|
PR ARTHROPLASTY PATELLA W/O PROSTHESIS
|
Professional
|
Both
|
$2,933.88
|
|
|
Service Code
|
HCPCS 27437
|
| Min. Negotiated Rate |
$553.80 |
| Max. Negotiated Rate |
$1,780.07 |
| Rate for Payer: Cash Price |
$795.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$791.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$712.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$712.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$751.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$791.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$751.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$791.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$791.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$593.36
|
| Rate for Payer: Healthfirst Commercial |
$791.14
|
| Rate for Payer: Healthfirst Essential Plan |
$1,780.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$751.58
|
| Rate for Payer: Healthfirst QHP |
$791.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$553.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$791.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$672.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$553.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$791.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$593.36
|
| Rate for Payer: SOMOS Essential |
$593.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$791.14
|
|
|
PR ARTHROPLASTY PATELLA W/PROSTHESIS
|
Professional
|
Both
|
$3,719.21
|
|
|
Service Code
|
HCPCS 27438
|
| Min. Negotiated Rate |
$701.25 |
| Max. Negotiated Rate |
$2,254.01 |
| Rate for Payer: Cash Price |
$1,005.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,001.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$901.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$901.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$951.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,001.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$951.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,001.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,001.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$751.34
|
| Rate for Payer: Healthfirst Commercial |
$1,001.78
|
| Rate for Payer: Healthfirst Essential Plan |
$2,254.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$951.69
|
| Rate for Payer: Healthfirst QHP |
$1,001.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$701.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,001.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$851.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$701.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,001.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$751.34
|
| Rate for Payer: SOMOS Essential |
$751.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,001.78
|
|
|
PR ARTHROPLASTY RADIAL HEAD
|
Professional
|
Both
|
$2,849.63
|
|
|
Service Code
|
HCPCS 24365
|
| Min. Negotiated Rate |
$538.50 |
| Max. Negotiated Rate |
$1,730.90 |
| Rate for Payer: Cash Price |
$771.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$769.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$692.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$692.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$730.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$769.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$730.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$769.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$769.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$576.97
|
| Rate for Payer: Healthfirst Commercial |
$769.29
|
| Rate for Payer: Healthfirst Essential Plan |
$1,730.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$730.83
|
| Rate for Payer: Healthfirst QHP |
$769.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$538.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$769.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$653.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$538.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$769.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$576.97
|
| Rate for Payer: SOMOS Essential |
$576.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$769.29
|
|
|
PR ARTHROPLASTY RADIAL HEAD W/IMPLANT
|
Professional
|
Both
|
$3,007.87
|
|
|
Service Code
|
HCPCS 24366
|
| Min. Negotiated Rate |
$569.49 |
| Max. Negotiated Rate |
$1,830.51 |
| Rate for Payer: Cash Price |
$814.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$813.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$732.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$732.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$772.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$813.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$772.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$813.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$813.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$610.17
|
| Rate for Payer: Healthfirst Commercial |
$813.56
|
| Rate for Payer: Healthfirst Essential Plan |
$1,830.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$772.88
|
| Rate for Payer: Healthfirst QHP |
$813.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$569.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$813.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$691.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$569.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$813.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$610.17
|
| Rate for Payer: SOMOS Essential |
$610.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$813.56
|
|
|
PR ARTHROPLASTY TEMPOROMANDIBULAR JT W/ALLOGRAFT
|
Professional
|
Both
|
$4,266.36
|
|
|
Service Code
|
HCPCS 21242
|
| Min. Negotiated Rate |
$807.79 |
| Max. Negotiated Rate |
$2,596.45 |
| Rate for Payer: Cash Price |
$1,159.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,153.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,038.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,038.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,096.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,153.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,096.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,153.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,153.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$865.49
|
| Rate for Payer: Healthfirst Commercial |
$1,153.98
|
| Rate for Payer: Healthfirst Essential Plan |
$2,596.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,096.28
|
| Rate for Payer: Healthfirst QHP |
$1,153.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$807.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,153.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$980.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$807.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,153.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$865.49
|
| Rate for Payer: SOMOS Essential |
$865.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,153.98
|
|
|
PR ARTHROPLASTY W/PROSTHETIC REPLACEMENT LUNATE
|
Professional
|
Both
|
$3,651.62
|
|
|
Service Code
|
HCPCS 25444
|
| Min. Negotiated Rate |
$689.85 |
| Max. Negotiated Rate |
$2,217.38 |
| Rate for Payer: Cash Price |
$981.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$985.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$886.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$886.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$936.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$985.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$936.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$985.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$985.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$739.12
|
| Rate for Payer: Healthfirst Commercial |
$985.50
|
| Rate for Payer: Healthfirst Essential Plan |
$2,217.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$936.23
|
| Rate for Payer: Healthfirst QHP |
$985.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$689.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$985.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$837.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$689.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$985.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$739.12
|
| Rate for Payer: SOMOS Essential |
$739.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$985.50
|
|
|
PR ARTHROPLASTY W/PROSTHETIC REPLACEMENT TRAPEZIUM
|
Professional
|
Both
|
$3,188.19
|
|
|
Service Code
|
HCPCS 25445
|
| Min. Negotiated Rate |
$602.50 |
| Max. Negotiated Rate |
$1,936.60 |
| Rate for Payer: Cash Price |
$862.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$860.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$774.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$774.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$817.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$860.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$817.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$860.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$860.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$645.53
|
| Rate for Payer: Healthfirst Commercial |
$860.71
|
| Rate for Payer: Healthfirst Essential Plan |
$1,936.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$817.67
|
| Rate for Payer: Healthfirst QHP |
$860.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$602.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$860.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$731.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$602.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$860.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$645.53
|
| Rate for Payer: SOMOS Essential |
$645.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$860.71
|
|
|
PR ARTHROPLASTY W/PROSTHETIC RPLCMT DISTAL RADIUS
|
Professional
|
Both
|
$4,160.21
|
|
|
Service Code
|
HCPCS 25441
|
| Min. Negotiated Rate |
$782.59 |
| Max. Negotiated Rate |
$2,515.48 |
| Rate for Payer: Cash Price |
$1,122.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,117.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,006.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,006.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,062.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,117.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,062.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,117.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,117.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$838.49
|
| Rate for Payer: Healthfirst Commercial |
$1,117.99
|
| Rate for Payer: Healthfirst Essential Plan |
$2,515.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,062.09
|
| Rate for Payer: Healthfirst QHP |
$1,117.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$782.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,117.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$950.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$782.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,117.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$838.49
|
| Rate for Payer: SOMOS Essential |
$838.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,117.99
|
|
|
PR ARTHROPLASTY W/PROSTHETIC RPLCMT DISTAL ULNA
|
Professional
|
Both
|
$3,571.89
|
|
|
Service Code
|
HCPCS 25442
|
| Min. Negotiated Rate |
$675.13 |
| Max. Negotiated Rate |
$2,170.06 |
| Rate for Payer: Cash Price |
$965.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$964.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$868.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$868.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$916.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$964.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$916.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$964.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$964.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$723.35
|
| Rate for Payer: Healthfirst Commercial |
$964.47
|
| Rate for Payer: Healthfirst Essential Plan |
$2,170.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$916.25
|
| Rate for Payer: Healthfirst QHP |
$964.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$675.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$964.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$819.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$675.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$964.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$723.35
|
| Rate for Payer: SOMOS Essential |
$723.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$964.47
|
|
|
PR ARTHROPLASTY W/PROSTHETIC RPLCMT SCAPHOID CARPAL
|
Professional
|
Both
|
$3,486.11
|
|
|
Service Code
|
HCPCS 25443
|
| Min. Negotiated Rate |
$657.17 |
| Max. Negotiated Rate |
$2,112.34 |
| Rate for Payer: Cash Price |
$943.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$938.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$844.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$844.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$891.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$938.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$891.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$938.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$938.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$704.12
|
| Rate for Payer: Healthfirst Commercial |
$938.82
|
| Rate for Payer: Healthfirst Essential Plan |
$2,112.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.88
|
| Rate for Payer: Healthfirst QHP |
$938.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$657.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$938.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$798.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$657.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$938.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$704.12
|
| Rate for Payer: SOMOS Essential |
$704.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$938.82
|
|
|
PR ARTHROSCOPY AID TX SPINE&/FX KNEE W/FIXJ
|
Professional
|
Both
|
$4,113.48
|
|
|
Service Code
|
HCPCS 29851
|
| Min. Negotiated Rate |
$775.35 |
| Max. Negotiated Rate |
$2,492.19 |
| Rate for Payer: Cash Price |
$1,110.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,107.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$996.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$996.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,052.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,107.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,052.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,107.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,107.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$830.73
|
| Rate for Payer: Healthfirst Commercial |
$1,107.64
|
| Rate for Payer: Healthfirst Essential Plan |
$2,492.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,052.26
|
| Rate for Payer: Healthfirst QHP |
$1,107.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$775.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,107.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$941.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$775.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,107.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$830.73
|
| Rate for Payer: SOMOS Essential |
$830.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,107.64
|
|
|
PR ARTHROSCOPY AID TX SPINE&/FX KNEE W/O FIXJ
|
Professional
|
Both
|
$2,770.67
|
|
|
Service Code
|
HCPCS 29850
|
| Min. Negotiated Rate |
$524.31 |
| Max. Negotiated Rate |
$1,685.30 |
| Rate for Payer: Cash Price |
$751.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$749.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$674.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$674.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$711.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$749.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$711.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$749.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$749.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$561.76
|
| Rate for Payer: Healthfirst Commercial |
$749.02
|
| Rate for Payer: Healthfirst Essential Plan |
$1,685.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$711.57
|
| Rate for Payer: Healthfirst QHP |
$749.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$524.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$749.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$636.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$524.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$749.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$561.76
|
| Rate for Payer: SOMOS Essential |
$561.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$749.02
|
|
|
PR ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT EXTENSIVE
|
Professional
|
Both
|
$2,423.26
|
|
|
Service Code
|
HCPCS 29898
|
| Min. Negotiated Rate |
$458.37 |
| Max. Negotiated Rate |
$1,473.32 |
| Rate for Payer: Cash Price |
$657.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$654.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$589.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$589.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$622.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$654.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$622.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$654.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$654.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$491.11
|
| Rate for Payer: Healthfirst Commercial |
$654.81
|
| Rate for Payer: Healthfirst Essential Plan |
$1,473.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$622.07
|
| Rate for Payer: Healthfirst QHP |
$654.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$458.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$654.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$556.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$458.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$654.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$491.11
|
| Rate for Payer: SOMOS Essential |
$491.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$654.81
|
|
|
PR ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT LIMITED
|
Professional
|
Both
|
$2,161.81
|
|
|
Service Code
|
HCPCS 29897
|
| Min. Negotiated Rate |
$404.74 |
| Max. Negotiated Rate |
$1,300.95 |
| Rate for Payer: Cash Price |
$585.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$578.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$520.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$520.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$549.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$578.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$549.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$578.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$578.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$433.65
|
| Rate for Payer: Healthfirst Commercial |
$578.20
|
| Rate for Payer: Healthfirst Essential Plan |
$1,300.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$549.29
|
| Rate for Payer: Healthfirst QHP |
$578.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$404.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$578.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$491.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$404.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$578.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$433.65
|
| Rate for Payer: SOMOS Essential |
$433.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$578.20
|
|
|
PR ARTHROSCOPY ANKLE SURGICAL SYNOVECTOMY PARTIAL
|
Professional
|
Both
|
$1,994.90
|
|
|
Service Code
|
HCPCS 29895
|
| Min. Negotiated Rate |
$374.55 |
| Max. Negotiated Rate |
$1,203.91 |
| Rate for Payer: Cash Price |
$543.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$535.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$481.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$481.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$508.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$535.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$508.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$535.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$535.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$401.30
|
| Rate for Payer: Healthfirst Commercial |
$535.07
|
| Rate for Payer: Healthfirst Essential Plan |
$1,203.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$508.32
|
| Rate for Payer: Healthfirst QHP |
$535.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$374.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$535.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$454.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$374.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$535.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$401.30
|
| Rate for Payer: SOMOS Essential |
$401.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$535.07
|
|
|
PR ARTHROSCOPY ANKLE SURGICAL W/ANKLE ARTHRODESIS
|
Professional
|
Both
|
$4,392.68
|
|
|
Service Code
|
HCPCS 29899
|
| Min. Negotiated Rate |
$818.74 |
| Max. Negotiated Rate |
$2,631.67 |
| Rate for Payer: Cash Price |
$1,187.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,169.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,052.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,052.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,111.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,169.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,111.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,169.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,169.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$877.22
|
| Rate for Payer: Healthfirst Commercial |
$1,169.63
|
| Rate for Payer: Healthfirst Essential Plan |
$2,631.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,111.15
|
| Rate for Payer: Healthfirst QHP |
$1,169.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$818.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,169.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$994.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$818.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,169.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$877.22
|
| Rate for Payer: SOMOS Essential |
$877.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,169.63
|
|
|
PR ARTHROSCOPY ANKLE W/REMOVAL LOOSE/FOREIGN BODY
|
Professional
|
Both
|
$2,152.64
|
|
|
Service Code
|
HCPCS 29894
|
| Min. Negotiated Rate |
$417.35 |
| Max. Negotiated Rate |
$1,341.47 |
| Rate for Payer: Cash Price |
$596.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$596.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$536.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$536.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$566.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$596.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$566.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$596.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$596.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$447.16
|
| Rate for Payer: Healthfirst Commercial |
$596.21
|
| Rate for Payer: Healthfirst Essential Plan |
$1,341.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$566.40
|
| Rate for Payer: Healthfirst QHP |
$596.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$417.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$596.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$506.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$417.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$596.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$447.16
|
| Rate for Payer: SOMOS Essential |
$447.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$596.21
|
|
|
PR ARTHROSCOPY ELBOW DIAG W/WO SYNOVIAL BIOPSY SPX
|
Professional
|
Both
|
$1,995.91
|
|
|
Service Code
|
HCPCS 29830
|
| Min. Negotiated Rate |
$385.71 |
| Max. Negotiated Rate |
$1,239.77 |
| Rate for Payer: Cash Price |
$546.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$551.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$495.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$495.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$523.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$551.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$523.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$551.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$551.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$413.26
|
| Rate for Payer: Healthfirst Commercial |
$551.01
|
| Rate for Payer: Healthfirst Essential Plan |
$1,239.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$523.46
|
| Rate for Payer: Healthfirst QHP |
$551.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$385.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$551.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$468.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$385.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$551.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$413.26
|
| Rate for Payer: SOMOS Essential |
$413.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$551.01
|
|
|
PR ARTHROSCOPY ELBOW SURGICAL DEBRIDEMENT EXTENSIVE
|
Professional
|
Both
|
$2,630.46
|
|
|
Service Code
|
HCPCS 29838
|
| Min. Negotiated Rate |
$497.23 |
| Max. Negotiated Rate |
$1,598.24 |
| Rate for Payer: Cash Price |
$713.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$710.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$639.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$639.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$674.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$710.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$674.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$710.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$710.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$532.75
|
| Rate for Payer: Healthfirst Commercial |
$710.33
|
| Rate for Payer: Healthfirst Essential Plan |
$1,598.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$674.81
|
| Rate for Payer: Healthfirst QHP |
$710.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$497.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$710.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$603.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$497.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$710.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$532.75
|
| Rate for Payer: SOMOS Essential |
$532.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$710.33
|
|
|
PR ARTHROSCOPY ELBOW SURGICAL DEBRIDEMENT LIMITED
|
Professional
|
Both
|
$2,331.67
|
|
|
Service Code
|
HCPCS 29837
|
| Min. Negotiated Rate |
$435.15 |
| Max. Negotiated Rate |
$1,398.71 |
| Rate for Payer: Cash Price |
$629.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$621.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$559.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$559.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$590.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$621.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$590.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$621.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$621.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$466.24
|
| Rate for Payer: Healthfirst Commercial |
$621.65
|
| Rate for Payer: Healthfirst Essential Plan |
$1,398.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$590.57
|
| Rate for Payer: Healthfirst QHP |
$621.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$435.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$621.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$528.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$435.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$621.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$466.24
|
| Rate for Payer: SOMOS Essential |
$466.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$621.65
|
|
|
PR ARTHROSCOPY ELBOW SURGICAL SYNOVECTOMY COMPLETE
|
Professional
|
Both
|
$2,589.44
|
|
|
Service Code
|
HCPCS 29836
|
| Min. Negotiated Rate |
$490.60 |
| Max. Negotiated Rate |
$1,576.93 |
| Rate for Payer: Cash Price |
$701.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$700.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$630.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$630.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$665.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$700.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$665.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$700.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$700.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$525.64
|
| Rate for Payer: Healthfirst Commercial |
$700.86
|
| Rate for Payer: Healthfirst Essential Plan |
$1,576.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$665.82
|
| Rate for Payer: Healthfirst QHP |
$700.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$490.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$700.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$595.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$490.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$700.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$525.64
|
| Rate for Payer: SOMOS Essential |
$525.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$700.86
|
|
|
PR ARTHROSCOPY ELBOW SURGICAL SYNOVECTOMY PARTIAL
|
Professional
|
Both
|
$2,261.25
|
|
|
Service Code
|
HCPCS 29835
|
| Min. Negotiated Rate |
$429.22 |
| Max. Negotiated Rate |
$1,379.63 |
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$613.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$551.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$551.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$582.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$613.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$582.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$613.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$613.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$459.88
|
| Rate for Payer: Healthfirst Commercial |
$613.17
|
| Rate for Payer: Healthfirst Essential Plan |
$1,379.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$582.51
|
| Rate for Payer: Healthfirst QHP |
$613.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$429.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$613.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$521.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$429.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$613.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$459.88
|
| Rate for Payer: SOMOS Essential |
$459.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$613.17
|
|
|
PR ARTHROSCOPY ELBOW SURGICAL W/REMOVAL LOOSE/FB
|
Professional
|
Both
|
$2,177.35
|
|
|
Service Code
|
HCPCS 29834
|
| Min. Negotiated Rate |
$414.59 |
| Max. Negotiated Rate |
$1,332.61 |
| Rate for Payer: Cash Price |
$589.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$592.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$533.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$533.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$562.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$592.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$562.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$592.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$592.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$444.20
|
| Rate for Payer: Healthfirst Commercial |
$592.27
|
| Rate for Payer: Healthfirst Essential Plan |
$1,332.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$562.66
|
| Rate for Payer: Healthfirst QHP |
$592.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$414.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$592.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$503.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$414.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$592.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$444.20
|
| Rate for Payer: SOMOS Essential |
$444.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$592.27
|
|
|
PR ARTHROSCOPY HIP DIAGNOSTIC W/WO SYNOVIAL BYP SPX
|
Professional
|
Both
|
$2,829.89
|
|
|
Service Code
|
HCPCS 29860
|
| Min. Negotiated Rate |
$549.52 |
| Max. Negotiated Rate |
$1,766.32 |
| Rate for Payer: Cash Price |
$783.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$785.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$706.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$706.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$745.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$785.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$745.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$785.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$785.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$588.77
|
| Rate for Payer: Healthfirst Commercial |
$785.03
|
| Rate for Payer: Healthfirst Essential Plan |
$1,766.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$745.78
|
| Rate for Payer: Healthfirst QHP |
$785.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$549.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$785.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$667.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$549.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$785.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$588.77
|
| Rate for Payer: SOMOS Essential |
$588.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$785.03
|
|
|
PR ARTHROSCOPY HIP SURGICAL W/REMOVAL LOOSE/FB
|
Professional
|
Both
|
$3,137.30
|
|
|
Service Code
|
HCPCS 29861
|
| Min. Negotiated Rate |
$577.10 |
| Max. Negotiated Rate |
$1,854.97 |
| Rate for Payer: Cash Price |
$853.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$824.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$741.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$741.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$783.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$824.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$783.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$824.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$824.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$618.32
|
| Rate for Payer: Healthfirst Commercial |
$824.43
|
| Rate for Payer: Healthfirst Essential Plan |
$1,854.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$783.21
|
| Rate for Payer: Healthfirst QHP |
$824.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$577.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$824.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$700.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$577.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$824.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$618.32
|
| Rate for Payer: SOMOS Essential |
$618.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$824.43
|
|
