|
PR AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT
|
Professional
|
Both
|
$4,445.56
|
|
|
Service Code
|
HCPCS 66179
|
| Min. Negotiated Rate |
$845.75 |
| Max. Negotiated Rate |
$2,718.47 |
| Rate for Payer: Cash Price |
$1,226.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,208.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,087.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,087.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,147.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,208.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,147.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,208.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,208.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$906.16
|
| Rate for Payer: Healthfirst Commercial |
$1,208.21
|
| Rate for Payer: Healthfirst Essential Plan |
$2,718.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,147.80
|
| Rate for Payer: Healthfirst QHP |
$1,208.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$845.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,208.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,026.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$845.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,208.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$906.16
|
| Rate for Payer: SOMOS Essential |
$906.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,208.21
|
|
|
PR A-ROOT TLCJ VSD PULM STNS RPR W/O C OST RIMPLTJ
|
Professional
|
Both
|
$14,340.73
|
|
|
Service Code
|
HCPCS 33782
|
| Min. Negotiated Rate |
$2,631.33 |
| Max. Negotiated Rate |
$8,457.84 |
| Rate for Payer: Cash Price |
$3,801.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,759.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,383.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,383.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,571.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,759.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,571.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,759.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,759.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,819.28
|
| Rate for Payer: Healthfirst Commercial |
$3,759.04
|
| Rate for Payer: Healthfirst Essential Plan |
$8,457.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,571.09
|
| Rate for Payer: Healthfirst QHP |
$3,759.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,631.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,759.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,195.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,631.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,759.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,819.28
|
| Rate for Payer: SOMOS Essential |
$2,819.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,759.04
|
|
|
PR A-ROOT TLCJ VSD PULM STNS RPR W/RIMPLTJ C OSTIA
|
Professional
|
Both
|
$15,499.30
|
|
|
Service Code
|
HCPCS 33783
|
| Min. Negotiated Rate |
$2,843.75 |
| Max. Negotiated Rate |
$9,140.62 |
| Rate for Payer: Cash Price |
$4,109.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,062.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,656.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,656.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,859.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,062.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,859.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,062.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,062.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,046.88
|
| Rate for Payer: Healthfirst Commercial |
$4,062.50
|
| Rate for Payer: Healthfirst Essential Plan |
$9,140.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,859.38
|
| Rate for Payer: Healthfirst QHP |
$4,062.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,843.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,062.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,453.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,843.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,062.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,046.88
|
| Rate for Payer: SOMOS Essential |
$3,046.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,062.50
|
|
|
PR ARREST EPIPHYSEAL ANY METHOD TIBIA & FIBULA
|
Professional
|
Both
|
$3,146.08
|
|
|
Service Code
|
HCPCS 27740
|
| Min. Negotiated Rate |
$593.31 |
| Max. Negotiated Rate |
$1,907.08 |
| Rate for Payer: Cash Price |
$851.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$847.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$762.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$762.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$805.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$847.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$805.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$847.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$847.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$635.69
|
| Rate for Payer: Healthfirst Commercial |
$847.59
|
| Rate for Payer: Healthfirst Essential Plan |
$1,907.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$805.21
|
| Rate for Payer: Healthfirst QHP |
$847.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$593.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$847.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$720.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$593.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$847.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$635.69
|
| Rate for Payer: SOMOS Essential |
$635.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$847.59
|
|
|
PR ARREST EPIPHYSEAL DISTAL FEMUR
|
Professional
|
Both
|
$2,946.55
|
|
|
Service Code
|
HCPCS 27475
|
| Min. Negotiated Rate |
$555.86 |
| Max. Negotiated Rate |
$1,786.70 |
| Rate for Payer: Cash Price |
$797.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$794.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$714.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$714.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$754.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$794.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$754.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$794.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$794.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$595.57
|
| Rate for Payer: Healthfirst Commercial |
$794.09
|
| Rate for Payer: Healthfirst Essential Plan |
$1,786.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$754.39
|
| Rate for Payer: Healthfirst QHP |
$794.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$555.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$794.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$674.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$555.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$794.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$595.57
|
| Rate for Payer: SOMOS Essential |
$595.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$794.09
|
|
|
PR ARREST EPIPHYSEAL OPEN DISTAL FIBULA
|
Professional
|
Both
|
$2,024.02
|
|
|
Service Code
|
HCPCS 27732
|
| Min. Negotiated Rate |
$383.80 |
| Max. Negotiated Rate |
$1,233.63 |
| Rate for Payer: Cash Price |
$550.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$548.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$493.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$493.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$520.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$548.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$520.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$548.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$548.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$411.21
|
| Rate for Payer: Healthfirst Commercial |
$548.28
|
| Rate for Payer: Healthfirst Essential Plan |
$1,233.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$520.87
|
| Rate for Payer: Healthfirst QHP |
$548.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$383.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$548.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$466.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$383.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$548.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$411.21
|
| Rate for Payer: SOMOS Essential |
$411.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$548.28
|
|
|
PR ARREST EPIPHYSEAL OPEN DISTAL TIBIA
|
Professional
|
Both
|
$2,616.15
|
|
|
Service Code
|
HCPCS 27730
|
| Min. Negotiated Rate |
$494.35 |
| Max. Negotiated Rate |
$1,588.97 |
| Rate for Payer: Cash Price |
$709.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$706.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$635.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$635.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$670.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$706.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$670.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$706.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$706.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$529.66
|
| Rate for Payer: Healthfirst Commercial |
$706.21
|
| Rate for Payer: Healthfirst Essential Plan |
$1,588.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$670.90
|
| Rate for Payer: Healthfirst QHP |
$706.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$494.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$706.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$600.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$494.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$706.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$529.66
|
| Rate for Payer: SOMOS Essential |
$529.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$706.21
|
|
|
PR ARREST EPIPHYSEAL OPEN DISTAL TIBIA&FIBULA
|
Professional
|
Both
|
$2,922.82
|
|
|
Service Code
|
HCPCS 27734
|
| Min. Negotiated Rate |
$551.93 |
| Max. Negotiated Rate |
$1,774.06 |
| Rate for Payer: Cash Price |
$791.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$788.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$709.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$709.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$749.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$788.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$749.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$788.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$788.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$591.35
|
| Rate for Payer: Healthfirst Commercial |
$788.47
|
| Rate for Payer: Healthfirst Essential Plan |
$1,774.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$749.05
|
| Rate for Payer: Healthfirst QHP |
$788.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$551.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$788.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$670.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$551.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$788.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$591.35
|
| Rate for Payer: SOMOS Essential |
$591.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$788.47
|
|
|
PR ARREST EPIPHYSEAL TIBIA & FIBULA PROXIMAL
|
Professional
|
Both
|
$3,257.07
|
|
|
Service Code
|
HCPCS 27477
|
| Min. Negotiated Rate |
$614.54 |
| Max. Negotiated Rate |
$1,975.32 |
| Rate for Payer: Cash Price |
$880.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$877.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$790.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$790.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$834.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$877.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$834.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$877.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$877.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$658.44
|
| Rate for Payer: Healthfirst Commercial |
$877.92
|
| Rate for Payer: Healthfirst Essential Plan |
$1,975.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$834.02
|
| Rate for Payer: Healthfirst QHP |
$877.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$614.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$877.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$746.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$614.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$877.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$658.44
|
| Rate for Payer: SOMOS Essential |
$658.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$877.92
|
|
|
PR ARRST EPIPHYSL ANY METH TIBFIB&DSTL FEMUR
|
Professional
|
Both
|
$3,447.85
|
|
|
Service Code
|
HCPCS 27742
|
| Min. Negotiated Rate |
$650.04 |
| Max. Negotiated Rate |
$2,089.42 |
| Rate for Payer: Cash Price |
$933.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$928.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$835.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$835.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$882.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$928.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$882.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$928.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$928.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$696.47
|
| Rate for Payer: Healthfirst Commercial |
$928.63
|
| Rate for Payer: Healthfirst Essential Plan |
$2,089.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$882.20
|
| Rate for Payer: Healthfirst QHP |
$928.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$650.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$928.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$789.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$650.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$928.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$696.47
|
| Rate for Payer: SOMOS Essential |
$696.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$928.63
|
|
|
PR ARRST EPIPHYSL CMBN DSTL FEMUR PROX TIBFIB
|
Professional
|
Both
|
$4,068.16
|
|
|
Service Code
|
HCPCS 27479
|
| Min. Negotiated Rate |
$764.79 |
| Max. Negotiated Rate |
$2,458.26 |
| Rate for Payer: Cash Price |
$1,097.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,092.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$983.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$983.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,037.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,092.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,037.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,092.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,092.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$819.42
|
| Rate for Payer: Healthfirst Commercial |
$1,092.56
|
| Rate for Payer: Healthfirst Essential Plan |
$2,458.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,037.93
|
| Rate for Payer: Healthfirst QHP |
$1,092.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$764.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,092.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$928.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$764.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,092.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$819.42
|
| Rate for Payer: SOMOS Essential |
$819.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,092.56
|
|
|
PR ARRST HEMIEPIPHYSL DSTL FEMUR/PROX TIBIA/FIBULA
|
Professional
|
Both
|
$2,989.46
|
|
|
Service Code
|
HCPCS 27485
|
| Min. Negotiated Rate |
$564.14 |
| Max. Negotiated Rate |
$1,813.32 |
| Rate for Payer: Cash Price |
$807.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$805.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$725.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$725.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$765.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$805.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$765.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$805.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$805.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$604.44
|
| Rate for Payer: Healthfirst Commercial |
$805.92
|
| Rate for Payer: Healthfirst Essential Plan |
$1,813.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$765.62
|
| Rate for Payer: Healthfirst QHP |
$805.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$564.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$805.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$685.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$564.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$805.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$604.44
|
| Rate for Payer: SOMOS Essential |
$604.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$805.92
|
|
|
PR ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX
|
Professional
|
Both
|
$59.92
|
|
|
Service Code
|
HCPCS 36600
|
| Min. Negotiated Rate |
$11.30 |
| Max. Negotiated Rate |
$36.31 |
| Rate for Payer: Cash Price |
$16.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.11
|
| Rate for Payer: Healthfirst Commercial |
$16.14
|
| Rate for Payer: Healthfirst Essential Plan |
$36.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.33
|
| Rate for Payer: Healthfirst QHP |
$16.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.11
|
| Rate for Payer: SOMOS Essential |
$12.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.14
|
|
|
PR ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT
|
Professional
|
Both
|
$2,935.56
|
|
|
Service Code
|
HCPCS 36821
|
| Min. Negotiated Rate |
$537.71 |
| Max. Negotiated Rate |
$1,728.34 |
| Rate for Payer: Cash Price |
$777.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$768.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$691.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$691.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$729.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$768.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$729.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$768.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$768.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$576.11
|
| Rate for Payer: Healthfirst Commercial |
$768.15
|
| Rate for Payer: Healthfirst Essential Plan |
$1,728.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$729.74
|
| Rate for Payer: Healthfirst QHP |
$768.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$537.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$768.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$652.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$537.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$768.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$576.11
|
| Rate for Payer: SOMOS Essential |
$576.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$768.15
|
|
|
PR ARTERY EXPOS/GRAFT ARTERY PERFUSION ECMO/ECLS
|
Professional
|
Both
|
$913.12
|
|
|
Service Code
|
HCPCS 33987
|
| Min. Negotiated Rate |
$166.96 |
| Max. Negotiated Rate |
$536.65 |
| Rate for Payer: Cash Price |
$242.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$238.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$214.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$214.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$226.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$238.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$226.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$238.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$238.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$178.88
|
| Rate for Payer: Healthfirst Commercial |
$238.51
|
| Rate for Payer: Healthfirst Essential Plan |
$536.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$226.58
|
| Rate for Payer: Healthfirst QHP |
$238.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$166.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$238.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$202.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$166.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$238.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$178.88
|
| Rate for Payer: SOMOS Essential |
$178.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$238.51
|
|
|
PR ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2
|
Professional
|
Both
|
$7,943.22
|
|
|
Service Code
|
HCPCS 22551
|
| Min. Negotiated Rate |
$1,461.26 |
| Max. Negotiated Rate |
$4,696.92 |
| Rate for Payer: Cash Price |
$2,107.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,087.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,878.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,878.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,983.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,087.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,983.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,087.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,087.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,565.64
|
| Rate for Payer: Healthfirst Commercial |
$2,087.52
|
| Rate for Payer: Healthfirst Essential Plan |
$4,696.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,983.14
|
| Rate for Payer: Healthfirst QHP |
$2,087.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,461.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,087.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,774.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,461.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,087.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,565.64
|
| Rate for Payer: SOMOS Essential |
$1,565.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,087.52
|
|
|
PR ARTHRD ANT INTERDY CERVCL BELW C2 EA ADDL NTRSPC
|
Professional
|
Both
|
$1,846.11
|
|
|
Service Code
|
HCPCS 22552
|
| Min. Negotiated Rate |
$337.87 |
| Max. Negotiated Rate |
$1,086.01 |
| Rate for Payer: Cash Price |
$486.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$482.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$434.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$434.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$458.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$482.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$458.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$482.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$482.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$362.00
|
| Rate for Payer: Healthfirst Commercial |
$482.67
|
| Rate for Payer: Healthfirst Essential Plan |
$1,086.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$458.54
|
| Rate for Payer: Healthfirst QHP |
$482.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$337.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$482.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$410.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$337.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$482.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$362.00
|
| Rate for Payer: SOMOS Essential |
$362.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$482.67
|
|
|
PR ARTHRD ANT MIN DISCECT INTERBODY CERV BELOW C2
|
Professional
|
Both
|
$5,869.99
|
|
|
Service Code
|
HCPCS 22554
|
| Min. Negotiated Rate |
$1,086.21 |
| Max. Negotiated Rate |
$3,491.39 |
| Rate for Payer: Cash Price |
$1,564.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,551.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,396.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,396.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,474.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,551.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,474.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,551.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,551.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,163.80
|
| Rate for Payer: Healthfirst Commercial |
$1,551.73
|
| Rate for Payer: Healthfirst Essential Plan |
$3,491.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,474.14
|
| Rate for Payer: Healthfirst QHP |
$1,551.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,086.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,551.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,318.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,086.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,551.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,163.80
|
| Rate for Payer: SOMOS Essential |
$1,163.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,551.73
|
|
|
PR ARTHRD ANT MIN DISCECTOMY INTERBODY THORACIC
|
Professional
|
Both
|
$7,709.73
|
|
|
Service Code
|
HCPCS 22556
|
| Min. Negotiated Rate |
$1,441.32 |
| Max. Negotiated Rate |
$4,632.82 |
| Rate for Payer: Cash Price |
$2,079.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,059.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,853.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,853.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,956.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,059.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,956.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,059.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,059.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,544.27
|
| Rate for Payer: Healthfirst Commercial |
$2,059.03
|
| Rate for Payer: Healthfirst Essential Plan |
$4,632.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,956.08
|
| Rate for Payer: Healthfirst QHP |
$2,059.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,441.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,059.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,750.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,441.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,059.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,544.27
|
| Rate for Payer: SOMOS Essential |
$1,544.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,059.03
|
|
|
PR ARTHRD ANT TRANSORL/XTRORAL C1-C2 W/WO EXC ODNTD
|
Professional
|
Both
|
$9,447.34
|
|
|
Service Code
|
HCPCS 22548
|
| Min. Negotiated Rate |
$1,733.41 |
| Max. Negotiated Rate |
$5,571.68 |
| Rate for Payer: Cash Price |
$2,497.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,476.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,228.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,228.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,352.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,476.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,352.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,476.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,476.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,857.22
|
| Rate for Payer: Healthfirst Commercial |
$2,476.30
|
| Rate for Payer: Healthfirst Essential Plan |
$5,571.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,352.49
|
| Rate for Payer: Healthfirst QHP |
$2,476.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,733.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,476.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,104.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,733.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,476.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,857.22
|
| Rate for Payer: SOMOS Essential |
$1,857.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,476.30
|
|
|
PR ARTHRD CARP/MTCRPL JT DGT OTHER THAN THUMB EACH
|
Professional
|
Both
|
$3,481.35
|
|
|
Service Code
|
HCPCS 26843
|
| Min. Negotiated Rate |
$645.77 |
| Max. Negotiated Rate |
$2,075.69 |
| Rate for Payer: Cash Price |
$938.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$922.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$830.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$830.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$876.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$922.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$876.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$922.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$922.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$691.90
|
| Rate for Payer: Healthfirst Commercial |
$922.53
|
| Rate for Payer: Healthfirst Essential Plan |
$2,075.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$876.40
|
| Rate for Payer: Healthfirst QHP |
$922.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$645.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$922.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$784.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$645.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$922.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$691.90
|
| Rate for Payer: SOMOS Essential |
$691.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$922.53
|
|
|
PR ARTHRD CARP/MTCRPL JT DGT OTH/THN THMB W/AGRFT
|
Professional
|
Both
|
$3,828.09
|
|
|
Service Code
|
HCPCS 26844
|
| Min. Negotiated Rate |
$711.34 |
| Max. Negotiated Rate |
$2,286.45 |
| Rate for Payer: Cash Price |
$1,030.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,016.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$914.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$914.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$965.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,016.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$965.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,016.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,016.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$762.15
|
| Rate for Payer: Healthfirst Commercial |
$1,016.20
|
| Rate for Payer: Healthfirst Essential Plan |
$2,286.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$965.39
|
| Rate for Payer: Healthfirst QHP |
$1,016.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$711.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,016.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$863.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$711.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,016.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$762.15
|
| Rate for Payer: SOMOS Essential |
$762.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,016.20
|
|
|
PR ARTHRD CARPO/METACARPAL JT THUMB W/WO INT FIXJ
|
Professional
|
Both
|
$3,421.36
|
|
|
Service Code
|
HCPCS 26841
|
| Min. Negotiated Rate |
$637.44 |
| Max. Negotiated Rate |
$2,048.92 |
| Rate for Payer: Cash Price |
$927.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$910.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$819.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$819.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$865.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$910.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$865.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$910.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$910.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$682.97
|
| Rate for Payer: Healthfirst Commercial |
$910.63
|
| Rate for Payer: Healthfirst Essential Plan |
$2,048.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.10
|
| Rate for Payer: Healthfirst QHP |
$910.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$637.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$910.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$774.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$637.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$910.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$682.97
|
| Rate for Payer: SOMOS Essential |
$682.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$910.63
|
|
|
PR ARTHRD CRP/MTACRPL JT THMB W/WO INT FIXJ W/AGRFT
|
Professional
|
Both
|
$3,704.75
|
|
|
Service Code
|
HCPCS 26842
|
| Min. Negotiated Rate |
$688.13 |
| Max. Negotiated Rate |
$2,211.84 |
| Rate for Payer: Cash Price |
$997.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$983.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$884.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$884.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$933.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$983.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$933.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$983.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$983.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$737.28
|
| Rate for Payer: Healthfirst Commercial |
$983.04
|
| Rate for Payer: Healthfirst Essential Plan |
$2,211.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$933.89
|
| Rate for Payer: Healthfirst QHP |
$983.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$688.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$983.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$835.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$688.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$983.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$737.28
|
| Rate for Payer: SOMOS Essential |
$737.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$983.04
|
|
|
PR ARTHRD DSTL RAD/ULN JT SGMTL RSCJ ULNA W/WO BONE
|
Professional
|
Both
|
$4,464.50
|
|
|
Service Code
|
HCPCS 25830
|
| Min. Negotiated Rate |
$849.56 |
| Max. Negotiated Rate |
$2,730.74 |
| Rate for Payer: Cash Price |
$1,230.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,213.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,092.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,092.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,152.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,213.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,152.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,213.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,213.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$910.25
|
| Rate for Payer: Healthfirst Commercial |
$1,213.66
|
| Rate for Payer: Healthfirst Essential Plan |
$2,730.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,152.98
|
| Rate for Payer: Healthfirst QHP |
$1,213.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$849.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,213.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,031.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$849.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,213.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$910.25
|
| Rate for Payer: SOMOS Essential |
$910.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,213.66
|
|
