|
PR ARTHRODESIS SACROILIAC JOINT PERCUTANEOUS
|
Professional
|
Both
|
$3,615.54
|
|
|
Service Code
|
HCPCS 27279
|
| Min. Negotiated Rate |
$666.32 |
| Max. Negotiated Rate |
$2,141.73 |
| Rate for Payer: Cash Price |
$952.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$951.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$856.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$856.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$904.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$951.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$904.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$951.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$951.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$713.91
|
| Rate for Payer: Healthfirst Commercial |
$951.88
|
| Rate for Payer: Healthfirst Essential Plan |
$2,141.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$904.29
|
| Rate for Payer: Healthfirst QHP |
$951.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$666.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$951.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$809.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$666.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$951.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$713.91
|
| Rate for Payer: SOMOS Essential |
$713.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$951.88
|
|
|
PR ARTHRODESIS SI JT OPN W/OBTAINING B1 GRF INSTRMJ
|
Professional
|
Both
|
$6,262.31
|
|
|
Service Code
|
HCPCS 27280
|
| Min. Negotiated Rate |
$1,162.64 |
| Max. Negotiated Rate |
$3,737.05 |
| Rate for Payer: Cash Price |
$1,667.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,660.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,494.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,494.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,577.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,660.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,577.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,660.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,660.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,245.68
|
| Rate for Payer: Healthfirst Commercial |
$1,660.91
|
| Rate for Payer: Healthfirst Essential Plan |
$3,737.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,577.86
|
| Rate for Payer: Healthfirst QHP |
$1,660.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,162.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,660.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,411.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,162.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,660.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,245.68
|
| Rate for Payer: SOMOS Essential |
$1,245.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,660.91
|
|
|
PR ARTHRODESIS SUBTALAR
|
Professional
|
Both
|
$3,374.25
|
|
|
Service Code
|
HCPCS 28725
|
| Min. Negotiated Rate |
$639.61 |
| Max. Negotiated Rate |
$2,055.89 |
| Rate for Payer: Cash Price |
$918.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$913.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$822.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$822.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$868.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$913.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$868.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$913.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$913.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$685.30
|
| Rate for Payer: Healthfirst Commercial |
$913.73
|
| Rate for Payer: Healthfirst Essential Plan |
$2,055.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$868.04
|
| Rate for Payer: Healthfirst QHP |
$913.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$639.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$913.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$776.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$639.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$913.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$685.30
|
| Rate for Payer: SOMOS Essential |
$685.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$913.73
|
|
|
PR ARTHRODESIS SYMPHYSIS PUBIS W/OBTAINING GRAFT
|
Professional
|
Both
|
$3,814.13
|
|
|
Service Code
|
HCPCS 27282
|
| Min. Negotiated Rate |
$717.18 |
| Max. Negotiated Rate |
$2,305.22 |
| Rate for Payer: Cash Price |
$1,029.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,024.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$922.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$922.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$973.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,024.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$973.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,024.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,024.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$768.40
|
| Rate for Payer: Healthfirst Commercial |
$1,024.54
|
| Rate for Payer: Healthfirst Essential Plan |
$2,305.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$973.31
|
| Rate for Payer: Healthfirst QHP |
$1,024.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$717.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,024.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$870.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$717.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,024.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$768.40
|
| Rate for Payer: SOMOS Essential |
$768.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,024.54
|
|
|
PR ARTHRODESIS TIBIOFIBULAR JOINT PROXIMAL/DISTAL
|
Professional
|
Both
|
$3,046.09
|
|
|
Service Code
|
HCPCS 27871
|
| Min. Negotiated Rate |
$572.04 |
| Max. Negotiated Rate |
$1,838.70 |
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$817.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$735.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$735.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$776.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$817.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$776.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$817.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$817.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$612.90
|
| Rate for Payer: Healthfirst Commercial |
$817.20
|
| Rate for Payer: Healthfirst Essential Plan |
$1,838.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$776.34
|
| Rate for Payer: Healthfirst QHP |
$817.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$572.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$817.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$694.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$572.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$817.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$612.90
|
| Rate for Payer: SOMOS Essential |
$612.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$817.20
|
|
|
PR ARTHRODESIS TRIPLE
|
Professional
|
Both
|
$4,095.95
|
|
|
Service Code
|
HCPCS 28715
|
| Min. Negotiated Rate |
$775.71 |
| Max. Negotiated Rate |
$2,493.34 |
| Rate for Payer: Cash Price |
$1,109.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,108.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$997.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$997.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,052.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,108.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,052.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,108.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,108.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$831.11
|
| Rate for Payer: Healthfirst Commercial |
$1,108.15
|
| Rate for Payer: Healthfirst Essential Plan |
$2,493.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,052.74
|
| Rate for Payer: Healthfirst QHP |
$1,108.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$775.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,108.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$941.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$775.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,108.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$831.11
|
| Rate for Payer: SOMOS Essential |
$831.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,108.15
|
|
|
PR ARTHRODESIS WRIST COMPLETE W/O BONE GRAFT
|
Professional
|
Both
|
$3,234.70
|
|
|
Service Code
|
HCPCS 25800
|
| Min. Negotiated Rate |
$610.34 |
| Max. Negotiated Rate |
$1,961.80 |
| Rate for Payer: Cash Price |
$873.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$871.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$784.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$784.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$828.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$871.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$828.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$871.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$871.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$653.93
|
| Rate for Payer: Healthfirst Commercial |
$871.91
|
| Rate for Payer: Healthfirst Essential Plan |
$1,961.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$828.31
|
| Rate for Payer: Healthfirst QHP |
$871.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$610.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$871.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$741.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$610.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$871.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$653.93
|
| Rate for Payer: SOMOS Essential |
$653.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$871.91
|
|
|
PR ARTHRODESIS WRIST LIMITED W/AUTOGRAFT
|
Professional
|
Both
|
$3,499.13
|
|
|
Service Code
|
HCPCS 25825
|
| Min. Negotiated Rate |
$659.89 |
| Max. Negotiated Rate |
$2,121.07 |
| Rate for Payer: Cash Price |
$948.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$942.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$848.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$848.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$895.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$942.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$895.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$942.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$942.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$707.02
|
| Rate for Payer: Healthfirst Commercial |
$942.70
|
| Rate for Payer: Healthfirst Essential Plan |
$2,121.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$895.57
|
| Rate for Payer: Healthfirst QHP |
$942.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$659.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$942.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$801.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$659.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$942.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$707.02
|
| Rate for Payer: SOMOS Essential |
$707.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$942.70
|
|
|
PR ARTHRODESIS WRIST LIMITED W/O BONE GRAFT
|
Professional
|
Both
|
$2,876.09
|
|
|
Service Code
|
HCPCS 25820
|
| Min. Negotiated Rate |
$541.83 |
| Max. Negotiated Rate |
$1,741.59 |
| Rate for Payer: Cash Price |
$778.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$774.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$696.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$696.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$735.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$774.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$735.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$774.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$774.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$580.53
|
| Rate for Payer: Healthfirst Commercial |
$774.04
|
| Rate for Payer: Healthfirst Essential Plan |
$1,741.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$735.34
|
| Rate for Payer: Healthfirst QHP |
$774.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$541.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$774.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$657.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$541.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$774.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$580.53
|
| Rate for Payer: SOMOS Essential |
$580.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$774.04
|
|
|
PR ARTHRODESIS WRIST W/ILIAC/OTHER AUTOGRAFT
|
Professional
|
Both
|
$3,823.26
|
|
|
Service Code
|
HCPCS 25810
|
| Min. Negotiated Rate |
$723.10 |
| Max. Negotiated Rate |
$2,324.25 |
| Rate for Payer: Cash Price |
$1,034.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,033.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$929.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$929.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$981.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,033.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$981.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,033.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,033.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$774.75
|
| Rate for Payer: Healthfirst Commercial |
$1,033.00
|
| Rate for Payer: Healthfirst Essential Plan |
$2,324.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$981.35
|
| Rate for Payer: Healthfirst QHP |
$1,033.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$723.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,033.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$878.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$723.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,033.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$774.75
|
| Rate for Payer: SOMOS Essential |
$774.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,033.00
|
|
|
PR ARTHRODESIS WRIST W/SLIDING GRAFT
|
Professional
|
Both
|
$3,760.82
|
|
|
Service Code
|
HCPCS 25805
|
| Min. Negotiated Rate |
$707.98 |
| Max. Negotiated Rate |
$2,275.65 |
| Rate for Payer: Cash Price |
$1,016.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,011.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$910.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$910.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$960.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,011.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$960.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,011.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,011.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$758.55
|
| Rate for Payer: Healthfirst Commercial |
$1,011.40
|
| Rate for Payer: Healthfirst Essential Plan |
$2,275.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$960.83
|
| Rate for Payer: Healthfirst QHP |
$1,011.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$707.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,011.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$859.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$707.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,011.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$758.55
|
| Rate for Payer: SOMOS Essential |
$758.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,011.40
|
|
|
PR ARTHRO, LOOSE BODY + CHONDRO
|
Professional
|
Both
|
$373.98
|
|
|
Service Code
|
HCPCS G0289
|
| Min. Negotiated Rate |
$69.16 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Cash Price |
$100.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$98.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$88.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$88.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$98.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.10
|
| Rate for Payer: Healthfirst Commercial |
$98.80
|
| Rate for Payer: Healthfirst Essential Plan |
$222.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$93.86
|
| Rate for Payer: Healthfirst QHP |
$98.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$69.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$98.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$83.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$69.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$74.10
|
| Rate for Payer: SOMOS Essential |
$74.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.80
|
|
|
PR ARTHROPLASTY ANKLE
|
Professional
|
Both
|
$2,617.09
|
|
|
Service Code
|
HCPCS 27700
|
| Min. Negotiated Rate |
$595.49 |
| Max. Negotiated Rate |
$1,914.08 |
| Rate for Payer: Cash Price |
$854.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$850.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$765.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$765.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$808.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$850.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$808.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$850.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$850.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$638.02
|
| Rate for Payer: Healthfirst Commercial |
$850.70
|
| Rate for Payer: Healthfirst Essential Plan |
$1,914.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$808.16
|
| Rate for Payer: Healthfirst QHP |
$850.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$595.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$850.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$723.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$595.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$850.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$638.02
|
| Rate for Payer: SOMOS Essential |
$638.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$850.70
|
|
|
PR ARTHROPLASTY ANKLE REVISION TOTAL ANKLE
|
Professional
|
Both
|
$4,866.54
|
|
|
Service Code
|
HCPCS 27703
|
| Min. Negotiated Rate |
$917.21 |
| Max. Negotiated Rate |
$2,948.18 |
| Rate for Payer: Cash Price |
$1,312.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,310.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,179.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,179.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,244.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,310.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,244.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,310.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,310.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$982.73
|
| Rate for Payer: Healthfirst Commercial |
$1,310.30
|
| Rate for Payer: Healthfirst Essential Plan |
$2,948.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,244.79
|
| Rate for Payer: Healthfirst QHP |
$1,310.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$917.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,310.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,113.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$917.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,310.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$982.73
|
| Rate for Payer: SOMOS Essential |
$982.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,310.30
|
|
|
PR ARTHROPLASTY ANKLE W/IMPLANT
|
Professional
|
Both
|
$4,205.67
|
|
|
Service Code
|
HCPCS 27702
|
| Min. Negotiated Rate |
$792.26 |
| Max. Negotiated Rate |
$2,546.55 |
| Rate for Payer: Cash Price |
$1,138.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,131.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,018.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,018.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,075.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,131.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,075.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,131.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,131.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$848.85
|
| Rate for Payer: Healthfirst Commercial |
$1,131.80
|
| Rate for Payer: Healthfirst Essential Plan |
$2,546.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,075.21
|
| Rate for Payer: Healthfirst QHP |
$1,131.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$792.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,131.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$962.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$792.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,131.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$848.85
|
| Rate for Payer: SOMOS Essential |
$848.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,131.80
|
|
|
PR ARTHROPLASTY ELBOW W/DISTAL HUMRL PROSTC RPLCMT
|
Professional
|
Both
|
$4,458.58
|
|
|
Service Code
|
HCPCS 24361
|
| Min. Negotiated Rate |
$839.38 |
| Max. Negotiated Rate |
$2,698.02 |
| Rate for Payer: Cash Price |
$1,202.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,199.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,079.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,079.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,139.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,199.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,139.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,199.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,199.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$899.34
|
| Rate for Payer: Healthfirst Commercial |
$1,199.12
|
| Rate for Payer: Healthfirst Essential Plan |
$2,698.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,139.16
|
| Rate for Payer: Healthfirst QHP |
$1,199.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$839.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,199.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,019.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$839.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,199.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$899.34
|
| Rate for Payer: SOMOS Essential |
$899.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,199.12
|
|
|
PR ARTHROPLASTY ELBOW W/MEMBRANE
|
Professional
|
Both
|
$4,000.99
|
|
|
Service Code
|
HCPCS 24360
|
| Min. Negotiated Rate |
$752.62 |
| Max. Negotiated Rate |
$2,419.13 |
| Rate for Payer: Cash Price |
$1,080.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,075.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$967.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$967.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,021.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,075.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,021.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,075.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,075.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$806.38
|
| Rate for Payer: Healthfirst Commercial |
$1,075.17
|
| Rate for Payer: Healthfirst Essential Plan |
$2,419.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,021.41
|
| Rate for Payer: Healthfirst QHP |
$1,075.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$752.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,075.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$913.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$752.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,075.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$806.38
|
| Rate for Payer: SOMOS Essential |
$806.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,075.17
|
|
|
PR ARTHROPLASTY FEM CONDYLES/TIBIAL PLATEAU KNEE
|
Professional
|
Both
|
$3,860.89
|
|
|
Service Code
|
HCPCS 27442
|
| Min. Negotiated Rate |
$726.71 |
| Max. Negotiated Rate |
$2,335.84 |
| Rate for Payer: Cash Price |
$1,037.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,038.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$934.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$934.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$986.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,038.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$986.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,038.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,038.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$778.61
|
| Rate for Payer: Healthfirst Commercial |
$1,038.15
|
| Rate for Payer: Healthfirst Essential Plan |
$2,335.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$986.24
|
| Rate for Payer: Healthfirst QHP |
$1,038.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$726.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,038.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$882.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$726.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,038.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$778.61
|
| Rate for Payer: SOMOS Essential |
$778.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,038.15
|
|
|
PR ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER
|
Professional
|
Both
|
$6,354.95
|
|
|
Service Code
|
HCPCS 23472
|
| Min. Negotiated Rate |
$1,190.69 |
| Max. Negotiated Rate |
$3,827.20 |
| Rate for Payer: Cash Price |
$1,710.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,700.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,530.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,530.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,615.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,700.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,615.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,700.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,700.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,275.73
|
| Rate for Payer: Healthfirst Commercial |
$1,700.98
|
| Rate for Payer: Healthfirst Essential Plan |
$3,827.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,615.93
|
| Rate for Payer: Healthfirst QHP |
$1,700.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,190.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,700.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,445.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,190.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,700.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,275.73
|
| Rate for Payer: SOMOS Essential |
$1,275.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,700.98
|
|
|
PR ARTHROPLASTY GLENOHUMRL JT HEMIARTHROPLASTY
|
Professional
|
Both
|
$5,269.18
|
|
|
Service Code
|
HCPCS 23470
|
| Min. Negotiated Rate |
$989.33 |
| Max. Negotiated Rate |
$3,179.99 |
| Rate for Payer: Cash Price |
$1,422.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,413.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,272.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,272.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,342.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,413.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,342.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,413.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,413.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,060.00
|
| Rate for Payer: Healthfirst Commercial |
$1,413.33
|
| Rate for Payer: Healthfirst Essential Plan |
$3,179.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,342.66
|
| Rate for Payer: Healthfirst QHP |
$1,413.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$989.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,413.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,201.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$989.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,413.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,060.00
|
| Rate for Payer: SOMOS Essential |
$1,060.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,413.33
|
|
|
PR ARTHROPLASTY INTERPHALANGEAL JOINT EACH
|
Professional
|
Both
|
$1,935.15
|
|
|
Service Code
|
HCPCS 26535
|
| Min. Negotiated Rate |
$371.21 |
| Max. Negotiated Rate |
$1,193.17 |
| Rate for Payer: Cash Price |
$527.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$530.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$477.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$477.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$503.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$530.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$503.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$530.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$530.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$397.73
|
| Rate for Payer: Healthfirst Commercial |
$530.30
|
| Rate for Payer: Healthfirst Essential Plan |
$1,193.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$503.79
|
| Rate for Payer: Healthfirst QHP |
$530.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$371.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$530.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$450.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$371.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$530.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$397.73
|
| Rate for Payer: SOMOS Essential |
$397.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$530.30
|
|
|
PR ARTHROPLASTY INTERPHALANGEAL JT W/PROSTHETIC EA
|
Professional
|
Both
|
$3,316.29
|
|
|
Service Code
|
HCPCS 26536
|
| Min. Negotiated Rate |
$616.69 |
| Max. Negotiated Rate |
$1,982.23 |
| Rate for Payer: Cash Price |
$895.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$880.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$792.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$792.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$836.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$880.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$836.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$880.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$880.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$660.74
|
| Rate for Payer: Healthfirst Commercial |
$880.99
|
| Rate for Payer: Healthfirst Essential Plan |
$1,982.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$836.94
|
| Rate for Payer: Healthfirst QHP |
$880.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$616.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$880.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$748.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$616.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$880.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$660.74
|
| Rate for Payer: SOMOS Essential |
$660.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$880.99
|
|
|
PR ARTHROPLASTY KNEE HINGE PROSTHESIS
|
Professional
|
Both
|
$5,536.69
|
|
|
Service Code
|
HCPCS 27445
|
| Min. Negotiated Rate |
$1,039.24 |
| Max. Negotiated Rate |
$3,340.42 |
| Rate for Payer: Cash Price |
$1,491.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,484.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,336.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,336.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,484.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,410.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,484.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,484.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,113.47
|
| Rate for Payer: Healthfirst Commercial |
$1,484.63
|
| Rate for Payer: Healthfirst Essential Plan |
$3,340.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,410.40
|
| Rate for Payer: Healthfirst QHP |
$1,484.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,039.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,484.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,261.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,039.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,484.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,113.47
|
| Rate for Payer: SOMOS Essential |
$1,113.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,484.63
|
|
|
PR ARTHROPLASTY KNEE TIBIAL PLATEAU
|
Professional
|
Both
|
$3,540.04
|
|
|
Service Code
|
HCPCS 27440
|
| Min. Negotiated Rate |
$666.98 |
| Max. Negotiated Rate |
$2,143.87 |
| Rate for Payer: Cash Price |
$956.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$952.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$857.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$857.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$905.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$952.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$905.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$952.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$952.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$714.62
|
| Rate for Payer: Healthfirst Commercial |
$952.83
|
| Rate for Payer: Healthfirst Essential Plan |
$2,143.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$905.19
|
| Rate for Payer: Healthfirst QHP |
$952.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$666.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$952.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$809.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$666.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$952.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$714.62
|
| Rate for Payer: SOMOS Essential |
$714.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$952.83
|
|
|
PR ARTHROPLASTY METACARPOPHALANGEAL JOINT EACH
|
Professional
|
Both
|
$2,388.09
|
|
|
Service Code
|
HCPCS 26530
|
| Min. Negotiated Rate |
$456.37 |
| Max. Negotiated Rate |
$1,466.91 |
| Rate for Payer: Cash Price |
$652.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$651.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$586.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$586.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$619.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$651.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$619.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$651.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$651.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$488.97
|
| Rate for Payer: Healthfirst Commercial |
$651.96
|
| Rate for Payer: Healthfirst Essential Plan |
$1,466.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$619.36
|
| Rate for Payer: Healthfirst QHP |
$651.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$456.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$651.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$554.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$456.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$651.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$488.97
|
| Rate for Payer: SOMOS Essential |
$488.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$651.96
|
|
