|
PR ARTHRS METACARPOPHALANGEAL JOINT DEBRIDEMENT
|
Professional
|
Both
|
$2,401.25
|
|
|
Service Code
|
HCPCS 29901
|
| Min. Negotiated Rate |
$456.32 |
| Max. Negotiated Rate |
$1,466.75 |
| Rate for Payer: Cash Price |
$653.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$651.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$586.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$586.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$619.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$651.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$619.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$651.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$651.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$488.92
|
| Rate for Payer: Healthfirst Commercial |
$651.89
|
| Rate for Payer: Healthfirst Essential Plan |
$1,466.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$619.30
|
| Rate for Payer: Healthfirst QHP |
$651.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$456.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$651.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$554.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$456.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$651.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$488.92
|
| Rate for Payer: SOMOS Essential |
$488.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$651.89
|
|
|
PR ARTHRS MTCARPHLNGL JT W/RDCTJ UR COLTRL LIGM
|
Professional
|
Both
|
$2,548.46
|
|
|
Service Code
|
HCPCS 29902
|
| Min. Negotiated Rate |
$483.25 |
| Max. Negotiated Rate |
$1,553.31 |
| Rate for Payer: Cash Price |
$692.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$690.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$621.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$621.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$655.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$690.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$655.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$690.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$690.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$517.77
|
| Rate for Payer: Healthfirst Commercial |
$690.36
|
| Rate for Payer: Healthfirst Essential Plan |
$1,553.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$655.84
|
| Rate for Payer: Healthfirst QHP |
$690.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$483.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$690.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$586.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$483.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$690.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$517.77
|
| Rate for Payer: SOMOS Essential |
$517.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$690.36
|
|
|
PR ARTHRS SUBTALAR JOINT REMOVE LOOSE/FOREIGN BODY
|
Professional
|
Both
|
$2,835.98
|
|
|
Service Code
|
HCPCS 29904
|
| Min. Negotiated Rate |
$537.49 |
| Max. Negotiated Rate |
$1,727.64 |
| Rate for Payer: Cash Price |
$768.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$767.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$691.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$691.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$729.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$767.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$729.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$767.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$767.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$575.88
|
| Rate for Payer: Healthfirst Commercial |
$767.84
|
| Rate for Payer: Healthfirst Essential Plan |
$1,727.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$729.45
|
| Rate for Payer: Healthfirst QHP |
$767.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$537.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$767.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$652.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$537.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$767.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$575.88
|
| Rate for Payer: SOMOS Essential |
$575.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$767.84
|
|
|
PR ARTHRS TEMPOROMANDIBULR JT DX W/WO SYNVAL BX SPX
|
Professional
|
Both
|
$2,351.51
|
|
|
Service Code
|
HCPCS 29800
|
| Min. Negotiated Rate |
$445.72 |
| Max. Negotiated Rate |
$1,432.66 |
| Rate for Payer: Cash Price |
$639.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$636.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$573.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$573.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$604.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$636.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$604.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$636.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$636.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$477.56
|
| Rate for Payer: Healthfirst Commercial |
$636.74
|
| Rate for Payer: Healthfirst Essential Plan |
$1,432.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$604.90
|
| Rate for Payer: Healthfirst QHP |
$636.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$445.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$636.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$541.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$445.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$636.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$477.56
|
| Rate for Payer: SOMOS Essential |
$477.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$636.74
|
|
|
PR ARTHRS WRST EXC&/RPR TRIANG FIBROCART&/JOINT
|
Professional
|
Both
|
$2,311.44
|
|
|
Service Code
|
HCPCS 29846
|
| Min. Negotiated Rate |
$437.43 |
| Max. Negotiated Rate |
$1,406.03 |
| Rate for Payer: Cash Price |
$626.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$624.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$562.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$562.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$593.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$624.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$593.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$624.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$624.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$468.68
|
| Rate for Payer: Healthfirst Commercial |
$624.90
|
| Rate for Payer: Healthfirst Essential Plan |
$1,406.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$593.65
|
| Rate for Payer: Healthfirst QHP |
$624.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$437.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$624.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$531.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$437.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$624.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$468.68
|
| Rate for Payer: SOMOS Essential |
$468.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$624.90
|
|
|
PR ARTHRT ACROMCLAV STRNCLAV JT EXPL/DRG/RMVL FB
|
Professional
|
Both
|
$2,533.09
|
|
|
Service Code
|
HCPCS 23044
|
| Min. Negotiated Rate |
$470.33 |
| Max. Negotiated Rate |
$1,511.78 |
| Rate for Payer: Cash Price |
$680.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$671.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$604.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$604.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$638.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$671.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$638.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$671.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$671.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$503.93
|
| Rate for Payer: Healthfirst Commercial |
$671.90
|
| Rate for Payer: Healthfirst Essential Plan |
$1,511.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$638.30
|
| Rate for Payer: Healthfirst QHP |
$671.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$470.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$671.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$571.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$470.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$671.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$503.93
|
| Rate for Payer: SOMOS Essential |
$503.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$671.90
|
|
|
PR ARTHRT ACROMCLAV/STRNCLAV JT W/BX&/EXC CRTLG
|
Professional
|
Both
|
$2,034.59
|
|
|
Service Code
|
HCPCS 23101
|
| Min. Negotiated Rate |
$385.66 |
| Max. Negotiated Rate |
$1,239.62 |
| Rate for Payer: Cash Price |
$554.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$550.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$495.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$495.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$523.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$550.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$523.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$550.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$550.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$413.20
|
| Rate for Payer: Healthfirst Commercial |
$550.94
|
| Rate for Payer: Healthfirst Essential Plan |
$1,239.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$523.39
|
| Rate for Payer: Healthfirst QHP |
$550.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$385.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$550.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$468.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$385.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$550.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$413.20
|
| Rate for Payer: SOMOS Essential |
$413.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$550.94
|
|
|
PR ARTHRT ANKLE W/EXPL W/WO BX W/WO RMVL LOOSE/FB
|
Professional
|
Both
|
$1,924.90
|
|
|
Service Code
|
HCPCS 27620
|
| Min. Negotiated Rate |
$371.18 |
| Max. Negotiated Rate |
$1,193.09 |
| Rate for Payer: Cash Price |
$530.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$530.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$477.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$477.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$503.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$530.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$503.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$530.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$530.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$397.69
|
| Rate for Payer: Healthfirst Commercial |
$530.26
|
| Rate for Payer: Healthfirst Essential Plan |
$1,193.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$503.75
|
| Rate for Payer: Healthfirst QHP |
$530.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$371.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$530.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$450.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$371.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$530.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$397.69
|
| Rate for Payer: SOMOS Essential |
$397.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$530.26
|
|
|
PR ARTHRT ELBOW CAPSULAR EXCISION CAPSULAR RLS SPX
|
Professional
|
Both
|
$3,151.82
|
|
|
Service Code
|
HCPCS 24006
|
| Min. Negotiated Rate |
$597.93 |
| Max. Negotiated Rate |
$1,921.90 |
| Rate for Payer: Cash Price |
$855.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$854.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$768.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$768.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$811.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$854.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$811.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$854.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$854.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$640.63
|
| Rate for Payer: Healthfirst Commercial |
$854.18
|
| Rate for Payer: Healthfirst Essential Plan |
$1,921.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$811.47
|
| Rate for Payer: Healthfirst QHP |
$854.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$597.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$854.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$726.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$597.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$854.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$640.63
|
| Rate for Payer: SOMOS Essential |
$640.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$854.18
|
|
|
PR ARTHRT ELBOW W/EXPLORATION DRAINAGE/REMOVAL FB
|
Professional
|
Both
|
$2,126.43
|
|
|
Service Code
|
HCPCS 24000
|
| Min. Negotiated Rate |
$404.17 |
| Max. Negotiated Rate |
$1,299.11 |
| Rate for Payer: Cash Price |
$577.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$577.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$519.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$519.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$548.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$577.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$548.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$577.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$577.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$433.04
|
| Rate for Payer: Healthfirst Commercial |
$577.38
|
| Rate for Payer: Healthfirst Essential Plan |
$1,299.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$548.51
|
| Rate for Payer: Healthfirst QHP |
$577.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$404.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$577.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$490.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$404.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$577.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$433.04
|
| Rate for Payer: SOMOS Essential |
$433.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$577.38
|
|
|
PR ARTHRT ELBOW W/JNT EXPL W/WOBX W/WORMVL LOOSE/FB
|
Professional
|
Both
|
$2,239.97
|
|
|
Service Code
|
HCPCS 24101
|
| Min. Negotiated Rate |
$423.87 |
| Max. Negotiated Rate |
$1,362.44 |
| Rate for Payer: Cash Price |
$606.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$605.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$544.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$544.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$575.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$605.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$575.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$605.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$605.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$454.15
|
| Rate for Payer: Healthfirst Commercial |
$605.53
|
| Rate for Payer: Healthfirst Essential Plan |
$1,362.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$575.25
|
| Rate for Payer: Healthfirst QHP |
$605.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$423.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$605.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$514.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$423.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$605.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$454.15
|
| Rate for Payer: SOMOS Essential |
$454.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$605.53
|
|
|
PR ARTHRT EXPL DRG/RMVL LOOSE/FB CARP/MTCRPL JT
|
Professional
|
Both
|
$1,426.85
|
|
|
Service Code
|
HCPCS 26070
|
| Min. Negotiated Rate |
$272.85 |
| Max. Negotiated Rate |
$877.03 |
| Rate for Payer: Cash Price |
$390.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$389.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$350.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$350.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$370.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$389.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$370.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$389.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$389.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$292.34
|
| Rate for Payer: Healthfirst Commercial |
$389.79
|
| Rate for Payer: Healthfirst Essential Plan |
$877.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$370.30
|
| Rate for Payer: Healthfirst QHP |
$389.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$272.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$389.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$331.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$272.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$389.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$292.34
|
| Rate for Payer: SOMOS Essential |
$292.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$389.79
|
|
|
PR ARTHRT EXPL DRG/RMVL LOOSE/FB IPHAL JT EA
|
Professional
|
Both
|
$1,766.03
|
|
|
Service Code
|
HCPCS 26080
|
| Min. Negotiated Rate |
$337.32 |
| Max. Negotiated Rate |
$1,084.25 |
| Rate for Payer: Cash Price |
$482.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$481.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$433.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$433.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$457.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$481.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$457.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$481.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$481.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$361.42
|
| Rate for Payer: Healthfirst Commercial |
$481.89
|
| Rate for Payer: Healthfirst Essential Plan |
$1,084.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$457.80
|
| Rate for Payer: Healthfirst QHP |
$481.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$337.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$481.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$409.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$337.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$481.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$361.42
|
| Rate for Payer: SOMOS Essential |
$361.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$481.89
|
|
|
PR ARTHRT EXPL DRG/RMVL LOOSE/FB MTCARPHLNGL JT EA
|
Professional
|
Both
|
$1,503.22
|
|
|
Service Code
|
HCPCS 26075
|
| Min. Negotiated Rate |
$286.18 |
| Max. Negotiated Rate |
$919.87 |
| Rate for Payer: Cash Price |
$409.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$408.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$367.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$367.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$388.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$408.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$388.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$408.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$408.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$306.62
|
| Rate for Payer: Healthfirst Commercial |
$408.83
|
| Rate for Payer: Healthfirst Essential Plan |
$919.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$388.39
|
| Rate for Payer: Healthfirst QHP |
$408.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$286.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$408.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$347.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$286.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$408.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$306.62
|
| Rate for Payer: SOMOS Essential |
$306.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$408.83
|
|
|
PR ARTHRT GLENOHMRL JT W/JT EXPL W/WO RMVL LOOSE/FB
|
Professional
|
Both
|
$2,933.98
|
|
|
Service Code
|
HCPCS 23107
|
| Min. Negotiated Rate |
$556.81 |
| Max. Negotiated Rate |
$1,789.74 |
| Rate for Payer: Cash Price |
$799.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$795.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$715.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$715.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$755.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$795.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$755.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$795.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$795.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$596.58
|
| Rate for Payer: Healthfirst Commercial |
$795.44
|
| Rate for Payer: Healthfirst Essential Plan |
$1,789.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$755.67
|
| Rate for Payer: Healthfirst QHP |
$795.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$556.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$795.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$676.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$556.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$795.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$596.58
|
| Rate for Payer: SOMOS Essential |
$596.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$795.44
|
|
|
PR ARTHRT GLENOHUMRL JT STRNCLAV JT W/SYNVCT W/WOBX
|
Professional
|
Both
|
$2,238.36
|
|
|
Service Code
|
HCPCS 23106
|
| Min. Negotiated Rate |
$424.33 |
| Max. Negotiated Rate |
$1,363.90 |
| Rate for Payer: Cash Price |
$607.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$606.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$545.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$545.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$575.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$606.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$575.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$606.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$606.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$454.63
|
| Rate for Payer: Healthfirst Commercial |
$606.18
|
| Rate for Payer: Healthfirst Essential Plan |
$1,363.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$575.87
|
| Rate for Payer: Healthfirst QHP |
$606.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$424.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$606.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$515.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$424.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$606.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$454.63
|
| Rate for Payer: SOMOS Essential |
$454.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$606.18
|
|
|
PR ARTHRT GLENOHUMRL JT W/SYNOVECTOMY W/WO BIOPSY
|
Professional
|
Both
|
$2,835.81
|
|
|
Service Code
|
HCPCS 23105
|
| Min. Negotiated Rate |
$537.85 |
| Max. Negotiated Rate |
$1,728.81 |
| Rate for Payer: Cash Price |
$771.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$768.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$691.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$691.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$729.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$768.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$729.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$768.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$768.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$576.27
|
| Rate for Payer: Healthfirst Commercial |
$768.36
|
| Rate for Payer: Healthfirst Essential Plan |
$1,728.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$729.94
|
| Rate for Payer: Healthfirst QHP |
$768.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$537.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$768.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$653.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$537.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$768.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$576.27
|
| Rate for Payer: SOMOS Essential |
$576.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$768.36
|
|
|
PR ARTHRT KNE W/EXPL DRG/RMVL FB
|
Professional
|
Both
|
$3,248.84
|
|
|
Service Code
|
HCPCS 27310
|
| Min. Negotiated Rate |
$612.76 |
| Max. Negotiated Rate |
$1,969.58 |
| Rate for Payer: Cash Price |
$879.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$875.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$787.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$787.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$831.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$875.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$831.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$875.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$875.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$656.53
|
| Rate for Payer: Healthfirst Commercial |
$875.37
|
| Rate for Payer: Healthfirst Essential Plan |
$1,969.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$831.60
|
| Rate for Payer: Healthfirst QHP |
$875.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$612.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$875.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$744.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$612.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$875.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$656.53
|
| Rate for Payer: SOMOS Essential |
$656.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$875.37
|
|
|
PR ARTHRT KNE W/JT EXPL BX/RMVL LOOSE/FB
|
Professional
|
Both
|
$2,123.07
|
|
|
Service Code
|
HCPCS 27331
|
| Min. Negotiated Rate |
$402.99 |
| Max. Negotiated Rate |
$1,295.33 |
| Rate for Payer: Cash Price |
$576.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$575.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$518.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$518.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$546.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$575.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$546.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$575.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$575.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$431.77
|
| Rate for Payer: Healthfirst Commercial |
$575.70
|
| Rate for Payer: Healthfirst Essential Plan |
$1,295.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$546.91
|
| Rate for Payer: Healthfirst QHP |
$575.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$402.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$575.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$489.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$402.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$575.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$431.77
|
| Rate for Payer: SOMOS Essential |
$431.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$575.70
|
|
|
PR ARTHRTOMY W/BX INTERPHALANGEAL JOINT
|
Professional
|
Both
|
$968.07
|
|
|
Service Code
|
HCPCS 28054
|
| Min. Negotiated Rate |
$188.41 |
| Max. Negotiated Rate |
$605.61 |
| Rate for Payer: Cash Price |
$269.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$269.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$242.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$242.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$255.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$269.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$255.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$269.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$269.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$201.87
|
| Rate for Payer: Healthfirst Commercial |
$269.16
|
| Rate for Payer: Healthfirst Essential Plan |
$605.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$255.70
|
| Rate for Payer: Healthfirst QHP |
$269.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$188.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$269.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$228.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$188.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$269.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$201.87
|
| Rate for Payer: SOMOS Essential |
$201.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$269.16
|
|
|
PR ARTHRTOMY W/BX METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$1,053.47
|
|
|
Service Code
|
HCPCS 28052
|
| Min. Negotiated Rate |
$204.09 |
| Max. Negotiated Rate |
$655.99 |
| Rate for Payer: Cash Price |
$294.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$291.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$262.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$262.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$276.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$291.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$276.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$291.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$291.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$218.66
|
| Rate for Payer: Healthfirst Commercial |
$291.55
|
| Rate for Payer: Healthfirst Essential Plan |
$655.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$276.97
|
| Rate for Payer: Healthfirst QHP |
$291.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$204.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$291.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$247.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$204.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$291.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$218.66
|
| Rate for Payer: SOMOS Essential |
$218.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$291.55
|
|
|
PR ARTHRT PST CAPSUL RLS ANKLE W/WO ACHLL TDN LNGTH
|
Professional
|
Both
|
$2,450.25
|
|
|
Service Code
|
HCPCS 27612
|
| Min. Negotiated Rate |
$473.58 |
| Max. Negotiated Rate |
$1,522.24 |
| Rate for Payer: Cash Price |
$675.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$676.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$608.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$608.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$642.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$676.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$642.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$676.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$676.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$507.41
|
| Rate for Payer: Healthfirst Commercial |
$676.55
|
| Rate for Payer: Healthfirst Essential Plan |
$1,522.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$642.72
|
| Rate for Payer: Healthfirst QHP |
$676.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$473.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$676.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$575.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$473.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$676.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$507.41
|
| Rate for Payer: SOMOS Essential |
$507.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$676.55
|
|
|
PR ARTHRT RDCRPL/MIDCARPL JT W/EXPL DRG/RMVL FB
|
Professional
|
Both
|
$2,472.58
|
|
|
Service Code
|
HCPCS 25040
|
| Min. Negotiated Rate |
$469.28 |
| Max. Negotiated Rate |
$1,508.40 |
| Rate for Payer: Cash Price |
$671.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$670.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$603.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$603.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$636.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$670.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$636.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$670.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$670.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$502.80
|
| Rate for Payer: Healthfirst Commercial |
$670.40
|
| Rate for Payer: Healthfirst Essential Plan |
$1,508.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$636.88
|
| Rate for Payer: Healthfirst QHP |
$670.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$469.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$670.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$569.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$469.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$670.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$502.80
|
| Rate for Payer: SOMOS Essential |
$502.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$670.40
|
|
|
PR ARTHRT W/BX INTERTARSAL/TARSOMETATARSAL JOINT
|
Professional
|
Both
|
$1,155.91
|
|
|
Service Code
|
HCPCS 28050
|
| Min. Negotiated Rate |
$223.71 |
| Max. Negotiated Rate |
$719.08 |
| Rate for Payer: Cash Price |
$320.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$319.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$287.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$287.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$303.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$319.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$303.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$319.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$319.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$239.69
|
| Rate for Payer: Healthfirst Commercial |
$319.59
|
| Rate for Payer: Healthfirst Essential Plan |
$719.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$303.61
|
| Rate for Payer: Healthfirst QHP |
$319.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$223.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$319.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$271.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$223.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$319.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$239.69
|
| Rate for Payer: SOMOS Essential |
$239.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$319.59
|
|
|
PR ARTHRT W/EXC SEMILUNAR CRTLG KNEE MEDIAL&LAT
|
Professional
|
Both
|
$2,623.50
|
|
|
Service Code
|
HCPCS 27333
|
| Min. Negotiated Rate |
$496.39 |
| Max. Negotiated Rate |
$1,595.54 |
| Rate for Payer: Cash Price |
$711.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$709.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$638.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$638.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$673.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$709.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$673.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$709.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$709.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$531.85
|
| Rate for Payer: Healthfirst Commercial |
$709.13
|
| Rate for Payer: Healthfirst Essential Plan |
$1,595.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$673.67
|
| Rate for Payer: Healthfirst QHP |
$709.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$496.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$709.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$602.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$496.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$709.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$531.85
|
| Rate for Payer: SOMOS Essential |
$531.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$709.13
|
|
