|
PR ARTHROSCOPY HIP SURGICAL W/SYNOVECTOMY
|
Professional
|
Both
|
$3,577.18
|
|
|
Service Code
|
HCPCS 29863
|
| Min. Negotiated Rate |
$678.81 |
| Max. Negotiated Rate |
$2,181.89 |
| Rate for Payer: Cash Price |
$973.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$969.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$872.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$872.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$921.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$969.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$921.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$969.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$969.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$727.30
|
| Rate for Payer: Healthfirst Commercial |
$969.73
|
| Rate for Payer: Healthfirst Essential Plan |
$2,181.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$921.24
|
| Rate for Payer: Healthfirst QHP |
$969.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$678.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$969.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$824.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$678.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$969.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$727.30
|
| Rate for Payer: SOMOS Essential |
$727.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$969.73
|
|
|
PR ARTHROSCOPY HIP W/ACETABULOPLASTY
|
Professional
|
Both
|
$4,478.11
|
|
|
Service Code
|
HCPCS 29915
|
| Min. Negotiated Rate |
$839.61 |
| Max. Negotiated Rate |
$2,698.74 |
| Rate for Payer: Cash Price |
$1,209.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,199.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,079.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,079.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,139.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,199.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,139.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,199.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,199.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$899.58
|
| Rate for Payer: Healthfirst Commercial |
$1,199.44
|
| Rate for Payer: Healthfirst Essential Plan |
$2,698.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,139.47
|
| Rate for Payer: Healthfirst QHP |
$1,199.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$839.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,199.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,019.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$839.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,199.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$899.58
|
| Rate for Payer: SOMOS Essential |
$899.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,199.44
|
|
|
PR ARTHROSCOPY HIP W/FEMOROPLASTY
|
Professional
|
Both
|
$4,370.77
|
|
|
Service Code
|
HCPCS 29914
|
| Min. Negotiated Rate |
$823.57 |
| Max. Negotiated Rate |
$2,647.19 |
| Rate for Payer: Cash Price |
$1,178.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,176.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,058.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,058.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,117.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,176.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,117.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,176.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,176.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$882.40
|
| Rate for Payer: Healthfirst Commercial |
$1,176.53
|
| Rate for Payer: Healthfirst Essential Plan |
$2,647.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,117.70
|
| Rate for Payer: Healthfirst QHP |
$1,176.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$823.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,176.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,000.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$823.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,176.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$882.40
|
| Rate for Payer: SOMOS Essential |
$882.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,176.53
|
|
|
PR ARTHROSCOPY HIP W/LABRAL REPAIR
|
Professional
|
Both
|
$4,482.45
|
|
|
Service Code
|
HCPCS 29916
|
| Min. Negotiated Rate |
$840.53 |
| Max. Negotiated Rate |
$2,701.71 |
| Rate for Payer: Cash Price |
$1,203.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,200.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,080.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,080.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,140.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,200.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,140.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,200.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,200.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$900.57
|
| Rate for Payer: Healthfirst Commercial |
$1,200.76
|
| Rate for Payer: Healthfirst Essential Plan |
$2,701.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,140.72
|
| Rate for Payer: Healthfirst QHP |
$1,200.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$840.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,200.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,020.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$840.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,200.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$900.57
|
| Rate for Payer: SOMOS Essential |
$900.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,200.76
|
|
|
PR ARTHROSCOPY KNEE DIAGNOSTIC W/WO SYNOVIAL BX SPX
|
Professional
|
Both
|
$1,793.89
|
|
|
Service Code
|
HCPCS 29870
|
| Min. Negotiated Rate |
$347.10 |
| Max. Negotiated Rate |
$1,115.66 |
| Rate for Payer: Cash Price |
$493.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$495.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$446.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$446.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$471.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$495.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$471.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$495.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$495.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$371.89
|
| Rate for Payer: Healthfirst Commercial |
$495.85
|
| Rate for Payer: Healthfirst Essential Plan |
$1,115.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$471.06
|
| Rate for Payer: Healthfirst QHP |
$495.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$347.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$495.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$421.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$347.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$495.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$371.89
|
| Rate for Payer: SOMOS Essential |
$371.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$495.85
|
|
|
PR ARTHROSCOPY KNEE INFECTION LAVAGE & DRAINAGE
|
Professional
|
Both
|
$2,285.82
|
|
|
Service Code
|
HCPCS 29871
|
| Min. Negotiated Rate |
$432.49 |
| Max. Negotiated Rate |
$1,390.14 |
| Rate for Payer: Cash Price |
$619.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$617.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$556.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$556.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$586.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$617.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$586.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$617.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$617.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$463.38
|
| Rate for Payer: Healthfirst Commercial |
$617.84
|
| Rate for Payer: Healthfirst Essential Plan |
$1,390.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$586.95
|
| Rate for Payer: Healthfirst QHP |
$617.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$432.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$617.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$525.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$432.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$617.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$463.38
|
| Rate for Payer: SOMOS Essential |
$463.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$617.84
|
|
|
PR ARTHROSCOPY KNEE LATERAL RELEASE
|
Professional
|
Both
|
$2,371.88
|
|
|
Service Code
|
HCPCS 29873
|
| Min. Negotiated Rate |
$451.28 |
| Max. Negotiated Rate |
$1,450.53 |
| Rate for Payer: Cash Price |
$647.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$644.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$580.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$580.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$612.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$644.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$612.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$644.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$644.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$483.51
|
| Rate for Payer: Healthfirst Commercial |
$644.68
|
| Rate for Payer: Healthfirst Essential Plan |
$1,450.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$612.45
|
| Rate for Payer: Healthfirst QHP |
$644.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$451.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$644.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$547.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$451.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$644.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$483.51
|
| Rate for Payer: SOMOS Essential |
$483.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$644.68
|
|
|
PR ARTHROSCOPY KNEE MENISCAL TRNSPLJ MED/LAT
|
Professional
|
Both
|
$7,364.28
|
|
|
Service Code
|
HCPCS 29868
|
| Min. Negotiated Rate |
$1,380.45 |
| Max. Negotiated Rate |
$4,437.16 |
| Rate for Payer: Cash Price |
$1,982.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,972.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,774.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,774.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,873.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,972.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,873.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,972.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,972.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,479.05
|
| Rate for Payer: Healthfirst Commercial |
$1,972.07
|
| Rate for Payer: Healthfirst Essential Plan |
$4,437.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,873.47
|
| Rate for Payer: Healthfirst QHP |
$1,972.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,380.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,972.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,676.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,380.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,972.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,479.05
|
| Rate for Payer: SOMOS Essential |
$1,479.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,972.07
|
|
|
PR ARTHROSCOPY KNEE OSTEOCHONDRAL AGRFT MOSAICPLAST
|
Professional
|
Both
|
$4,651.43
|
|
|
Service Code
|
HCPCS 29866
|
| Min. Negotiated Rate |
$877.27 |
| Max. Negotiated Rate |
$2,819.81 |
| Rate for Payer: Cash Price |
$1,257.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,253.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,127.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,127.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,190.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,253.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,190.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,253.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,253.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$939.94
|
| Rate for Payer: Healthfirst Commercial |
$1,253.25
|
| Rate for Payer: Healthfirst Essential Plan |
$2,819.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,190.59
|
| Rate for Payer: Healthfirst QHP |
$1,253.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$877.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,253.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,065.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$877.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,253.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$939.94
|
| Rate for Payer: SOMOS Essential |
$939.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,253.25
|
|
|
PR ARTHROSCOPY KNEE OSTEOCHONDRAL ALLOGRAFT
|
Professional
|
Both
|
$5,647.32
|
|
|
Service Code
|
HCPCS 29867
|
| Min. Negotiated Rate |
$1,062.63 |
| Max. Negotiated Rate |
$3,415.59 |
| Rate for Payer: Cash Price |
$1,524.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,518.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,366.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,366.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,442.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,518.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,442.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,518.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,518.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,138.53
|
| Rate for Payer: Healthfirst Commercial |
$1,518.04
|
| Rate for Payer: Healthfirst Essential Plan |
$3,415.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,442.14
|
| Rate for Payer: Healthfirst QHP |
$1,518.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,062.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,518.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,290.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,062.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,518.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,138.53
|
| Rate for Payer: SOMOS Essential |
$1,138.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,518.04
|
|
|
PR ARTHROSCOPY KNEE REMOVAL LOOSE/FOREIGN BODY
|
Professional
|
Both
|
$2,367.89
|
|
|
Service Code
|
HCPCS 29874
|
| Min. Negotiated Rate |
$447.96 |
| Max. Negotiated Rate |
$1,439.87 |
| Rate for Payer: Cash Price |
$646.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$639.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$575.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$575.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$607.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$639.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$607.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$639.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$639.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$479.95
|
| Rate for Payer: Healthfirst Commercial |
$639.94
|
| Rate for Payer: Healthfirst Essential Plan |
$1,439.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$607.94
|
| Rate for Payer: Healthfirst QHP |
$639.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$447.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$639.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$543.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$447.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$639.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$479.95
|
| Rate for Payer: SOMOS Essential |
$479.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$639.94
|
|
|
PR ARTHROSCOPY KNEE SYNOVECTOMY 2/>COMPARTMENTS
|
Professional
|
Both
|
$2,885.23
|
|
|
Service Code
|
HCPCS 29876
|
| Min. Negotiated Rate |
$545.62 |
| Max. Negotiated Rate |
$1,753.76 |
| Rate for Payer: Cash Price |
$781.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$779.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$701.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$701.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$740.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$779.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$740.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$779.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$779.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$584.59
|
| Rate for Payer: Healthfirst Commercial |
$779.45
|
| Rate for Payer: Healthfirst Essential Plan |
$1,753.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$740.48
|
| Rate for Payer: Healthfirst QHP |
$779.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$545.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$779.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$662.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$545.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$779.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$584.59
|
| Rate for Payer: SOMOS Essential |
$584.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$779.45
|
|
|
PR ARTHROSCOPY KNEE SYNOVECTOMY LIMITED SPX
|
Professional
|
Both
|
$2,199.12
|
|
|
Service Code
|
HCPCS 29875
|
| Min. Negotiated Rate |
$416.23 |
| Max. Negotiated Rate |
$1,337.87 |
| Rate for Payer: Cash Price |
$597.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$594.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$535.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$535.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$564.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$594.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$564.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$594.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$594.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$445.96
|
| Rate for Payer: Healthfirst Commercial |
$594.61
|
| Rate for Payer: Healthfirst Essential Plan |
$1,337.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$564.88
|
| Rate for Payer: Healthfirst QHP |
$594.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$416.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$594.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$505.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$416.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$594.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$445.96
|
| Rate for Payer: SOMOS Essential |
$445.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$594.61
|
|
|
PR ARTHROSCOPY KNEE W/LYSIS ADHESIONS W/WO MANJ SPX
|
Professional
|
Both
|
$2,740.99
|
|
|
Service Code
|
HCPCS 29884
|
| Min. Negotiated Rate |
$517.89 |
| Max. Negotiated Rate |
$1,664.64 |
| Rate for Payer: Cash Price |
$743.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$739.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$665.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$665.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$702.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$739.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$702.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$739.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$739.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$554.88
|
| Rate for Payer: Healthfirst Commercial |
$739.84
|
| Rate for Payer: Healthfirst Essential Plan |
$1,664.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$702.85
|
| Rate for Payer: Healthfirst QHP |
$739.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$517.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$739.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$628.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$517.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$739.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$554.88
|
| Rate for Payer: SOMOS Essential |
$554.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$739.84
|
|
|
PR ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL&LATERAL
|
Professional
|
Both
|
$3,732.93
|
|
|
Service Code
|
HCPCS 29883
|
| Min. Negotiated Rate |
$697.93 |
| Max. Negotiated Rate |
$2,243.34 |
| Rate for Payer: Cash Price |
$1,008.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$997.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$897.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$897.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$947.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$997.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$947.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$997.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$997.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$747.78
|
| Rate for Payer: Healthfirst Commercial |
$997.04
|
| Rate for Payer: Healthfirst Essential Plan |
$2,243.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$947.19
|
| Rate for Payer: Healthfirst QHP |
$997.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$697.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$997.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$847.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$697.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$997.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$747.78
|
| Rate for Payer: SOMOS Essential |
$747.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$997.04
|
|
|
PR ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL/LATERAL
|
Professional
|
Both
|
$3,045.46
|
|
|
Service Code
|
HCPCS 29882
|
| Min. Negotiated Rate |
$573.52 |
| Max. Negotiated Rate |
$1,843.47 |
| Rate for Payer: Cash Price |
$822.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$819.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$737.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$737.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$778.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$819.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$778.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$819.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$819.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$614.49
|
| Rate for Payer: Healthfirst Commercial |
$819.32
|
| Rate for Payer: Healthfirst Essential Plan |
$1,843.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$778.35
|
| Rate for Payer: Healthfirst QHP |
$819.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$573.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$819.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$696.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$573.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$819.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$614.49
|
| Rate for Payer: SOMOS Essential |
$614.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$819.32
|
|
|
PR ARTHROSCOPY METACARPOPHALANGEAL SYNOVIAL BIOPSY
|
Professional
|
Both
|
$2,240.81
|
|
|
Service Code
|
HCPCS 29900
|
| Min. Negotiated Rate |
$426.19 |
| Max. Negotiated Rate |
$1,369.89 |
| Rate for Payer: Cash Price |
$610.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$608.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$547.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$547.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$578.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$608.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$578.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$608.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$608.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$456.63
|
| Rate for Payer: Healthfirst Commercial |
$608.84
|
| Rate for Payer: Healthfirst Essential Plan |
$1,369.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$578.40
|
| Rate for Payer: Healthfirst QHP |
$608.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$426.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$608.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$517.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$426.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$608.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$456.63
|
| Rate for Payer: SOMOS Essential |
$456.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$608.84
|
|
|
PR ARTHROSCOPY SUBTALAR JOINT SUBTALAR ARTHRODESIS
|
Professional
|
Both
|
$3,883.50
|
|
|
Service Code
|
HCPCS 29907
|
| Min. Negotiated Rate |
$731.53 |
| Max. Negotiated Rate |
$2,351.36 |
| Rate for Payer: Cash Price |
$1,050.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,045.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$940.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$940.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$992.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,045.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$992.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,045.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,045.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$783.79
|
| Rate for Payer: Healthfirst Commercial |
$1,045.05
|
| Rate for Payer: Healthfirst Essential Plan |
$2,351.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$992.80
|
| Rate for Payer: Healthfirst QHP |
$1,045.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$731.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,045.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$888.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$731.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,045.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$783.79
|
| Rate for Payer: SOMOS Essential |
$783.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,045.05
|
|
|
PR ARTHROSCOPY SUBTALAR JOINT WITH DEBRIDEMENT
|
Professional
|
Both
|
$2,766.96
|
|
|
Service Code
|
HCPCS 29906
|
| Min. Negotiated Rate |
$548.55 |
| Max. Negotiated Rate |
$1,763.19 |
| Rate for Payer: Cash Price |
$769.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$783.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$705.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$705.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$744.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$783.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$744.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$783.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$783.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$587.73
|
| Rate for Payer: Healthfirst Commercial |
$783.64
|
| Rate for Payer: Healthfirst Essential Plan |
$1,763.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$744.46
|
| Rate for Payer: Healthfirst QHP |
$783.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$548.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$783.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$666.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$548.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$783.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$587.73
|
| Rate for Payer: SOMOS Essential |
$587.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$783.64
|
|
|
PR ARTHROSCOPY SUBTALAR JOINT WITH SYNOVECTOMY
|
Professional
|
Both
|
$2,118.73
|
|
|
Service Code
|
HCPCS 29905
|
| Min. Negotiated Rate |
$408.05 |
| Max. Negotiated Rate |
$1,311.59 |
| Rate for Payer: Cash Price |
$586.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$582.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$524.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$524.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$553.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$582.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$553.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$582.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$582.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$437.20
|
| Rate for Payer: Healthfirst Commercial |
$582.93
|
| Rate for Payer: Healthfirst Essential Plan |
$1,311.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$553.78
|
| Rate for Payer: Healthfirst QHP |
$582.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$408.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$582.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$495.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$408.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$582.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$437.20
|
| Rate for Payer: SOMOS Essential |
$437.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$582.93
|
|
|
PR ARTHROSCOPY TEMPOROMANDIBULAR JOINT SURGICAL
|
Professional
|
Both
|
$2,506.32
|
|
|
Service Code
|
HCPCS 29804
|
| Min. Negotiated Rate |
$477.22 |
| Max. Negotiated Rate |
$1,533.91 |
| Rate for Payer: Cash Price |
$684.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$681.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$613.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$613.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$647.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$681.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$647.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$681.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$681.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$511.31
|
| Rate for Payer: Healthfirst Commercial |
$681.74
|
| Rate for Payer: Healthfirst Essential Plan |
$1,533.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$647.65
|
| Rate for Payer: Healthfirst QHP |
$681.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$477.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$681.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$579.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$477.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$681.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$511.31
|
| Rate for Payer: SOMOS Essential |
$511.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$681.74
|
|
|
PR ARTHROSCOPY WRIST DIAG W/WO SYNOVIAL BIOPSY SPX
|
Professional
|
Both
|
$1,992.45
|
|
|
Service Code
|
HCPCS 29840
|
| Min. Negotiated Rate |
$383.88 |
| Max. Negotiated Rate |
$1,233.90 |
| Rate for Payer: Cash Price |
$540.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$548.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$493.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$493.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$520.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$548.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$520.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$548.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$548.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$411.30
|
| Rate for Payer: Healthfirst Commercial |
$548.40
|
| Rate for Payer: Healthfirst Essential Plan |
$1,233.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$520.98
|
| Rate for Payer: Healthfirst QHP |
$548.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$383.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$548.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$466.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$383.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$548.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$411.30
|
| Rate for Payer: SOMOS Essential |
$411.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$548.40
|
|
|
PR ARTHROSCOPY WRIST INFECTION LAVAGE&DRAINAGE
|
Professional
|
Both
|
$2,163.25
|
|
|
Service Code
|
HCPCS 29843
|
| Min. Negotiated Rate |
$410.14 |
| Max. Negotiated Rate |
$1,318.30 |
| Rate for Payer: Cash Price |
$587.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$585.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$527.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$527.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$556.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$585.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$556.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$585.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$585.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$439.43
|
| Rate for Payer: Healthfirst Commercial |
$585.91
|
| Rate for Payer: Healthfirst Essential Plan |
$1,318.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$556.61
|
| Rate for Payer: Healthfirst QHP |
$585.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$410.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$585.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$498.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$410.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$585.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$439.43
|
| Rate for Payer: SOMOS Essential |
$439.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$585.91
|
|
|
PR ARTHROSCOPY WRIST SURGICAL SYNOVECTOMY COMPLETE
|
Professional
|
Both
|
$2,597.18
|
|
|
Service Code
|
HCPCS 29845
|
| Min. Negotiated Rate |
$490.32 |
| Max. Negotiated Rate |
$1,576.04 |
| Rate for Payer: Cash Price |
$703.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$700.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$630.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$630.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$665.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$700.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$665.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$700.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$700.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$525.35
|
| Rate for Payer: Healthfirst Commercial |
$700.46
|
| Rate for Payer: Healthfirst Essential Plan |
$1,576.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$665.44
|
| Rate for Payer: Healthfirst QHP |
$700.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$490.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$700.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$595.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$490.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$700.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$525.35
|
| Rate for Payer: SOMOS Essential |
$525.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$700.46
|
|
|
PR ARTHROSCOPY WRIST SURGICAL SYNOVECTOMY PARTIAL
|
Professional
|
Both
|
$2,208.89
|
|
|
Service Code
|
HCPCS 29844
|
| Min. Negotiated Rate |
$420.45 |
| Max. Negotiated Rate |
$1,351.44 |
| Rate for Payer: Cash Price |
$598.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$600.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$540.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$540.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$570.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$600.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$570.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$600.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$600.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$450.48
|
| Rate for Payer: Healthfirst Commercial |
$600.64
|
| Rate for Payer: Healthfirst Essential Plan |
$1,351.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$570.61
|
| Rate for Payer: Healthfirst QHP |
$600.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$420.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$600.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$510.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$420.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$600.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$450.48
|
| Rate for Payer: SOMOS Essential |
$450.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$600.64
|
|
