|
PR EXC CONSTRICTING RING FNGR W/MLT Z-PLASTIES
|
Professional
|
Both
|
$3,640.46
|
|
|
Service Code
|
HCPCS 26596
|
| Min. Negotiated Rate |
$678.78 |
| Max. Negotiated Rate |
$2,181.78 |
| Rate for Payer: Cash Price |
$980.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$969.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$872.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$872.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$921.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$969.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$921.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$969.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$969.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$727.26
|
| Rate for Payer: Healthfirst Commercial |
$969.68
|
| Rate for Payer: Healthfirst Essential Plan |
$2,181.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$921.20
|
| Rate for Payer: Healthfirst QHP |
$969.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$678.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$969.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$824.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$678.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$969.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$727.26
|
| Rate for Payer: SOMOS Essential |
$727.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$969.68
|
|
|
PR EXC CRV STUMP VAG APPR W/ANT &/POST REPAIR
|
Professional
|
Both
|
$2,709.88
|
|
|
Service Code
|
HCPCS 57555
|
| Min. Negotiated Rate |
$503.51 |
| Max. Negotiated Rate |
$1,618.42 |
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$719.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$647.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$647.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$683.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$719.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$683.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$719.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$719.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$539.48
|
| Rate for Payer: Healthfirst Commercial |
$719.30
|
| Rate for Payer: Healthfirst Essential Plan |
$1,618.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$683.34
|
| Rate for Payer: Healthfirst QHP |
$719.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$503.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$719.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$611.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$503.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$719.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$539.48
|
| Rate for Payer: SOMOS Essential |
$539.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$719.30
|
|
|
PR EXC CRV STUMP VAG APPR W/RPR NTRCL
|
Professional
|
Both
|
$2,572.50
|
|
|
Service Code
|
HCPCS 57556
|
| Min. Negotiated Rate |
$478.13 |
| Max. Negotiated Rate |
$1,536.86 |
| Rate for Payer: Cash Price |
$693.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$683.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$614.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$614.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$648.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$683.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$648.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$683.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$683.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$512.29
|
| Rate for Payer: Healthfirst Commercial |
$683.05
|
| Rate for Payer: Healthfirst Essential Plan |
$1,536.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$648.90
|
| Rate for Payer: Healthfirst QHP |
$683.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$478.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$683.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$580.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$478.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$683.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$512.29
|
| Rate for Payer: SOMOS Essential |
$512.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$683.05
|
|
|
PR EXC CSTIC HYGROMA AX/CRV W/DP NEUROVASC DSJ
|
Professional
|
Both
|
$4,639.36
|
|
|
Service Code
|
HCPCS 38555
|
| Min. Negotiated Rate |
$861.71 |
| Max. Negotiated Rate |
$2,769.77 |
| Rate for Payer: Cash Price |
$1,238.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,231.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,107.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,107.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,169.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,231.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,169.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,231.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,231.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$923.26
|
| Rate for Payer: Healthfirst Commercial |
$1,231.01
|
| Rate for Payer: Healthfirst Essential Plan |
$2,769.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,169.46
|
| Rate for Payer: Healthfirst QHP |
$1,231.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$861.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,231.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,046.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$861.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,231.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$923.26
|
| Rate for Payer: SOMOS Essential |
$923.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,231.01
|
|
|
PR EXC CSTIC HYGROMA AX/CRV W/O DP NEUROVASC DSJ
|
Professional
|
Both
|
$2,352.32
|
|
|
Service Code
|
HCPCS 38550
|
| Min. Negotiated Rate |
$440.89 |
| Max. Negotiated Rate |
$1,417.16 |
| Rate for Payer: Cash Price |
$632.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$629.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$566.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$566.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$598.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$629.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$598.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$629.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$629.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$472.39
|
| Rate for Payer: Healthfirst Commercial |
$629.85
|
| Rate for Payer: Healthfirst Essential Plan |
$1,417.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$598.36
|
| Rate for Payer: Healthfirst QHP |
$629.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$440.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$629.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$535.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$440.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$629.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$472.39
|
| Rate for Payer: SOMOS Essential |
$472.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$629.85
|
|
|
PR EXC/CURETTAGE CYST/TUMOR METACARPAL W/AUTOGRAFT
|
Professional
|
Both
|
$2,694.58
|
|
|
Service Code
|
HCPCS 26205
|
| Min. Negotiated Rate |
$509.01 |
| Max. Negotiated Rate |
$1,636.11 |
| Rate for Payer: Cash Price |
$729.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$727.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$654.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$654.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$690.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$727.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$690.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$727.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$727.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$545.37
|
| Rate for Payer: Healthfirst Commercial |
$727.16
|
| Rate for Payer: Healthfirst Essential Plan |
$1,636.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$690.80
|
| Rate for Payer: Healthfirst QHP |
$727.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$509.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$727.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$618.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$509.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$727.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$545.37
|
| Rate for Payer: SOMOS Essential |
$545.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$727.16
|
|
|
PR EXC/CURETTAGE CYST/TUMOR PHALANX FINGER W/AGRAFT
|
Professional
|
Both
|
$2,531.62
|
|
|
Service Code
|
HCPCS 26215
|
| Min. Negotiated Rate |
$476.67 |
| Max. Negotiated Rate |
$1,532.14 |
| Rate for Payer: Cash Price |
$685.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$680.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$612.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$612.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$680.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$646.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$680.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$680.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$510.71
|
| Rate for Payer: Healthfirst Commercial |
$680.95
|
| Rate for Payer: Healthfirst Essential Plan |
$1,532.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$646.90
|
| Rate for Payer: Healthfirst QHP |
$680.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$476.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$680.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$578.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$476.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$680.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$510.71
|
| Rate for Payer: SOMOS Essential |
$510.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$680.95
|
|
|
PR EXC/CURETTAGE CYST/TUMOR TALUS/CALCANEUS ALGRFT
|
Professional
|
Both
|
$1,597.37
|
|
|
Service Code
|
HCPCS 28103
|
| Min. Negotiated Rate |
$308.06 |
| Max. Negotiated Rate |
$990.18 |
| Rate for Payer: Cash Price |
$441.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$440.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$396.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$396.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$418.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$440.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$418.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$440.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$440.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$330.06
|
| Rate for Payer: Healthfirst Commercial |
$440.08
|
| Rate for Payer: Healthfirst Essential Plan |
$990.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$418.08
|
| Rate for Payer: Healthfirst QHP |
$440.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$308.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$440.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$374.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$308.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$440.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$330.06
|
| Rate for Payer: SOMOS Essential |
$330.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$440.08
|
|
|
PR EXC/CURETTAGE CYST/TUMOR TIBIA/FIBULA W/AGRAFT
|
Professional
|
Both
|
$3,265.36
|
|
|
Service Code
|
HCPCS 27637
|
| Min. Negotiated Rate |
$623.89 |
| Max. Negotiated Rate |
$2,005.36 |
| Rate for Payer: Cash Price |
$890.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$891.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$802.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$802.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$846.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$891.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$846.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$891.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$891.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$668.45
|
| Rate for Payer: Healthfirst Commercial |
$891.27
|
| Rate for Payer: Healthfirst Essential Plan |
$2,005.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$846.71
|
| Rate for Payer: Healthfirst QHP |
$891.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$623.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$891.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$757.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$623.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$891.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$668.45
|
| Rate for Payer: SOMOS Essential |
$668.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$891.27
|
|
|
PR EXC/CURETTAGE CYST/TUMOR TIBIA/FIBULA W/ALGRAFT
|
Professional
|
Both
|
$3,265.40
|
|
|
Service Code
|
HCPCS 27638
|
| Min. Negotiated Rate |
$615.68 |
| Max. Negotiated Rate |
$1,978.96 |
| Rate for Payer: Cash Price |
$879.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$879.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$791.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$791.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$835.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$879.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$835.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$879.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$879.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$659.65
|
| Rate for Payer: Healthfirst Commercial |
$879.54
|
| Rate for Payer: Healthfirst Essential Plan |
$1,978.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$835.56
|
| Rate for Payer: Healthfirst QHP |
$879.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$615.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$879.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$747.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$615.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$879.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$659.65
|
| Rate for Payer: SOMOS Essential |
$659.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$879.54
|
|
|
PR EXC/CURTG BONE CST/B9 TUM CLAV/SCAPULA W/AGRFT
|
Professional
|
Both
|
$3,094.46
|
|
|
Service Code
|
HCPCS 23145
|
| Min. Negotiated Rate |
$582.93 |
| Max. Negotiated Rate |
$1,873.71 |
| Rate for Payer: Cash Price |
$836.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$832.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$749.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$749.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$791.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$832.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$791.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$832.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$832.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$624.57
|
| Rate for Payer: Healthfirst Commercial |
$832.76
|
| Rate for Payer: Healthfirst Essential Plan |
$1,873.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$791.12
|
| Rate for Payer: Healthfirst QHP |
$832.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$582.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$832.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$707.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$582.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$832.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$624.57
|
| Rate for Payer: SOMOS Essential |
$624.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$832.76
|
|
|
PR EXC/CURTG BONE CST/B9 TUM CLAV/SCAPULA W/ALGRFT
|
Professional
|
Both
|
$2,772.00
|
|
|
Service Code
|
HCPCS 23146
|
| Min. Negotiated Rate |
$524.91 |
| Max. Negotiated Rate |
$1,687.21 |
| Rate for Payer: Cash Price |
$752.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$749.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$674.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$674.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$712.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$749.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$712.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$749.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$749.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$562.40
|
| Rate for Payer: Healthfirst Commercial |
$749.87
|
| Rate for Payer: Healthfirst Essential Plan |
$1,687.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$712.38
|
| Rate for Payer: Healthfirst QHP |
$749.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$524.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$749.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$637.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$524.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$749.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$562.40
|
| Rate for Payer: SOMOS Essential |
$562.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$749.87
|
|
|
PR EXC/CURTG BONE CST/B9 TUM H/N RDS/OLECRN W/AGRFT
|
Professional
|
Both
|
$2,769.34
|
|
|
Service Code
|
HCPCS 24125
|
| Min. Negotiated Rate |
$524.23 |
| Max. Negotiated Rate |
$1,685.03 |
| Rate for Payer: Cash Price |
$751.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$748.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$674.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$674.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$711.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$748.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$711.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$748.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$748.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$561.67
|
| Rate for Payer: Healthfirst Commercial |
$748.90
|
| Rate for Payer: Healthfirst Essential Plan |
$1,685.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$711.46
|
| Rate for Payer: Healthfirst QHP |
$748.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$524.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$748.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$636.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$524.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$748.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$561.67
|
| Rate for Payer: SOMOS Essential |
$561.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$748.90
|
|
|
PR EXC/CURTG BONE CST/B9 TUM H/N RDS/OLECRN W/ALGRT
|
Professional
|
Both
|
$2,892.75
|
|
|
Service Code
|
HCPCS 24126
|
| Min. Negotiated Rate |
$547.20 |
| Max. Negotiated Rate |
$1,758.85 |
| Rate for Payer: Cash Price |
$783.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$781.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$703.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$703.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$742.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$781.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$742.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$781.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$781.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$586.28
|
| Rate for Payer: Healthfirst Commercial |
$781.71
|
| Rate for Payer: Healthfirst Essential Plan |
$1,758.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$742.62
|
| Rate for Payer: Healthfirst QHP |
$781.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$547.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$781.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$664.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$547.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$781.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$586.28
|
| Rate for Payer: SOMOS Essential |
$586.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$781.71
|
|
|
PR EXC/CURTG BONE CYST/B9 TUMORTARSAL/METATARSAL
|
Professional
|
Both
|
$1,494.43
|
|
|
Service Code
|
HCPCS 28104
|
| Min. Negotiated Rate |
$290.23 |
| Max. Negotiated Rate |
$932.87 |
| Rate for Payer: Cash Price |
$413.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$414.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$373.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$373.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$393.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$414.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$393.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$414.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$414.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$310.96
|
| Rate for Payer: Healthfirst Commercial |
$414.61
|
| Rate for Payer: Healthfirst Essential Plan |
$932.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$393.88
|
| Rate for Payer: Healthfirst QHP |
$414.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$290.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$414.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$352.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$290.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$414.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$310.96
|
| Rate for Payer: SOMOS Essential |
$310.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$414.61
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUM HUMERUS W/ALGRFT
|
Professional
|
Both
|
$3,813.43
|
|
|
Service Code
|
HCPCS 24116
|
| Min. Negotiated Rate |
$716.60 |
| Max. Negotiated Rate |
$2,303.35 |
| Rate for Payer: Cash Price |
$1,029.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,023.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$921.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$921.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$972.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,023.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$972.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,023.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,023.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$767.78
|
| Rate for Payer: Healthfirst Commercial |
$1,023.71
|
| Rate for Payer: Healthfirst Essential Plan |
$2,303.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$972.52
|
| Rate for Payer: Healthfirst QHP |
$1,023.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$716.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,023.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$870.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$716.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,023.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$767.78
|
| Rate for Payer: SOMOS Essential |
$767.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,023.71
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUMOR CLAV/SCAPULA
|
Professional
|
Both
|
$2,473.14
|
|
|
Service Code
|
HCPCS 23140
|
| Min. Negotiated Rate |
$467.89 |
| Max. Negotiated Rate |
$1,503.92 |
| Rate for Payer: Cash Price |
$670.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$668.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$601.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$601.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$634.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$668.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$634.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$668.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$668.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$501.31
|
| Rate for Payer: Healthfirst Commercial |
$668.41
|
| Rate for Payer: Healthfirst Essential Plan |
$1,503.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$634.99
|
| Rate for Payer: Healthfirst QHP |
$668.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$467.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$668.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$568.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$467.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$668.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$501.31
|
| Rate for Payer: SOMOS Essential |
$501.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$668.41
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN
|
Professional
|
Both
|
$2,362.78
|
|
|
Service Code
|
HCPCS 24120
|
| Min. Negotiated Rate |
$449.48 |
| Max. Negotiated Rate |
$1,444.77 |
| Rate for Payer: Cash Price |
$642.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$642.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$577.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$577.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$610.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$642.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$610.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$642.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$642.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$481.59
|
| Rate for Payer: Healthfirst Commercial |
$642.12
|
| Rate for Payer: Healthfirst Essential Plan |
$1,444.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$610.01
|
| Rate for Payer: Healthfirst QHP |
$642.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$449.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$642.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$545.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$449.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$642.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$481.59
|
| Rate for Payer: SOMOS Essential |
$481.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$642.12
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUMOR HUMERUS W/AGRFT
|
Professional
|
Both
|
$3,274.81
|
|
|
Service Code
|
HCPCS 24115
|
| Min. Negotiated Rate |
$617.54 |
| Max. Negotiated Rate |
$1,984.95 |
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$882.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$793.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$793.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$838.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$882.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$838.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$882.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$882.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$661.65
|
| Rate for Payer: Healthfirst Commercial |
$882.20
|
| Rate for Payer: Healthfirst Essential Plan |
$1,984.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$838.09
|
| Rate for Payer: Healthfirst QHP |
$882.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$617.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$882.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$749.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$617.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$882.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$661.65
|
| Rate for Payer: SOMOS Essential |
$661.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$882.20
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUMOR PROX HUMERUS
|
Professional
|
Both
|
$2,964.29
|
|
|
Service Code
|
HCPCS 23150
|
| Min. Negotiated Rate |
$559.57 |
| Max. Negotiated Rate |
$1,798.61 |
| Rate for Payer: Cash Price |
$802.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$799.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$719.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$719.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$759.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$799.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$759.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$799.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$799.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$599.53
|
| Rate for Payer: Healthfirst Commercial |
$799.38
|
| Rate for Payer: Healthfirst Essential Plan |
$1,798.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$759.41
|
| Rate for Payer: Healthfirst QHP |
$799.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$559.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$799.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$679.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$559.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$799.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$599.53
|
| Rate for Payer: SOMOS Essential |
$599.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$799.38
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/AGRFT
|
Professional
|
Both
|
$3,542.11
|
|
|
Service Code
|
HCPCS 23155
|
| Min. Negotiated Rate |
$667.85 |
| Max. Negotiated Rate |
$2,146.66 |
| Rate for Payer: Cash Price |
$956.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$954.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$858.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$858.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$954.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$954.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$715.55
|
| Rate for Payer: Healthfirst Commercial |
$954.07
|
| Rate for Payer: Healthfirst Essential Plan |
$2,146.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$906.37
|
| Rate for Payer: Healthfirst QHP |
$954.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$667.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$954.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$810.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$667.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$954.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$715.55
|
| Rate for Payer: SOMOS Essential |
$715.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$954.07
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/ALGRFT
|
Professional
|
Both
|
$3,020.15
|
|
|
Service Code
|
HCPCS 23156
|
| Min. Negotiated Rate |
$570.84 |
| Max. Negotiated Rate |
$1,834.83 |
| Rate for Payer: Cash Price |
$816.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$815.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$733.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$733.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$774.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$815.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$774.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$815.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$815.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$611.61
|
| Rate for Payer: Healthfirst Commercial |
$815.48
|
| Rate for Payer: Healthfirst Essential Plan |
$1,834.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$774.71
|
| Rate for Payer: Healthfirst QHP |
$815.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$570.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$815.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$693.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$570.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$815.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$611.61
|
| Rate for Payer: SOMOS Essential |
$611.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$815.48
|
|
|
PR EXC/CURTG CST/B9 TUM PHALANGES FOOT
|
Professional
|
Both
|
$1,203.16
|
|
|
Service Code
|
HCPCS 28108
|
| Min. Negotiated Rate |
$233.76 |
| Max. Negotiated Rate |
$751.37 |
| Rate for Payer: Cash Price |
$334.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$333.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$300.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$300.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$317.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$333.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$317.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$333.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$333.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$250.46
|
| Rate for Payer: Healthfirst Commercial |
$333.94
|
| Rate for Payer: Healthfirst Essential Plan |
$751.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$317.24
|
| Rate for Payer: Healthfirst QHP |
$333.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$233.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$333.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$283.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$233.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$333.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$250.46
|
| Rate for Payer: SOMOS Essential |
$250.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$333.94
|
|
|
PR EXC/CURTG CST/B9 TUM TALUS/CLCNS W/ILIAC/AGRFT
|
Professional
|
Both
|
$2,714.88
|
|
|
Service Code
|
HCPCS 28102
|
| Min. Negotiated Rate |
$513.93 |
| Max. Negotiated Rate |
$1,651.93 |
| Rate for Payer: Cash Price |
$735.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$734.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$660.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$660.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$697.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$734.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$697.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$734.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$734.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$550.64
|
| Rate for Payer: Healthfirst Commercial |
$734.19
|
| Rate for Payer: Healthfirst Essential Plan |
$1,651.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$697.48
|
| Rate for Payer: Healthfirst QHP |
$734.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$513.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$734.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$624.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$513.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$734.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$550.64
|
| Rate for Payer: SOMOS Essential |
$550.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$734.19
|
|
|
PR EXC/CURTG CST/B9 TUM TARSAL/METAR W/ALGRFT
|
Professional
|
Both
|
$1,430.31
|
|
|
Service Code
|
HCPCS 28107
|
| Min. Negotiated Rate |
$277.68 |
| Max. Negotiated Rate |
$892.55 |
| Rate for Payer: Cash Price |
$396.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$396.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$357.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$357.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$376.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$396.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$376.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$396.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$297.52
|
| Rate for Payer: Healthfirst Commercial |
$396.69
|
| Rate for Payer: Healthfirst Essential Plan |
$892.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$376.86
|
| Rate for Payer: Healthfirst QHP |
$396.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$277.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$396.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$337.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$277.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$396.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$297.52
|
| Rate for Payer: SOMOS Essential |
$297.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$396.69
|
|
