|
PR ARTHRD HIP JT W/OBTG GRF W/SUBTRCHNTRIC OSTEOT
|
Professional
|
Both
|
$7,244.97
|
|
|
Service Code
|
HCPCS 27286
|
| Min. Negotiated Rate |
$1,356.48 |
| Max. Negotiated Rate |
$4,360.12 |
| Rate for Payer: Cash Price |
$1,948.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,937.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,744.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,744.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,840.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,937.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,840.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,937.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,937.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,453.37
|
| Rate for Payer: Healthfirst Commercial |
$1,937.83
|
| Rate for Payer: Healthfirst Essential Plan |
$4,360.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,840.94
|
| Rate for Payer: Healthfirst QHP |
$1,937.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,356.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,937.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,647.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,356.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,937.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,453.37
|
| Rate for Payer: SOMOS Essential |
$1,453.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,937.83
|
|
|
PR ARTHRD MIDTARSL/TARS MLT/TRANSVRS W/OSTEOT
|
Professional
|
Both
|
$3,354.68
|
|
|
Service Code
|
HCPCS 28735
|
| Min. Negotiated Rate |
$635.61 |
| Max. Negotiated Rate |
$2,043.02 |
| Rate for Payer: Cash Price |
$907.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$908.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$817.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$817.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$862.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$908.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$862.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$908.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$908.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$681.01
|
| Rate for Payer: Healthfirst Commercial |
$908.01
|
| Rate for Payer: Healthfirst Essential Plan |
$2,043.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$862.61
|
| Rate for Payer: Healthfirst QHP |
$908.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$635.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$908.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$771.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$635.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$908.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$681.01
|
| Rate for Payer: SOMOS Essential |
$681.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$908.01
|
|
|
PR ARTHRD MIDTARSL/TARSOMETATARSAL MULT/TRANSVRS
|
Professional
|
Both
|
$3,143.70
|
|
|
Service Code
|
HCPCS 28730
|
| Min. Negotiated Rate |
$592.67 |
| Max. Negotiated Rate |
$1,905.01 |
| Rate for Payer: Cash Price |
$851.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$846.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$762.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$762.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$804.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$846.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$804.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$846.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$846.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$635.00
|
| Rate for Payer: Healthfirst Commercial |
$846.67
|
| Rate for Payer: Healthfirst Essential Plan |
$1,905.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$804.34
|
| Rate for Payer: Healthfirst QHP |
$846.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$592.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$846.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$719.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$592.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$846.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$635.00
|
| Rate for Payer: SOMOS Essential |
$635.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$846.67
|
|
|
PR ARTHRD PST/PSTLAT TQ 1NTRSPC CRV BELW C2 SEGMENT
|
Professional
|
Both
|
$6,097.14
|
|
|
Service Code
|
HCPCS 22600
|
| Min. Negotiated Rate |
$1,130.24 |
| Max. Negotiated Rate |
$3,632.92 |
| Rate for Payer: Cash Price |
$1,625.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,614.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,453.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,453.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,533.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,614.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,533.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,614.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,614.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,210.97
|
| Rate for Payer: Healthfirst Commercial |
$1,614.63
|
| Rate for Payer: Healthfirst Essential Plan |
$3,632.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,533.90
|
| Rate for Payer: Healthfirst QHP |
$1,614.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,130.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,614.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,372.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,130.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,614.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,210.97
|
| Rate for Payer: SOMOS Essential |
$1,210.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,614.63
|
|
|
PR ARTHRD W/TDN LNGTH&ADVMNT TARSL NVCLR-CUNEIFOR
|
Professional
|
Both
|
$2,917.99
|
|
|
Service Code
|
HCPCS 28737
|
| Min. Negotiated Rate |
$555.72 |
| Max. Negotiated Rate |
$1,786.25 |
| Rate for Payer: Cash Price |
$807.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$793.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$714.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$714.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$754.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$793.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$754.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$793.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$793.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$595.42
|
| Rate for Payer: Healthfirst Commercial |
$793.89
|
| Rate for Payer: Healthfirst Essential Plan |
$1,786.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$754.20
|
| Rate for Payer: Healthfirst QHP |
$793.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$555.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$793.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$674.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$555.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$793.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$595.42
|
| Rate for Payer: SOMOS Essential |
$595.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$793.89
|
|
|
PR ARTHRD W/XTNSR HALLUCIS LONGUS TR 1ST METAR NCK
|
Professional
|
Both
|
$2,376.43
|
|
|
Service Code
|
HCPCS 28760
|
| Min. Negotiated Rate |
$460.01 |
| Max. Negotiated Rate |
$1,478.61 |
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$657.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$591.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$591.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$624.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$657.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$624.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$657.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$657.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$492.87
|
| Rate for Payer: Healthfirst Commercial |
$657.16
|
| Rate for Payer: Healthfirst Essential Plan |
$1,478.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$624.30
|
| Rate for Payer: Healthfirst QHP |
$657.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$460.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$657.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$558.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$460.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$657.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$492.87
|
| Rate for Payer: SOMOS Essential |
$492.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$657.16
|
|
|
PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US
|
Professional
|
Both
|
$158.52
|
|
|
Service Code
|
HCPCS 20605
|
| Min. Negotiated Rate |
$29.10 |
| Max. Negotiated Rate |
$93.53 |
| Rate for Payer: Cash Price |
$42.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.18
|
| Rate for Payer: Healthfirst Commercial |
$41.57
|
| Rate for Payer: Healthfirst Essential Plan |
$93.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.49
|
| Rate for Payer: Healthfirst QHP |
$41.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.18
|
| Rate for Payer: SOMOS Essential |
$31.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.57
|
|
|
PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US
|
Professional
|
Both
|
$218.47
|
|
|
Service Code
|
HCPCS 20606
|
| Min. Negotiated Rate |
$41.43 |
| Max. Negotiated Rate |
$133.16 |
| Rate for Payer: Cash Price |
$59.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$59.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.38
|
| Rate for Payer: Healthfirst Commercial |
$59.18
|
| Rate for Payer: Healthfirst Essential Plan |
$133.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.22
|
| Rate for Payer: Healthfirst QHP |
$59.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.38
|
| Rate for Payer: SOMOS Essential |
$44.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.18
|
|
|
PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US
|
Professional
|
Both
|
$193.59
|
|
|
Service Code
|
HCPCS 20610
|
| Min. Negotiated Rate |
$36.63 |
| Max. Negotiated Rate |
$117.74 |
| Rate for Payer: Cash Price |
$52.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.25
|
| Rate for Payer: Healthfirst Commercial |
$52.33
|
| Rate for Payer: Healthfirst Essential Plan |
$117.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.71
|
| Rate for Payer: Healthfirst QHP |
$52.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.25
|
| Rate for Payer: SOMOS Essential |
$39.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.33
|
|
|
PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US
|
Professional
|
Both
|
$257.60
|
|
|
Service Code
|
HCPCS 20611
|
| Min. Negotiated Rate |
$47.31 |
| Max. Negotiated Rate |
$152.06 |
| Rate for Payer: Cash Price |
$67.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$67.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$67.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.69
|
| Rate for Payer: Healthfirst Commercial |
$67.58
|
| Rate for Payer: Healthfirst Essential Plan |
$152.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$64.20
|
| Rate for Payer: Healthfirst QHP |
$67.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$67.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$57.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$67.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$50.69
|
| Rate for Payer: SOMOS Essential |
$50.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$67.58
|
|
|
PR ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Professional
|
Both
|
$149.10
|
|
|
Service Code
|
HCPCS 20600
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$91.10 |
| Rate for Payer: Cash Price |
$41.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.37
|
| Rate for Payer: Healthfirst Commercial |
$40.49
|
| Rate for Payer: Healthfirst Essential Plan |
$91.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.47
|
| Rate for Payer: Healthfirst QHP |
$40.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.37
|
| Rate for Payer: SOMOS Essential |
$30.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.49
|
|
|
PR ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT
|
Professional
|
Both
|
$192.01
|
|
|
Service Code
|
HCPCS 20604
|
| Min. Negotiated Rate |
$36.98 |
| Max. Negotiated Rate |
$118.87 |
| Rate for Payer: Cash Price |
$51.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.62
|
| Rate for Payer: Healthfirst Commercial |
$52.83
|
| Rate for Payer: Healthfirst Essential Plan |
$118.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.19
|
| Rate for Payer: Healthfirst QHP |
$52.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.62
|
| Rate for Payer: SOMOS Essential |
$39.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.83
|
|
|
PR ARTHRODESIS ANKLE OPEN
|
Professional
|
Both
|
$4,404.72
|
|
|
Service Code
|
HCPCS 27870
|
| Min. Negotiated Rate |
$827.53 |
| Max. Negotiated Rate |
$2,659.93 |
| Rate for Payer: Cash Price |
$1,189.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,182.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,063.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,063.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,123.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,182.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,123.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,182.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,182.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$886.64
|
| Rate for Payer: Healthfirst Commercial |
$1,182.19
|
| Rate for Payer: Healthfirst Essential Plan |
$2,659.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,123.08
|
| Rate for Payer: Healthfirst QHP |
$1,182.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$827.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,182.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,004.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$827.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,182.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$886.64
|
| Rate for Payer: SOMOS Essential |
$886.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,182.19
|
|
|
PR ARTHRODESIS ANTERIOR INTERBODY EA ADDL NTRSPC
|
Professional
|
Both
|
$1,495.87
|
|
|
Service Code
|
HCPCS 22585
|
| Min. Negotiated Rate |
$272.99 |
| Max. Negotiated Rate |
$877.46 |
| Rate for Payer: Cash Price |
$394.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$389.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$350.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$350.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$370.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$389.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$370.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$389.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$389.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$292.49
|
| Rate for Payer: Healthfirst Commercial |
$389.98
|
| Rate for Payer: Healthfirst Essential Plan |
$877.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$370.48
|
| Rate for Payer: Healthfirst QHP |
$389.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$272.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$389.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$331.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$272.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$389.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$292.49
|
| Rate for Payer: SOMOS Essential |
$292.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$389.98
|
|
|
PR ARTHRODESIS ANTERIOR INTERBODY LUMBAR
|
Professional
|
Both
|
$6,966.02
|
|
|
Service Code
|
HCPCS 22558
|
| Min. Negotiated Rate |
$1,289.77 |
| Max. Negotiated Rate |
$4,145.69 |
| Rate for Payer: Cash Price |
$1,857.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,842.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,658.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,658.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,750.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,842.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,750.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,842.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,842.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,381.90
|
| Rate for Payer: Healthfirst Commercial |
$1,842.53
|
| Rate for Payer: Healthfirst Essential Plan |
$4,145.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,750.40
|
| Rate for Payer: Healthfirst QHP |
$1,842.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,289.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,842.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,566.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,289.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,842.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,381.90
|
| Rate for Payer: SOMOS Essential |
$1,381.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,842.53
|
|
|
PR ARTHRODESIS ANTERIOR SPINAL DFRM 2-3 VRT SEG
|
Professional
|
Both
|
$8,388.03
|
|
|
Service Code
|
HCPCS 22808
|
| Min. Negotiated Rate |
$1,546.96 |
| Max. Negotiated Rate |
$4,972.36 |
| Rate for Payer: Cash Price |
$2,246.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,209.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,988.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,988.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,099.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,209.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,099.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,209.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,209.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,657.45
|
| Rate for Payer: Healthfirst Commercial |
$2,209.94
|
| Rate for Payer: Healthfirst Essential Plan |
$4,972.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,099.44
|
| Rate for Payer: Healthfirst QHP |
$2,209.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,546.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,209.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,878.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,546.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,209.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,657.45
|
| Rate for Payer: SOMOS Essential |
$1,657.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,209.94
|
|
|
PR ARTHRODESIS ANTERIOR SPINAL DFRM 4-7 VRT SEG
|
Professional
|
Both
|
$8,848.42
|
|
|
Service Code
|
HCPCS 22810
|
| Min. Negotiated Rate |
$1,656.13 |
| Max. Negotiated Rate |
$5,323.27 |
| Rate for Payer: Cash Price |
$2,378.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,365.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,129.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,129.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,247.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,365.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,247.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,365.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,365.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,774.42
|
| Rate for Payer: Healthfirst Commercial |
$2,365.90
|
| Rate for Payer: Healthfirst Essential Plan |
$5,323.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,247.61
|
| Rate for Payer: Healthfirst QHP |
$2,365.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,656.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,365.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,011.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,656.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,365.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,774.42
|
| Rate for Payer: SOMOS Essential |
$1,774.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,365.90
|
|
|
PR ARTHRODESIS ANTERIOR SPINAL DFRM 8/> VRT SEG
|
Professional
|
Both
|
$9,694.09
|
|
|
Service Code
|
HCPCS 22812
|
| Min. Negotiated Rate |
$1,814.88 |
| Max. Negotiated Rate |
$5,833.53 |
| Rate for Payer: Cash Price |
$2,607.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,592.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,333.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,333.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,463.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,592.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,463.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,592.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,592.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,944.51
|
| Rate for Payer: Healthfirst Commercial |
$2,592.68
|
| Rate for Payer: Healthfirst Essential Plan |
$5,833.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,463.05
|
| Rate for Payer: Healthfirst QHP |
$2,592.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,814.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,592.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,203.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,814.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,592.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,944.51
|
| Rate for Payer: SOMOS Essential |
$1,944.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,592.68
|
|
|
PR ARTHRODESIS CMBN TQ 1NTRSPC EACH ADDITIONAL
|
Professional
|
Both
|
$2,250.26
|
|
|
Service Code
|
HCPCS 22634
|
| Min. Negotiated Rate |
$412.49 |
| Max. Negotiated Rate |
$1,325.86 |
| Rate for Payer: Cash Price |
$594.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$589.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$530.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$530.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$559.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$589.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$559.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$589.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$589.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$441.95
|
| Rate for Payer: Healthfirst Commercial |
$589.27
|
| Rate for Payer: Healthfirst Essential Plan |
$1,325.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$559.81
|
| Rate for Payer: Healthfirst QHP |
$589.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$412.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$589.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$500.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$412.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$589.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$441.95
|
| Rate for Payer: SOMOS Essential |
$441.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$589.27
|
|
|
PR ARTHRODESIS COMBINED TQ 1NTRSPC LUMBAR
|
Professional
|
Both
|
$8,371.69
|
|
|
Service Code
|
HCPCS 22633
|
| Min. Negotiated Rate |
$1,549.02 |
| Max. Negotiated Rate |
$4,979.00 |
| Rate for Payer: Cash Price |
$2,227.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,212.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,991.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,991.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,102.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,212.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,102.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,212.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,212.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,659.67
|
| Rate for Payer: Healthfirst Commercial |
$2,212.89
|
| Rate for Payer: Healthfirst Essential Plan |
$4,979.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,102.25
|
| Rate for Payer: Healthfirst QHP |
$2,212.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,549.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,212.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,880.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,549.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,212.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,659.67
|
| Rate for Payer: SOMOS Essential |
$1,659.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,212.89
|
|
|
PR ARTHRODESIS ELBOW JOINT LOCAL
|
Professional
|
Both
|
$3,695.86
|
|
|
Service Code
|
HCPCS 24800
|
| Min. Negotiated Rate |
$696.85 |
| Max. Negotiated Rate |
$2,239.88 |
| Rate for Payer: Cash Price |
$999.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$995.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$895.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$895.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$945.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$995.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$945.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$995.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$995.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$746.62
|
| Rate for Payer: Healthfirst Commercial |
$995.50
|
| Rate for Payer: Healthfirst Essential Plan |
$2,239.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$945.73
|
| Rate for Payer: Healthfirst QHP |
$995.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$696.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$995.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$846.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$696.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$995.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$746.62
|
| Rate for Payer: SOMOS Essential |
$746.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$995.50
|
|
|
PR ARTHRODESIS ELBOW JOINT W/AUTOGENOUS GRAFT
|
Professional
|
Both
|
$4,436.08
|
|
|
Service Code
|
HCPCS 24802
|
| Min. Negotiated Rate |
$834.83 |
| Max. Negotiated Rate |
$2,683.39 |
| Rate for Payer: Cash Price |
$1,196.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,192.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,073.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,073.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,132.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,192.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,132.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,192.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,192.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$894.47
|
| Rate for Payer: Healthfirst Commercial |
$1,192.62
|
| Rate for Payer: Healthfirst Essential Plan |
$2,683.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,132.99
|
| Rate for Payer: Healthfirst QHP |
$1,192.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$834.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,192.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,013.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$834.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,192.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$894.47
|
| Rate for Payer: SOMOS Essential |
$894.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,192.62
|
|
|
PR ARTHRODESIS GLENOHUMERAL JOINT
|
Professional
|
Both
|
$4,543.67
|
|
|
Service Code
|
HCPCS 23800
|
| Min. Negotiated Rate |
$853.73 |
| Max. Negotiated Rate |
$2,744.12 |
| Rate for Payer: Cash Price |
$1,226.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,219.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,097.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,097.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,158.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,219.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,158.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,219.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,219.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$914.71
|
| Rate for Payer: Healthfirst Commercial |
$1,219.61
|
| Rate for Payer: Healthfirst Essential Plan |
$2,744.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,158.63
|
| Rate for Payer: Healthfirst QHP |
$1,219.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$853.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,219.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,036.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$853.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,219.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$914.71
|
| Rate for Payer: SOMOS Essential |
$914.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,219.61
|
|
|
PR ARTHRODESIS GLENOHUMERAL JT W/AUTOGENOUS GRAFT
|
Professional
|
Both
|
$5,669.48
|
|
|
Service Code
|
HCPCS 23802
|
| Min. Negotiated Rate |
$1,065.80 |
| Max. Negotiated Rate |
$3,425.78 |
| Rate for Payer: Cash Price |
$1,529.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,522.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,370.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,370.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,446.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,522.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,446.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,522.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,522.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,141.93
|
| Rate for Payer: Healthfirst Commercial |
$1,522.57
|
| Rate for Payer: Healthfirst Essential Plan |
$3,425.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,446.44
|
| Rate for Payer: Healthfirst QHP |
$1,522.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,065.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,522.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,294.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,065.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,522.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,141.93
|
| Rate for Payer: SOMOS Essential |
$1,141.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,522.57
|
|
|
PR ARTHRODESIS GREAT TOE INTERPHALANGEAL JOINT
|
Professional
|
Both
|
$1,414.32
|
|
|
Service Code
|
HCPCS 28755
|
| Min. Negotiated Rate |
$274.01 |
| Max. Negotiated Rate |
$880.74 |
| Rate for Payer: Cash Price |
$390.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$391.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$352.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$352.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$371.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$391.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$371.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$391.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$391.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$293.58
|
| Rate for Payer: Healthfirst Commercial |
$391.44
|
| Rate for Payer: Healthfirst Essential Plan |
$880.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$371.87
|
| Rate for Payer: Healthfirst QHP |
$391.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$274.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$391.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$332.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$274.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$391.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$293.58
|
| Rate for Payer: SOMOS Essential |
$293.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$391.44
|
|
