|
PR ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$2,469.32
|
|
|
Service Code
|
HCPCS 28750
|
| Min. Negotiated Rate |
$467.49 |
| Max. Negotiated Rate |
$1,502.64 |
| Rate for Payer: Cash Price |
$674.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$667.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$601.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$601.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$634.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$667.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$634.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$667.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$667.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$500.88
|
| Rate for Payer: Healthfirst Commercial |
$667.84
|
| Rate for Payer: Healthfirst Essential Plan |
$1,502.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$634.45
|
| Rate for Payer: Healthfirst QHP |
$667.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$467.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$667.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$567.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$467.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$667.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$500.88
|
| Rate for Payer: SOMOS Essential |
$500.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$667.84
|
|
|
PR ARTHRODESIS HIP JOINT W/OBTAINING GRAFT
|
Professional
|
Both
|
$7,066.43
|
|
|
Service Code
|
HCPCS 27284
|
| Min. Negotiated Rate |
$1,322.80 |
| Max. Negotiated Rate |
$4,251.87 |
| Rate for Payer: Cash Price |
$1,900.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,889.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,700.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,700.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,795.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,889.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,795.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,889.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,889.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,417.29
|
| Rate for Payer: Healthfirst Commercial |
$1,889.72
|
| Rate for Payer: Healthfirst Essential Plan |
$4,251.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,795.23
|
| Rate for Payer: Healthfirst QHP |
$1,889.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,322.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,889.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,606.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,322.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,889.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,417.29
|
| Rate for Payer: SOMOS Essential |
$1,417.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,889.72
|
|
|
PR ARTHRODESIS INTERPHALANGEAL JT W/WO INT FIXJ
|
Professional
|
Both
|
$2,714.57
|
|
|
Service Code
|
HCPCS 26860
|
| Min. Negotiated Rate |
$503.87 |
| Max. Negotiated Rate |
$1,619.57 |
| Rate for Payer: Cash Price |
$733.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$719.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$647.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$647.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$683.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$719.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$683.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$719.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$719.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$539.86
|
| Rate for Payer: Healthfirst Commercial |
$719.81
|
| Rate for Payer: Healthfirst Essential Plan |
$1,619.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$683.82
|
| Rate for Payer: Healthfirst QHP |
$719.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$503.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$719.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$611.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$503.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$719.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$539.86
|
| Rate for Payer: SOMOS Essential |
$539.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$719.81
|
|
|
PR ARTHRODESIS IPHAL JT W/WO INT FIXJ EA IPHAL JT
|
Professional
|
Both
|
$439.32
|
|
|
Service Code
|
HCPCS 26861
|
| Min. Negotiated Rate |
$82.87 |
| Max. Negotiated Rate |
$266.36 |
| Rate for Payer: Cash Price |
$119.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$118.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$112.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$118.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$112.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$118.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.78
|
| Rate for Payer: Healthfirst Commercial |
$118.38
|
| Rate for Payer: Healthfirst Essential Plan |
$266.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$112.46
|
| Rate for Payer: Healthfirst QHP |
$118.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$118.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$100.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$118.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.78
|
| Rate for Payer: SOMOS Essential |
$88.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$118.38
|
|
|
PR ARTHRODESIS IPHAL JT W/WO INT FIXJ W/AGRFT EA JT
|
Professional
|
Both
|
$991.97
|
|
|
Service Code
|
HCPCS 26863
|
| Min. Negotiated Rate |
$184.19 |
| Max. Negotiated Rate |
$592.04 |
| Rate for Payer: Cash Price |
$265.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$263.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$236.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$236.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$249.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$263.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$249.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$263.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$263.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$197.35
|
| Rate for Payer: Healthfirst Commercial |
$263.13
|
| Rate for Payer: Healthfirst Essential Plan |
$592.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$249.97
|
| Rate for Payer: Healthfirst QHP |
$263.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$184.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$263.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$223.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$184.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$263.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$197.35
|
| Rate for Payer: SOMOS Essential |
$197.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$263.13
|
|
|
PR ARTHRODESIS IPHAL JT W/WO INT FIXJ W/AUTOGRAFT
|
Professional
|
Both
|
$3,387.41
|
|
|
Service Code
|
HCPCS 26862
|
| Min. Negotiated Rate |
$631.59 |
| Max. Negotiated Rate |
$2,030.11 |
| Rate for Payer: Cash Price |
$916.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$902.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$812.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$812.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$857.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$902.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$857.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$902.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$902.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$676.70
|
| Rate for Payer: Healthfirst Commercial |
$902.27
|
| Rate for Payer: Healthfirst Essential Plan |
$2,030.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$857.16
|
| Rate for Payer: Healthfirst QHP |
$902.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$631.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$902.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$766.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$631.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$902.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$676.70
|
| Rate for Payer: SOMOS Essential |
$676.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$902.27
|
|
|
PR ARTHRODESIS KNEE ANY TECHNIQUE
|
Professional
|
Both
|
$6,507.20
|
|
|
Service Code
|
HCPCS 27580
|
| Min. Negotiated Rate |
$1,218.62 |
| Max. Negotiated Rate |
$3,917.00 |
| Rate for Payer: Cash Price |
$1,756.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,740.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,566.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,566.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,653.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,740.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,653.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,740.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,740.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,305.67
|
| Rate for Payer: Healthfirst Commercial |
$1,740.89
|
| Rate for Payer: Healthfirst Essential Plan |
$3,917.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,653.85
|
| Rate for Payer: Healthfirst QHP |
$1,740.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,218.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,740.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,479.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,218.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,740.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,305.67
|
| Rate for Payer: SOMOS Essential |
$1,305.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,740.89
|
|
|
PR ARTHRODESIS LATERAL EXTRACAVITARY LUMBAR
|
Professional
|
Both
|
$7,465.85
|
|
|
Service Code
|
HCPCS 22533
|
| Min. Negotiated Rate |
$1,400.26 |
| Max. Negotiated Rate |
$4,500.83 |
| Rate for Payer: Cash Price |
$2,013.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,000.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,800.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,800.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,900.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,000.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,900.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,000.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,000.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,500.28
|
| Rate for Payer: Healthfirst Commercial |
$2,000.37
|
| Rate for Payer: Healthfirst Essential Plan |
$4,500.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,900.35
|
| Rate for Payer: Healthfirst QHP |
$2,000.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,400.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,000.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,700.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,400.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,000.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,500.28
|
| Rate for Payer: SOMOS Essential |
$1,500.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,000.37
|
|
|
PR ARTHRODESIS LATERAL EXTRACAVITARY THORACIC
|
Professional
|
Both
|
$8,355.66
|
|
|
Service Code
|
HCPCS 22532
|
| Min. Negotiated Rate |
$1,534.15 |
| Max. Negotiated Rate |
$4,931.21 |
| Rate for Payer: Cash Price |
$2,217.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,191.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,972.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,972.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,082.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,191.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,082.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,191.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,191.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,643.74
|
| Rate for Payer: Healthfirst Commercial |
$2,191.65
|
| Rate for Payer: Healthfirst Essential Plan |
$4,931.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,082.07
|
| Rate for Payer: Healthfirst QHP |
$2,191.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,534.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,191.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,862.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,534.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,191.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,643.74
|
| Rate for Payer: SOMOS Essential |
$1,643.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,191.65
|
|
|
PR ARTHRODESIS LAT EXTRACAVITARY EA ADDL THRC/LMBR
|
Professional
|
Both
|
$1,654.70
|
|
|
Service Code
|
HCPCS 22534
|
| Min. Negotiated Rate |
$305.20 |
| Max. Negotiated Rate |
$981.00 |
| Rate for Payer: Cash Price |
$438.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$436.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$392.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$392.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$414.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$436.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$414.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$436.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$436.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$327.00
|
| Rate for Payer: Healthfirst Commercial |
$436.00
|
| Rate for Payer: Healthfirst Essential Plan |
$981.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$414.20
|
| Rate for Payer: Healthfirst QHP |
$436.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$305.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$436.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$370.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$305.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$436.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$327.00
|
| Rate for Payer: SOMOS Essential |
$327.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$436.00
|
|
|
PR ARTHRODESIS METACARPOPHALANGEAL JT W/WO INT FIXJ
|
Professional
|
Both
|
$3,255.00
|
|
|
Service Code
|
HCPCS 26850
|
| Min. Negotiated Rate |
$605.55 |
| Max. Negotiated Rate |
$1,946.41 |
| Rate for Payer: Cash Price |
$877.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$865.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$778.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$778.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$821.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$865.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$821.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$865.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$865.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$648.80
|
| Rate for Payer: Healthfirst Commercial |
$865.07
|
| Rate for Payer: Healthfirst Essential Plan |
$1,946.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$821.82
|
| Rate for Payer: Healthfirst QHP |
$865.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$605.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$865.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$735.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$605.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$865.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$648.80
|
| Rate for Payer: SOMOS Essential |
$648.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$865.07
|
|
|
PR ARTHRODESIS MIDTARSOMETATARSAL SINGLE JOINT
|
Professional
|
Both
|
$2,645.37
|
|
|
Service Code
|
HCPCS 28740
|
| Min. Negotiated Rate |
$501.07 |
| Max. Negotiated Rate |
$1,610.60 |
| Rate for Payer: Cash Price |
$721.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$715.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$644.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$644.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$680.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$715.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$680.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$715.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$715.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$536.87
|
| Rate for Payer: Healthfirst Commercial |
$715.82
|
| Rate for Payer: Healthfirst Essential Plan |
$1,610.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$680.03
|
| Rate for Payer: Healthfirst QHP |
$715.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$501.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$715.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$608.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$501.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$715.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$536.87
|
| Rate for Payer: SOMOS Essential |
$536.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$715.82
|
|
|
PR ARTHRODESIS MTCRPL JT W/WO INT FIXJ W/AUTOGRAFT
|
Professional
|
Both
|
$3,682.49
|
|
|
Service Code
|
HCPCS 26852
|
| Min. Negotiated Rate |
$688.13 |
| Max. Negotiated Rate |
$2,211.86 |
| Rate for Payer: Cash Price |
$995.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$983.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$884.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$884.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$933.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$983.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$933.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$983.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$983.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$737.29
|
| Rate for Payer: Healthfirst Commercial |
$983.05
|
| Rate for Payer: Healthfirst Essential Plan |
$2,211.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$933.90
|
| Rate for Payer: Healthfirst QHP |
$983.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$688.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$983.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$835.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$688.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$983.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$737.29
|
| Rate for Payer: SOMOS Essential |
$737.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$983.05
|
|
|
PR ARTHRODESIS PANTALAR
|
Professional
|
Both
|
$5,254.03
|
|
|
Service Code
|
HCPCS 28705
|
| Min. Negotiated Rate |
$990.56 |
| Max. Negotiated Rate |
$3,183.93 |
| Rate for Payer: Cash Price |
$1,425.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,415.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,273.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,273.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,344.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,415.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,344.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,415.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,415.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,061.31
|
| Rate for Payer: Healthfirst Commercial |
$1,415.08
|
| Rate for Payer: Healthfirst Essential Plan |
$3,183.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,344.33
|
| Rate for Payer: Healthfirst QHP |
$1,415.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$990.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,415.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,202.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$990.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,415.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,061.31
|
| Rate for Payer: SOMOS Essential |
$1,061.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,415.08
|
|
|
PR ARTHRODESIS POSTERIOR ATLAS-AXIS C1-C2
|
Professional
|
Both
|
$7,152.85
|
|
|
Service Code
|
HCPCS 22595
|
| Min. Negotiated Rate |
$1,325.59 |
| Max. Negotiated Rate |
$4,260.82 |
| Rate for Payer: Cash Price |
$1,907.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,893.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,704.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,704.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,799.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,893.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,799.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,893.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,893.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,420.28
|
| Rate for Payer: Healthfirst Commercial |
$1,893.70
|
| Rate for Payer: Healthfirst Essential Plan |
$4,260.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,799.02
|
| Rate for Payer: Healthfirst QHP |
$1,893.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,325.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,893.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,609.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,325.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,893.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,420.28
|
| Rate for Payer: SOMOS Essential |
$1,420.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,893.70
|
|
|
PR ARTHRODESIS POSTERIOR CRANIOCERVICAL
|
Professional
|
Both
|
$7,513.45
|
|
|
Service Code
|
HCPCS 22590
|
| Min. Negotiated Rate |
$1,388.81 |
| Max. Negotiated Rate |
$4,464.02 |
| Rate for Payer: Cash Price |
$1,996.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,984.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,785.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,785.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,884.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,984.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,884.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,984.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,984.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,488.01
|
| Rate for Payer: Healthfirst Commercial |
$1,984.01
|
| Rate for Payer: Healthfirst Essential Plan |
$4,464.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,884.81
|
| Rate for Payer: Healthfirst QHP |
$1,984.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,388.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,984.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,686.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,388.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,984.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,488.01
|
| Rate for Payer: SOMOS Essential |
$1,488.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,984.01
|
|
|
PR ARTHRODESIS POSTERIOR INTERBODY EA ADDL
|
Professional
|
Both
|
$1,507.52
|
|
|
Service Code
|
HCPCS 22632
|
| Min. Negotiated Rate |
$274.95 |
| Max. Negotiated Rate |
$883.78 |
| Rate for Payer: Cash Price |
$397.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$392.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$353.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$353.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$373.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$392.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$373.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$392.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$392.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$294.59
|
| Rate for Payer: Healthfirst Commercial |
$392.79
|
| Rate for Payer: Healthfirst Essential Plan |
$883.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$373.15
|
| Rate for Payer: Healthfirst QHP |
$392.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$274.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$392.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$333.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$274.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$392.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$294.59
|
| Rate for Payer: SOMOS Essential |
$294.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$392.79
|
|
|
PR ARTHRODESIS POSTERIOR INTERBODY LUMBAR
|
Professional
|
Both
|
$7,330.82
|
|
|
Service Code
|
HCPCS 22630
|
| Min. Negotiated Rate |
$1,356.00 |
| Max. Negotiated Rate |
$4,358.56 |
| Rate for Payer: Cash Price |
$1,948.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,937.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,743.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,743.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,840.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,937.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,840.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,937.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,937.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,452.86
|
| Rate for Payer: Healthfirst Commercial |
$1,937.14
|
| Rate for Payer: Healthfirst Essential Plan |
$4,358.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,840.28
|
| Rate for Payer: Healthfirst QHP |
$1,937.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,356.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,937.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,646.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,356.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,937.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,452.86
|
| Rate for Payer: SOMOS Essential |
$1,452.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,937.14
|
|
|
PR ARTHRODESIS POSTERIOR/PSTLAT TQ 1NTRSPC LUMBAR
|
Professional
|
Both
|
$7,251.48
|
|
|
Service Code
|
HCPCS 22612
|
| Min. Negotiated Rate |
$1,340.00 |
| Max. Negotiated Rate |
$4,307.13 |
| Rate for Payer: Cash Price |
$1,930.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,914.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,722.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,722.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,818.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,914.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,818.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,914.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,914.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,435.71
|
| Rate for Payer: Healthfirst Commercial |
$1,914.28
|
| Rate for Payer: Healthfirst Essential Plan |
$4,307.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,818.57
|
| Rate for Payer: Healthfirst QHP |
$1,914.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,340.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,914.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,627.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,340.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,914.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,435.71
|
| Rate for Payer: SOMOS Essential |
$1,435.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,914.28
|
|
|
PR ARTHRODESIS POSTERIOR/PSTLAT TQ 1NTRSPC THORACIC
|
Professional
|
Both
|
$5,956.16
|
|
|
Service Code
|
HCPCS 22610
|
| Min. Negotiated Rate |
$1,108.50 |
| Max. Negotiated Rate |
$3,563.03 |
| Rate for Payer: Cash Price |
$1,590.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,583.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,425.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,425.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,504.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,583.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,504.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,583.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,583.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,187.68
|
| Rate for Payer: Healthfirst Commercial |
$1,583.57
|
| Rate for Payer: Healthfirst Essential Plan |
$3,563.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,504.39
|
| Rate for Payer: Healthfirst QHP |
$1,583.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,108.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,583.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,346.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,108.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,583.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,187.68
|
| Rate for Payer: SOMOS Essential |
$1,187.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,583.57
|
|
|
PR ARTHRODESIS POSTERIOR SPINAL DFRM 13/> VRT SEG
|
Professional
|
Both
|
$11,087.16
|
|
|
Service Code
|
HCPCS 22804
|
| Min. Negotiated Rate |
$2,038.22 |
| Max. Negotiated Rate |
$6,551.41 |
| Rate for Payer: Cash Price |
$2,958.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,911.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,620.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,620.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,766.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,911.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,766.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,911.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,911.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,183.80
|
| Rate for Payer: Healthfirst Commercial |
$2,911.74
|
| Rate for Payer: Healthfirst Essential Plan |
$6,551.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,766.15
|
| Rate for Payer: Healthfirst QHP |
$2,911.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,038.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,911.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,474.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,038.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,911.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,183.80
|
| Rate for Payer: SOMOS Essential |
$2,183.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,911.74
|
|
|
PR ARTHRODESIS POSTERIOR SPINAL DFRM 7-12 VRT SEG
|
Professional
|
Both
|
$9,678.76
|
|
|
Service Code
|
HCPCS 22802
|
| Min. Negotiated Rate |
$1,777.38 |
| Max. Negotiated Rate |
$5,713.02 |
| Rate for Payer: Cash Price |
$2,582.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,539.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,285.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,285.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,412.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,539.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,412.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,539.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,539.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,904.34
|
| Rate for Payer: Healthfirst Commercial |
$2,539.12
|
| Rate for Payer: Healthfirst Essential Plan |
$5,713.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,412.16
|
| Rate for Payer: Healthfirst QHP |
$2,539.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,777.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,539.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,158.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,777.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,539.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,904.34
|
| Rate for Payer: SOMOS Essential |
$1,904.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,539.12
|
|
|
PR ARTHRODESIS POSTERIOR SPINAL DFRM UP 6 VRT SEG
|
Professional
|
Both
|
$6,260.17
|
|
|
Service Code
|
HCPCS 22800
|
| Min. Negotiated Rate |
$1,163.86 |
| Max. Negotiated Rate |
$3,740.99 |
| Rate for Payer: Cash Price |
$1,670.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,662.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,496.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,496.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,579.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,662.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,579.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,662.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,662.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,246.99
|
| Rate for Payer: Healthfirst Commercial |
$1,662.66
|
| Rate for Payer: Healthfirst Essential Plan |
$3,740.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,579.53
|
| Rate for Payer: Healthfirst QHP |
$1,662.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,163.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,662.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,413.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,163.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,662.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,246.99
|
| Rate for Payer: SOMOS Essential |
$1,246.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,662.66
|
|
|
PR ARTHRODESIS PRESACRAL INTRBDY W/INSTRUMENT L5-S1
|
Professional
|
Both
|
$9,775.40
|
|
|
Service Code
|
HCPCS 22586
|
| Min. Negotiated Rate |
$1,792.79 |
| Max. Negotiated Rate |
$5,762.54 |
| Rate for Payer: Cash Price |
$2,583.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,561.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,305.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,305.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,433.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,561.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,433.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,561.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,561.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,920.85
|
| Rate for Payer: Healthfirst Commercial |
$2,561.13
|
| Rate for Payer: Healthfirst Essential Plan |
$5,762.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,433.07
|
| Rate for Payer: Healthfirst QHP |
$2,561.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,792.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,561.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,176.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,792.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,561.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,920.85
|
| Rate for Payer: SOMOS Essential |
$1,920.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,561.13
|
|
|
PR ARTHRODESIS PST/PSTLAT TQ 1NTRSPC EA ADDL NTRSPC
|
Professional
|
Both
|
$1,815.31
|
|
|
Service Code
|
HCPCS 22614
|
| Min. Negotiated Rate |
$333.20 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Cash Price |
$479.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$476.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$428.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$428.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$452.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$476.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$452.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$476.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$476.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$357.00
|
| Rate for Payer: Healthfirst Commercial |
$476.00
|
| Rate for Payer: Healthfirst Essential Plan |
$1,071.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$452.20
|
| Rate for Payer: Healthfirst QHP |
$476.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$333.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$476.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$404.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$333.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$476.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$357.00
|
| Rate for Payer: SOMOS Essential |
$357.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$476.00
|
|
