|
PR CALORIC VESTIBULAR TEST W/REC BI MONOTHERMAL
|
Professional
|
Both
|
$30.07
|
|
|
Service Code
|
HCPCS 92538 TC
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Amida Care Medicaid |
$13.28
|
| Rate for Payer: Cash Price |
$8.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.70
|
| Rate for Payer: Healthfirst Commercial |
$7.60
|
| Rate for Payer: Healthfirst Essential Plan |
$17.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.22
|
| Rate for Payer: Healthfirst QHP |
$7.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$7.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$6.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.70
|
| Rate for Payer: SOMOS Essential |
$5.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.60
|
|
|
PR CANALITH REPOSITIONING PROCEDURE
|
Professional
|
Both
|
$145.15
|
|
|
Service Code
|
HCPCS 95992
|
| Min. Negotiated Rate |
$26.99 |
| Max. Negotiated Rate |
$86.76 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.92
|
| Rate for Payer: Healthfirst Commercial |
$38.56
|
| Rate for Payer: Healthfirst Essential Plan |
$86.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.63
|
| Rate for Payer: Healthfirst QHP |
$38.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.92
|
| Rate for Payer: SOMOS Essential |
$28.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.56
|
|
|
PR CANNULATION THORACIC DUCT
|
Professional
|
Both
|
$1,172.43
|
|
|
Service Code
|
HCPCS 38794
|
| Min. Negotiated Rate |
$224.34 |
| Max. Negotiated Rate |
$721.08 |
| Rate for Payer: Cash Price |
$319.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$320.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$288.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$288.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$320.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$320.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$320.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$240.36
|
| Rate for Payer: Healthfirst Commercial |
$320.48
|
| Rate for Payer: Healthfirst Essential Plan |
$721.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$304.46
|
| Rate for Payer: Healthfirst QHP |
$320.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$224.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$320.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$272.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$224.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$320.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$240.36
|
| Rate for Payer: SOMOS Essential |
$240.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$320.48
|
|
|
PR CANTHOPLASTY
|
Professional
|
Both
|
$1,914.43
|
|
|
Service Code
|
HCPCS 67950
|
| Min. Negotiated Rate |
$363.94 |
| Max. Negotiated Rate |
$1,169.80 |
| Rate for Payer: Cash Price |
$525.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$519.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$467.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$467.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$493.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$519.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$493.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$519.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$519.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$389.93
|
| Rate for Payer: Healthfirst Commercial |
$519.91
|
| Rate for Payer: Healthfirst Essential Plan |
$1,169.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$493.91
|
| Rate for Payer: Healthfirst QHP |
$519.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$363.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$519.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$441.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$363.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$519.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$389.93
|
| Rate for Payer: SOMOS Essential |
$389.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$519.91
|
|
|
PR CANTHOTOMY SEPARATE PROCEDURE
|
Professional
|
Both
|
$461.30
|
|
|
Service Code
|
HCPCS 67715
|
| Min. Negotiated Rate |
$86.89 |
| Max. Negotiated Rate |
$279.29 |
| Rate for Payer: Cash Price |
$124.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$124.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$111.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$111.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$117.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$124.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$117.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$93.10
|
| Rate for Payer: Healthfirst Commercial |
$124.13
|
| Rate for Payer: Healthfirst Essential Plan |
$279.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$117.92
|
| Rate for Payer: Healthfirst QHP |
$124.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$86.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$124.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$105.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$86.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$124.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$93.10
|
| Rate for Payer: SOMOS Essential |
$93.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$124.13
|
|
|
PR CAPSLCTOMY/CAPSUL HIP W/RLS HIP FLXR MUSC
|
Professional
|
Both
|
$4,498.10
|
|
|
Service Code
|
HCPCS 27036
|
| Min. Negotiated Rate |
$846.94 |
| Max. Negotiated Rate |
$2,722.30 |
| Rate for Payer: Cash Price |
$1,215.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,209.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,088.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,088.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,149.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,209.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,149.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,209.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,209.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$907.43
|
| Rate for Payer: Healthfirst Commercial |
$1,209.91
|
| Rate for Payer: Healthfirst Essential Plan |
$2,722.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,149.41
|
| Rate for Payer: Healthfirst QHP |
$1,209.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$846.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,209.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,028.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$846.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,209.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$907.43
|
| Rate for Payer: SOMOS Essential |
$907.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,209.91
|
|
|
PR CAPSL-RHPHY/RCNSTJ WRST OPN CARPL INS
|
Professional
|
Both
|
$4,350.01
|
|
|
Service Code
|
HCPCS 25320
|
| Min. Negotiated Rate |
$827.13 |
| Max. Negotiated Rate |
$2,658.64 |
| Rate for Payer: Cash Price |
$1,183.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,181.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,063.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,063.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,122.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,181.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,122.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,181.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,181.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$886.22
|
| Rate for Payer: Healthfirst Commercial |
$1,181.62
|
| Rate for Payer: Healthfirst Essential Plan |
$2,658.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,122.54
|
| Rate for Payer: Healthfirst QHP |
$1,181.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$827.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,181.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,004.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$827.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,181.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$886.22
|
| Rate for Payer: SOMOS Essential |
$886.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,181.62
|
|
|
PR CAPSULAR CONTRACTURE RELEASE
|
Professional
|
Both
|
$3,061.38
|
|
|
Service Code
|
HCPCS 23020
|
| Min. Negotiated Rate |
$578.39 |
| Max. Negotiated Rate |
$1,859.11 |
| Rate for Payer: Cash Price |
$827.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$826.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$743.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$743.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$784.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$826.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$784.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$826.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$826.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$619.70
|
| Rate for Payer: Healthfirst Commercial |
$826.27
|
| Rate for Payer: Healthfirst Essential Plan |
$1,859.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$784.96
|
| Rate for Payer: Healthfirst QHP |
$826.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$578.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$826.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$702.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$578.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$826.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$619.70
|
| Rate for Payer: SOMOS Essential |
$619.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$826.27
|
|
|
PR CAPSULECTOMY/CAPSULOTOMY IPHAL JOINT EACH
|
Professional
|
Both
|
$3,036.50
|
|
|
Service Code
|
HCPCS 26525
|
| Min. Negotiated Rate |
$561.94 |
| Max. Negotiated Rate |
$1,806.23 |
| Rate for Payer: Cash Price |
$819.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$802.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$722.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$722.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$762.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$802.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$762.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$802.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$802.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$602.08
|
| Rate for Payer: Healthfirst Commercial |
$802.77
|
| Rate for Payer: Healthfirst Essential Plan |
$1,806.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$762.63
|
| Rate for Payer: Healthfirst QHP |
$802.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$561.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$802.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$682.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$561.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$802.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$602.08
|
| Rate for Payer: SOMOS Essential |
$602.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$802.77
|
|
|
PR CAPSULECTOMY/CAPSULOTOMY MTCARPHLNGL JOINT EACH
|
Professional
|
Both
|
$3,021.52
|
|
|
Service Code
|
HCPCS 26520
|
| Min. Negotiated Rate |
$557.79 |
| Max. Negotiated Rate |
$1,792.91 |
| Rate for Payer: Cash Price |
$814.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$796.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$717.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$717.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$757.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$796.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$757.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$796.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$796.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$597.64
|
| Rate for Payer: Healthfirst Commercial |
$796.85
|
| Rate for Payer: Healthfirst Essential Plan |
$1,792.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$757.01
|
| Rate for Payer: Healthfirst QHP |
$796.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$557.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$796.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$677.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$557.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$796.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$597.64
|
| Rate for Payer: SOMOS Essential |
$597.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$796.85
|
|
|
PR CAPSUL MIDFOOT W/PST TALOTIBL CAPSUL&TDN LNGTH
|
Professional
|
Both
|
$4,917.89
|
|
|
Service Code
|
HCPCS 28262
|
| Min. Negotiated Rate |
$916.99 |
| Max. Negotiated Rate |
$2,947.48 |
| Rate for Payer: Cash Price |
$1,305.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,309.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,178.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,178.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,244.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,309.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,244.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,309.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,309.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$982.49
|
| Rate for Payer: Healthfirst Commercial |
$1,309.99
|
| Rate for Payer: Healthfirst Essential Plan |
$2,947.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,244.49
|
| Rate for Payer: Healthfirst QHP |
$1,309.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$916.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,309.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,113.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$916.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,309.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$982.49
|
| Rate for Payer: SOMOS Essential |
$982.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,309.99
|
|
|
PR CAPSUL MTTARPHLNGL JT W/WO TENORRHAPHY EA JT SPX
|
Professional
|
Both
|
$1,404.17
|
|
|
Service Code
|
HCPCS 28270
|
| Min. Negotiated Rate |
$271.21 |
| Max. Negotiated Rate |
$871.74 |
| Rate for Payer: Cash Price |
$387.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$387.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$348.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$348.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$368.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$387.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$368.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$387.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$387.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$290.58
|
| Rate for Payer: Healthfirst Commercial |
$387.44
|
| Rate for Payer: Healthfirst Essential Plan |
$871.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$368.07
|
| Rate for Payer: Healthfirst QHP |
$387.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$271.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$387.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$329.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$271.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$387.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$290.58
|
| Rate for Payer: SOMOS Essential |
$290.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$387.44
|
|
|
PR CAPSULODESIS MTCARPHLNGL JOINT 2 DIGITS
|
Professional
|
Both
|
$3,858.75
|
|
|
Service Code
|
HCPCS 26517
|
| Min. Negotiated Rate |
$716.84 |
| Max. Negotiated Rate |
$2,304.11 |
| Rate for Payer: Cash Price |
$1,037.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,024.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$921.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$921.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$972.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,024.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$972.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,024.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,024.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$768.04
|
| Rate for Payer: Healthfirst Commercial |
$1,024.05
|
| Rate for Payer: Healthfirst Essential Plan |
$2,304.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$972.85
|
| Rate for Payer: Healthfirst QHP |
$1,024.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$716.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,024.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$870.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$716.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,024.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$768.04
|
| Rate for Payer: SOMOS Essential |
$768.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,024.05
|
|
|
PR CAPSULODESIS MTCARPHLNGL JOINT 3/4 DIGITS
|
Professional
|
Both
|
$3,907.89
|
|
|
Service Code
|
HCPCS 26518
|
| Min. Negotiated Rate |
$725.00 |
| Max. Negotiated Rate |
$2,330.37 |
| Rate for Payer: Cash Price |
$1,050.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,035.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$932.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$932.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$983.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,035.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$983.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,035.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,035.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$776.79
|
| Rate for Payer: Healthfirst Commercial |
$1,035.72
|
| Rate for Payer: Healthfirst Essential Plan |
$2,330.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$983.93
|
| Rate for Payer: Healthfirst QHP |
$1,035.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$725.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,035.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$880.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$725.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,035.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$776.79
|
| Rate for Payer: SOMOS Essential |
$776.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,035.72
|
|
|
PR CAPSULODESIS MTCARPHLNGL JOINT SINGLE DIGIT
|
Professional
|
Both
|
$3,291.65
|
|
|
Service Code
|
HCPCS 26516
|
| Min. Negotiated Rate |
$613.36 |
| Max. Negotiated Rate |
$1,971.52 |
| Rate for Payer: Cash Price |
$888.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$876.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$788.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$788.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$832.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$876.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$832.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$876.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$876.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$657.17
|
| Rate for Payer: Healthfirst Commercial |
$876.23
|
| Rate for Payer: Healthfirst Essential Plan |
$1,971.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$832.42
|
| Rate for Payer: Healthfirst QHP |
$876.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$613.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$876.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$744.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$613.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$876.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$657.17
|
| Rate for Payer: SOMOS Essential |
$657.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$876.23
|
|
|
PR CAPSULORRHAPHY ANTERIOR PUTTI-PLATT/MAGNUSON
|
Professional
|
Both
|
$4,188.91
|
|
|
Service Code
|
HCPCS 23450
|
| Min. Negotiated Rate |
$786.65 |
| Max. Negotiated Rate |
$2,528.53 |
| Rate for Payer: Cash Price |
$1,129.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,123.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,011.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,011.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,067.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,123.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,067.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,123.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,123.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$842.84
|
| Rate for Payer: Healthfirst Commercial |
$1,123.79
|
| Rate for Payer: Healthfirst Essential Plan |
$2,528.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,067.60
|
| Rate for Payer: Healthfirst QHP |
$1,123.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$786.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,123.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$955.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$786.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,123.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$842.84
|
| Rate for Payer: SOMOS Essential |
$842.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,123.79
|
|
|
PR CAPSULORRHAPHY ANTERIOR W/CORACOID PROCESS TR
|
Professional
|
Both
|
$4,725.00
|
|
|
Service Code
|
HCPCS 23462
|
| Min. Negotiated Rate |
$885.98 |
| Max. Negotiated Rate |
$2,847.80 |
| Rate for Payer: Cash Price |
$1,272.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,265.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,139.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,139.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,202.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,265.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,202.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,265.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,265.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$949.27
|
| Rate for Payer: Healthfirst Commercial |
$1,265.69
|
| Rate for Payer: Healthfirst Essential Plan |
$2,847.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,202.41
|
| Rate for Payer: Healthfirst QHP |
$1,265.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$885.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,265.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,075.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$885.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,265.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$949.27
|
| Rate for Payer: SOMOS Essential |
$949.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,265.69
|
|
|
PR CAPSULORRHAPHY ANTERIOR WITH BONE BLOCK
|
Professional
|
Both
|
$4,822.34
|
|
|
Service Code
|
HCPCS 23460
|
| Min. Negotiated Rate |
$905.72 |
| Max. Negotiated Rate |
$2,911.25 |
| Rate for Payer: Cash Price |
$1,300.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,293.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,164.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,164.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,229.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,293.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,229.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,293.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,293.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$970.42
|
| Rate for Payer: Healthfirst Commercial |
$1,293.89
|
| Rate for Payer: Healthfirst Essential Plan |
$2,911.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,229.20
|
| Rate for Payer: Healthfirst QHP |
$1,293.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$905.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,293.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,099.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$905.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,293.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$970.42
|
| Rate for Payer: SOMOS Essential |
$970.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,293.89
|
|
|
PR CAPSULORRHAPHY ANTERIOR W/LABRAL REPAIR
|
Professional
|
Both
|
$4,354.53
|
|
|
Service Code
|
HCPCS 23455
|
| Min. Negotiated Rate |
$803.15 |
| Max. Negotiated Rate |
$2,581.56 |
| Rate for Payer: Cash Price |
$1,173.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,147.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,032.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,032.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,089.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,147.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,089.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,147.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,147.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$860.52
|
| Rate for Payer: Healthfirst Commercial |
$1,147.36
|
| Rate for Payer: Healthfirst Essential Plan |
$2,581.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,089.99
|
| Rate for Payer: Healthfirst QHP |
$1,147.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$803.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,147.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$975.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$803.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,147.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$860.52
|
| Rate for Payer: SOMOS Essential |
$860.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,147.36
|
|
|
PR CAPSULORRHAPHY GLENOHUMERAL JT PST W/WO BONE BLK
|
Professional
|
Both
|
$4,945.75
|
|
|
Service Code
|
HCPCS 23465
|
| Min. Negotiated Rate |
$928.26 |
| Max. Negotiated Rate |
$2,983.68 |
| Rate for Payer: Cash Price |
$1,333.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,326.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,193.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,193.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,259.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,326.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,259.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,326.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,326.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$994.56
|
| Rate for Payer: Healthfirst Commercial |
$1,326.08
|
| Rate for Payer: Healthfirst Essential Plan |
$2,983.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,259.78
|
| Rate for Payer: Healthfirst QHP |
$1,326.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$928.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,326.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,127.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$928.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,326.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$994.56
|
| Rate for Payer: SOMOS Essential |
$994.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,326.08
|
|
|
PR CAPSULORRHAPHY GLENOHUMRL JT MULTI-DIRIONAL INS
|
Professional
|
Both
|
$4,948.72
|
|
|
Service Code
|
HCPCS 23466
|
| Min. Negotiated Rate |
$929.06 |
| Max. Negotiated Rate |
$2,986.27 |
| Rate for Payer: Cash Price |
$1,339.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,327.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,194.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,194.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,260.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,327.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,260.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,327.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,327.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$995.42
|
| Rate for Payer: Healthfirst Commercial |
$1,327.23
|
| Rate for Payer: Healthfirst Essential Plan |
$2,986.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,260.87
|
| Rate for Payer: Healthfirst QHP |
$1,327.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$929.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,327.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,128.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$929.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,327.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$995.42
|
| Rate for Payer: SOMOS Essential |
$995.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,327.23
|
|
|
PR CAPSULOTOMY IPHAL JOINT EACH JOINT SPX
|
Professional
|
Both
|
$1,037.37
|
|
|
Service Code
|
HCPCS 28272
|
| Min. Negotiated Rate |
$200.98 |
| Max. Negotiated Rate |
$646.00 |
| Rate for Payer: Cash Price |
$289.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$287.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$258.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$258.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$272.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$287.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$272.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$287.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$287.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$215.33
|
| Rate for Payer: Healthfirst Commercial |
$287.11
|
| Rate for Payer: Healthfirst Essential Plan |
$646.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$272.75
|
| Rate for Payer: Healthfirst QHP |
$287.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$200.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$287.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$244.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$200.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$287.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$215.33
|
| Rate for Payer: SOMOS Essential |
$215.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$287.11
|
|
|
PR CAPSULOTOMY MIDFOOT MEDIAL RELEASE ONLY SPX
|
Professional
|
Both
|
$2,288.02
|
|
|
Service Code
|
HCPCS 28260
|
| Min. Negotiated Rate |
$438.27 |
| Max. Negotiated Rate |
$1,408.72 |
| Rate for Payer: Cash Price |
$634.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$626.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$563.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$563.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$594.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$626.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$594.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$626.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$626.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$469.57
|
| Rate for Payer: Healthfirst Commercial |
$626.10
|
| Rate for Payer: Healthfirst Essential Plan |
$1,408.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$594.79
|
| Rate for Payer: Healthfirst QHP |
$626.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$438.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$626.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$532.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$438.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$626.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$469.57
|
| Rate for Payer: SOMOS Essential |
$469.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$626.10
|
|
|
PR CAPSULOTOMY MIDFOOT W/TENDON LENGTHENING
|
Professional
|
Both
|
$4,148.27
|
|
|
Service Code
|
HCPCS 28261
|
| Min. Negotiated Rate |
$698.44 |
| Max. Negotiated Rate |
$2,244.98 |
| Rate for Payer: Cash Price |
$990.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$997.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$897.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$897.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$947.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$997.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$947.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$997.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$997.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$748.33
|
| Rate for Payer: Healthfirst Commercial |
$997.77
|
| Rate for Payer: Healthfirst Essential Plan |
$2,244.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$947.88
|
| Rate for Payer: Healthfirst QHP |
$997.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$698.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$997.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$848.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$698.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$997.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$748.33
|
| Rate for Payer: SOMOS Essential |
$748.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$997.77
|
|
|
PR CAPSULOTOMY MIDTARSAL
|
Professional
|
Both
|
$2,893.14
|
|
|
Service Code
|
HCPCS 28264
|
| Min. Negotiated Rate |
$562.27 |
| Max. Negotiated Rate |
$1,807.31 |
| Rate for Payer: Cash Price |
$782.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$803.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$722.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$722.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$763.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$803.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$763.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$803.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$803.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$602.44
|
| Rate for Payer: Healthfirst Commercial |
$803.25
|
| Rate for Payer: Healthfirst Essential Plan |
$1,807.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$763.09
|
| Rate for Payer: Healthfirst QHP |
$803.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$562.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$803.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$682.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$562.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$803.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$602.44
|
| Rate for Payer: SOMOS Essential |
$602.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$803.25
|
|
