
| Rate for Payer: SOMOS Essential |
$176.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$235.20
|
|
|
PR CLTX POST HIP ARTHRP DISLC REQ ANES
|
Professional
|
Both
|
$2,597.42
|
|
|
Service Code
|
HCPCS 27266
|
| Min. Negotiated Rate |
$487.04 |
| Max. Negotiated Rate |
$1,565.48 |
| Rate for Payer: Cash Price |
$701.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$695.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$626.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$626.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$660.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$695.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$660.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$695.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$695.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$521.83
|
| Rate for Payer: Healthfirst Commercial |
$695.77
|
| Rate for Payer: Healthfirst Essential Plan |
$1,565.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$660.98
|
| Rate for Payer: Healthfirst QHP |
$695.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$487.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$695.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$591.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$487.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$695.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$521.83
|
| Rate for Payer: SOMOS Essential |
$521.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$695.77
|
|
|
PR CLTX POST HIP ARTHRP DISLC W/O ANES
|
Professional
|
Both
|
$1,862.04
|
|
|
Service Code
|
HCPCS 27265
|
| Min. Negotiated Rate |
$355.19 |
| Max. Negotiated Rate |
$1,141.67 |
| Rate for Payer: Cash Price |
$509.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$507.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$456.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$456.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$482.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$507.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$482.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$507.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$507.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$380.56
|
| Rate for Payer: Healthfirst Commercial |
$507.41
|
| Rate for Payer: Healthfirst Essential Plan |
$1,141.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$482.04
|
| Rate for Payer: Healthfirst QHP |
$507.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$355.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$507.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$431.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$355.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$507.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$380.56
|
| Rate for Payer: SOMOS Essential |
$380.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$507.41
|
|
|
PR CLTX PROX FIBULA/SHFT FX W/MANJ
|
Professional
|
Both
|
$1,808.56
|
|
|
Service Code
|
HCPCS 27781
|
| Min. Negotiated Rate |
$343.74 |
| Max. Negotiated Rate |
$1,104.88 |
| Rate for Payer: Cash Price |
$493.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$491.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$441.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$441.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$466.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$491.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$466.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$491.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$491.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$368.30
|
| Rate for Payer: Healthfirst Commercial |
$491.06
|
| Rate for Payer: Healthfirst Essential Plan |
$1,104.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$466.51
|
| Rate for Payer: Healthfirst QHP |
$491.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$343.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$491.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$417.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$343.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$491.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$368.30
|
| Rate for Payer: SOMOS Essential |
$368.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$491.06
|
|
|
PR CLTX PROX FIBULA/SHFT FX W/O MANJ
|
Professional
|
Both
|
$1,278.45
|
|
|
Service Code
|
HCPCS 27780
|
| Min. Negotiated Rate |
$245.56 |
| Max. Negotiated Rate |
$789.30 |
| Rate for Payer: Cash Price |
$350.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$350.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$315.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$315.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$333.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$350.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$333.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$350.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$350.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$263.10
|
| Rate for Payer: Healthfirst Commercial |
$350.80
|
| Rate for Payer: Healthfirst Essential Plan |
$789.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$333.26
|
| Rate for Payer: Healthfirst QHP |
$350.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$245.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$350.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$298.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$245.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$350.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$263.10
|
| Rate for Payer: SOMOS Essential |
$263.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$350.80
|
|
|
PR CLTX PROX HUMRL FX W/MANJ W/WO SKELETAL TRACJ
|
Professional
|
Both
|
$1,916.36
|
|
|
Service Code
|
HCPCS 23605
|
| Min. Negotiated Rate |
$363.85 |
| Max. Negotiated Rate |
$1,169.51 |
| Rate for Payer: Cash Price |
$523.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$519.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$467.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$467.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$493.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$519.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$493.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$519.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$519.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$389.83
|
| Rate for Payer: Healthfirst Commercial |
$519.78
|
| Rate for Payer: Healthfirst Essential Plan |
$1,169.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$493.79
|
| Rate for Payer: Healthfirst QHP |
$519.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$363.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$519.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$441.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$363.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$519.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$389.83
|
| Rate for Payer: SOMOS Essential |
$389.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$519.78
|
|
|
PR CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$1,418.52
|
|
|
Service Code
|
HCPCS 23600
|
| Min. Negotiated Rate |
$273.29 |
| Max. Negotiated Rate |
$878.42 |
| Rate for Payer: Cash Price |
$389.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$390.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$351.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$351.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$370.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$390.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$370.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$390.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$390.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$292.81
|
| Rate for Payer: Healthfirst Commercial |
$390.41
|
| Rate for Payer: Healthfirst Essential Plan |
$878.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$370.89
|
| Rate for Payer: Healthfirst QHP |
$390.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$273.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$390.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$331.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$273.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$390.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$292.81
|
| Rate for Payer: SOMOS Essential |
$292.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$390.41
|
|
|
PR CLTX PROX TIBFIB JT DISLC REQ ANES
|
Professional
|
Both
|
$1,828.44
|
|
|
Service Code
|
HCPCS 27831
|
| Min. Negotiated Rate |
$348.95 |
| Max. Negotiated Rate |
$1,121.62 |
| Rate for Payer: Cash Price |
$498.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$498.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$448.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$448.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$473.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$498.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$473.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$498.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$498.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$373.88
|
| Rate for Payer: Healthfirst Commercial |
$498.50
|
| Rate for Payer: Healthfirst Essential Plan |
$1,121.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$473.57
|
| Rate for Payer: Healthfirst QHP |
$498.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$348.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$498.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$423.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$348.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$498.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$373.88
|
| Rate for Payer: SOMOS Essential |
$373.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$498.50
|
|
|
PR CLTX PROX TIBFIB JT DISLC W/O ANES
|
Professional
|
Both
|
$1,616.34
|
|
|
Service Code
|
HCPCS 27830
|
| Min. Negotiated Rate |
$309.33 |
| Max. Negotiated Rate |
$994.27 |
| Rate for Payer: Cash Price |
$441.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$441.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$397.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$397.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$419.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$441.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$419.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$441.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$441.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$331.43
|
| Rate for Payer: Healthfirst Commercial |
$441.90
|
| Rate for Payer: Healthfirst Essential Plan |
$994.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$419.81
|
| Rate for Payer: Healthfirst QHP |
$441.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$309.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$441.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$375.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$309.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$441.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$331.43
|
| Rate for Payer: SOMOS Essential |
$331.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$441.90
|
|
|
PR CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ
|
Professional
|
Both
|
$2,009.98
|
|
|
Service Code
|
HCPCS 25660
|
| Min. Negotiated Rate |
$383.93 |
| Max. Negotiated Rate |
$1,234.06 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$548.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$493.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$493.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$521.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$548.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$521.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$548.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$548.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$411.35
|
| Rate for Payer: Healthfirst Commercial |
$548.47
|
| Rate for Payer: Healthfirst Essential Plan |
$1,234.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$521.05
|
| Rate for Payer: Healthfirst QHP |
$548.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$383.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$548.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$466.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$383.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$548.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$411.35
|
| Rate for Payer: SOMOS Essential |
$411.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$548.47
|
|
|
PR CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ
|
Professional
|
Both
|
$333.41
|
|
|
Service Code
|
HCPCS 24640
|
| Min. Negotiated Rate |
$62.41 |
| Max. Negotiated Rate |
$200.59 |
| Rate for Payer: Cash Price |
$91.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$89.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$89.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.86
|
| Rate for Payer: Healthfirst Commercial |
$89.15
|
| Rate for Payer: Healthfirst Essential Plan |
$200.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$84.69
|
| Rate for Payer: Healthfirst QHP |
$89.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$89.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$89.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$66.86
|
| Rate for Payer: SOMOS Essential |
$66.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$89.15
|
|
|
PR CLTX RDL SHFT FX&CLTX DISLC DSTL RAD/ULN JT
|
Professional
|
Both
|
$2,436.25
|
|
|
Service Code
|
HCPCS 25520
|
| Min. Negotiated Rate |
$464.16 |
| Max. Negotiated Rate |
$1,491.93 |
| Rate for Payer: Cash Price |
$664.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$663.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$596.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$596.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$629.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$663.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$629.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$663.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$663.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$497.31
|
| Rate for Payer: Healthfirst Commercial |
$663.08
|
| Rate for Payer: Healthfirst Essential Plan |
$1,491.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$629.93
|
| Rate for Payer: Healthfirst QHP |
$663.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$464.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$663.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$563.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$464.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$663.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$497.31
|
| Rate for Payer: SOMOS Essential |
$497.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$663.08
|
|
|
PR CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION
|
Professional
|
Both
|
$1,701.21
|
|
|
Service Code
|
HCPCS 23575
|
| Min. Negotiated Rate |
$325.61 |
| Max. Negotiated Rate |
$1,046.61 |
| Rate for Payer: Cash Price |
$466.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$465.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$418.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$418.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$441.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$465.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$441.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$465.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$465.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$348.87
|
| Rate for Payer: Healthfirst Commercial |
$465.16
|
| Rate for Payer: Healthfirst Essential Plan |
$1,046.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$441.90
|
| Rate for Payer: Healthfirst QHP |
$465.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$325.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$465.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$395.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$325.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$465.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$348.87
|
| Rate for Payer: SOMOS Essential |
$348.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$465.16
|
|
|
PR CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ
|
Professional
|
Both
|
$1,788.57
|
|
|
Service Code
|
HCPCS 23665
|
| Min. Negotiated Rate |
$342.32 |
| Max. Negotiated Rate |
$1,100.32 |
| Rate for Payer: Cash Price |
$491.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$489.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$440.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$440.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$464.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$489.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$464.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$489.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$489.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$366.77
|
| Rate for Payer: Healthfirst Commercial |
$489.03
|
| Rate for Payer: Healthfirst Essential Plan |
$1,100.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$464.58
|
| Rate for Payer: Healthfirst QHP |
$489.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$342.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$489.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$415.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$342.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$489.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$366.77
|
| Rate for Payer: SOMOS Essential |
$366.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$489.03
|
|
|
PR CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MANJ
|
Professional
|
Both
|
$2,230.45
|
|
|
Service Code
|
HCPCS 23675
|
| Min. Negotiated Rate |
$424.28 |
| Max. Negotiated Rate |
$1,363.77 |
| Rate for Payer: Cash Price |
$611.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$606.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$545.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$545.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$575.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$606.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$575.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$606.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$606.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$454.59
|
| Rate for Payer: Healthfirst Commercial |
$606.12
|
| Rate for Payer: Healthfirst Essential Plan |
$1,363.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$575.81
|
| Rate for Payer: Healthfirst QHP |
$606.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$424.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$606.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$515.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$424.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$606.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$454.59
|
| Rate for Payer: SOMOS Essential |
$454.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$606.12
|
|
|
PR CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ
|
Professional
|
Both
|
$2,545.90
|
|
|
Service Code
|
HCPCS 24535
|
| Min. Negotiated Rate |
$486.23 |
| Max. Negotiated Rate |
$1,562.89 |
| Rate for Payer: Cash Price |
$697.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$694.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$625.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$625.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$659.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$694.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$659.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$694.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$694.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$520.97
|
| Rate for Payer: Healthfirst Commercial |
$694.62
|
| Rate for Payer: Healthfirst Essential Plan |
$1,562.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$659.89
|
| Rate for Payer: Healthfirst QHP |
$694.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$486.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$694.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$590.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$486.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$694.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$520.97
|
| Rate for Payer: SOMOS Essential |
$520.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$694.62
|
|
|
PR CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ
|
Professional
|
Both
|
$1,579.17
|
|
|
Service Code
|
HCPCS 24530
|
| Min. Negotiated Rate |
$301.36 |
| Max. Negotiated Rate |
$968.67 |
| Rate for Payer: Cash Price |
$432.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$430.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$387.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$387.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$408.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$430.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$408.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$430.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$430.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$322.89
|
| Rate for Payer: Healthfirst Commercial |
$430.52
|
| Rate for Payer: Healthfirst Essential Plan |
$968.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$408.99
|
| Rate for Payer: Healthfirst QHP |
$430.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$301.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$430.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$365.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$301.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$430.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$322.89
|
| Rate for Payer: SOMOS Essential |
$322.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$430.52
|
|
|
PR CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/MANJ
|
Professional
|
Both
|
$3,559.15
|
|
|
Service Code
|
HCPCS 27503
|
| Min. Negotiated Rate |
$667.95 |
| Max. Negotiated Rate |
$2,146.97 |
| Rate for Payer: Cash Price |
$957.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$954.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$858.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$858.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$954.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$954.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$715.66
|
| Rate for Payer: Healthfirst Commercial |
$954.21
|
| Rate for Payer: Healthfirst Essential Plan |
$2,146.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$906.50
|
| Rate for Payer: Healthfirst QHP |
$954.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$667.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$954.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$811.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$667.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$954.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$715.66
|
| Rate for Payer: SOMOS Essential |
$715.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$954.21
|
|
|
PR CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ
|
Professional
|
Both
|
$2,217.53
|
|
|
Service Code
|
HCPCS 27501
|
| Min. Negotiated Rate |
$419.54 |
| Max. Negotiated Rate |
$1,348.52 |
| Rate for Payer: Cash Price |
$601.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$599.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$539.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$539.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$569.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$599.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$569.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$599.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$599.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$449.50
|
| Rate for Payer: Healthfirst Commercial |
$599.34
|
| Rate for Payer: Healthfirst Essential Plan |
$1,348.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$569.37
|
| Rate for Payer: Healthfirst QHP |
$599.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$419.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$599.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$509.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$419.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$599.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$449.50
|
| Rate for Payer: SOMOS Essential |
$449.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$599.34
|
|
