|
PR EXCISION EXCESSIVE SKIN & SUBQ TISSUE BUTTOCK
|
Professional
|
Both
|
$4,069.73
|
|
|
Service Code
|
HCPCS 15835
|
| Min. Negotiated Rate |
$767.28 |
| Max. Negotiated Rate |
$2,466.25 |
| Rate for Payer: Cash Price |
$1,098.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,096.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$986.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$986.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,041.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,096.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,041.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,096.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,096.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$822.08
|
| Rate for Payer: Healthfirst Commercial |
$1,096.11
|
| Rate for Payer: Healthfirst Essential Plan |
$2,466.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,041.30
|
| Rate for Payer: Healthfirst QHP |
$1,096.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$767.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,096.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$931.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$767.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,096.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$822.08
|
| Rate for Payer: SOMOS Essential |
$822.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,096.11
|
|
|
PR EXCISION EXCESSIVE SKIN & SUBQ TISSUE HIP
|
Professional
|
Both
|
$3,901.66
|
|
|
Service Code
|
HCPCS 15834
|
| Min. Negotiated Rate |
$736.55 |
| Max. Negotiated Rate |
$2,367.49 |
| Rate for Payer: Cash Price |
$1,053.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,052.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$947.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$947.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$999.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,052.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$999.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,052.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,052.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$789.16
|
| Rate for Payer: Healthfirst Commercial |
$1,052.22
|
| Rate for Payer: Healthfirst Essential Plan |
$2,367.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$999.61
|
| Rate for Payer: Healthfirst QHP |
$1,052.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$736.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,052.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$894.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$736.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,052.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$789.16
|
| Rate for Payer: SOMOS Essential |
$789.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,052.22
|
|
|
PR EXCISION EXCESSIVE SKIN & SUBQ TISSUE LEG
|
Professional
|
Both
|
$3,832.61
|
|
|
Service Code
|
HCPCS 15833
|
| Min. Negotiated Rate |
$722.67 |
| Max. Negotiated Rate |
$2,322.86 |
| Rate for Payer: Cash Price |
$1,035.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,032.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$929.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$929.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$980.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,032.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$980.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,032.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,032.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$774.28
|
| Rate for Payer: Healthfirst Commercial |
$1,032.38
|
| Rate for Payer: Healthfirst Essential Plan |
$2,322.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$980.76
|
| Rate for Payer: Healthfirst QHP |
$1,032.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$722.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,032.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$877.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$722.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,032.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$774.28
|
| Rate for Payer: SOMOS Essential |
$774.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,032.38
|
|
|
PR EXCISION EXCESSIVE SKIN & SUBQ TISSUE OTHER AREA
|
Professional
|
Both
|
$3,239.15
|
|
|
Service Code
|
HCPCS 15839
|
| Min. Negotiated Rate |
$608.37 |
| Max. Negotiated Rate |
$1,955.47 |
| Rate for Payer: Cash Price |
$873.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$869.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$782.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$782.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$825.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$869.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$825.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$869.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$869.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$651.83
|
| Rate for Payer: Healthfirst Commercial |
$869.10
|
| Rate for Payer: Healthfirst Essential Plan |
$1,955.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$825.64
|
| Rate for Payer: Healthfirst QHP |
$869.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$608.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$869.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$738.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$608.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$869.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$651.83
|
| Rate for Payer: SOMOS Essential |
$651.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$869.10
|
|
|
PR EXCISION EXCESSIVE SKIN & SUBQ TISSUE THIGH
|
Professional
|
Both
|
$4,044.01
|
|
|
Service Code
|
HCPCS 15832
|
| Min. Negotiated Rate |
$765.52 |
| Max. Negotiated Rate |
$2,460.60 |
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,093.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$984.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$984.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,038.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,093.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,038.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,093.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,093.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$820.20
|
| Rate for Payer: Healthfirst Commercial |
$1,093.60
|
| Rate for Payer: Healthfirst Essential Plan |
$2,460.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,038.92
|
| Rate for Payer: Healthfirst QHP |
$1,093.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$765.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,093.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$929.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$765.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,093.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$820.20
|
| Rate for Payer: SOMOS Essential |
$820.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,093.60
|
|
|
PR EXCISION EXOSTOSIS EXTERNAL AUDITORY CANAL
|
Professional
|
Both
|
$3,921.82
|
|
|
Service Code
|
HCPCS 69140
|
| Min. Negotiated Rate |
$729.20 |
| Max. Negotiated Rate |
$2,343.87 |
| Rate for Payer: Cash Price |
$1,061.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,041.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$937.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$937.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$989.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,041.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$989.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,041.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,041.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$781.29
|
| Rate for Payer: Healthfirst Commercial |
$1,041.72
|
| Rate for Payer: Healthfirst Essential Plan |
$2,343.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$989.63
|
| Rate for Payer: Healthfirst QHP |
$1,041.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$729.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,041.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$885.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$729.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,041.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$781.29
|
| Rate for Payer: SOMOS Essential |
$781.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,041.72
|
|
|
PR EXCISION EXTERNAL EAR COMPLETE AMPUTATION
|
Professional
|
Both
|
$1,687.63
|
|
|
Service Code
|
HCPCS 69120
|
| Min. Negotiated Rate |
$313.82 |
| Max. Negotiated Rate |
$1,008.70 |
| Rate for Payer: Cash Price |
$455.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$448.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$403.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$403.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$425.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$448.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$425.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$448.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$448.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$336.23
|
| Rate for Payer: Healthfirst Commercial |
$448.31
|
| Rate for Payer: Healthfirst Essential Plan |
$1,008.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$425.89
|
| Rate for Payer: Healthfirst QHP |
$448.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$313.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$448.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$381.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$313.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$448.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$336.23
|
| Rate for Payer: SOMOS Essential |
$336.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$448.31
|
|
|
PR EXCISION EXTERNAL EAR PARTIAL SIMPLE REPAIR
|
Professional
|
Both
|
$1,421.18
|
|
|
Service Code
|
HCPCS 69110
|
| Min. Negotiated Rate |
$266.46 |
| Max. Negotiated Rate |
$856.49 |
| Rate for Payer: Cash Price |
$385.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$380.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$342.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$342.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$361.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$380.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$361.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$380.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$380.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$285.50
|
| Rate for Payer: Healthfirst Commercial |
$380.66
|
| Rate for Payer: Healthfirst Essential Plan |
$856.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$361.63
|
| Rate for Payer: Healthfirst QHP |
$380.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$266.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$380.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$323.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$266.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$380.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$285.50
|
| Rate for Payer: SOMOS Essential |
$285.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$380.66
|
|
|
PR EXCISION FACIAL BONE
|
Professional
|
Both
|
$1,804.11
|
|
|
Service Code
|
HCPCS 21026
|
| Min. Negotiated Rate |
$354.05 |
| Max. Negotiated Rate |
$1,138.01 |
| Rate for Payer: Cash Price |
$495.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$505.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$455.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$455.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$480.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$505.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$480.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$505.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$505.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$379.33
|
| Rate for Payer: Healthfirst Commercial |
$505.78
|
| Rate for Payer: Healthfirst Essential Plan |
$1,138.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$480.49
|
| Rate for Payer: Healthfirst QHP |
$505.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$354.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$505.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$429.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$354.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$505.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$379.33
|
| Rate for Payer: SOMOS Essential |
$379.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$505.78
|
|
|
PR EXCISION/FULGURATION URETHRAL PROLAPSE
|
Professional
|
Both
|
$1,111.88
|
|
|
Service Code
|
HCPCS 53275
|
| Min. Negotiated Rate |
$210.34 |
| Max. Negotiated Rate |
$676.10 |
| Rate for Payer: Cash Price |
$303.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$300.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$270.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$270.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$285.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$300.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$285.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$300.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$225.37
|
| Rate for Payer: Healthfirst Commercial |
$300.49
|
| Rate for Payer: Healthfirst Essential Plan |
$676.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$285.47
|
| Rate for Payer: Healthfirst QHP |
$300.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$210.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$300.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$255.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$210.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$300.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$225.37
|
| Rate for Payer: SOMOS Essential |
$225.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$300.49
|
|
|
PR EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY
|
Professional
|
Both
|
$1,442.07
|
|
|
Service Code
|
HCPCS 25111
|
| Min. Negotiated Rate |
$275.89 |
| Max. Negotiated Rate |
$886.79 |
| Rate for Payer: Cash Price |
$394.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$394.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$354.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$354.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$374.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$394.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$374.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$394.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$394.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$295.60
|
| Rate for Payer: Healthfirst Commercial |
$394.13
|
| Rate for Payer: Healthfirst Essential Plan |
$886.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$374.42
|
| Rate for Payer: Healthfirst QHP |
$394.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$275.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$394.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$335.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$275.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$394.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$295.60
|
| Rate for Payer: SOMOS Essential |
$295.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$394.13
|
|
|
PR EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT
|
Professional
|
Both
|
$1,734.18
|
|
|
Service Code
|
HCPCS 25112
|
| Min. Negotiated Rate |
$330.56 |
| Max. Negotiated Rate |
$1,062.52 |
| Rate for Payer: Cash Price |
$473.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$472.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$425.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$425.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$448.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$472.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$448.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$472.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$472.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$354.17
|
| Rate for Payer: Healthfirst Commercial |
$472.23
|
| Rate for Payer: Healthfirst Essential Plan |
$1,062.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$448.62
|
| Rate for Payer: Healthfirst QHP |
$472.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$330.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$472.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$401.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$330.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$472.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$354.17
|
| Rate for Payer: SOMOS Essential |
$354.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$472.23
|
|
|
PR EXCISION HIDRADENITIS AXILLARY COMPLEX REPAIR
|
Professional
|
Both
|
$1,470.42
|
|
|
Service Code
|
HCPCS 11451
|
| Min. Negotiated Rate |
$277.27 |
| Max. Negotiated Rate |
$891.23 |
| Rate for Payer: Cash Price |
$396.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$396.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$356.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$356.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$376.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$396.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$376.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$396.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$297.07
|
| Rate for Payer: Healthfirst Commercial |
$396.10
|
| Rate for Payer: Healthfirst Essential Plan |
$891.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$376.30
|
| Rate for Payer: Healthfirst QHP |
$396.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$277.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$396.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$336.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$277.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$396.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$297.07
|
| Rate for Payer: SOMOS Essential |
$297.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$396.10
|
|
|
PR EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR
|
Professional
|
Both
|
$1,164.98
|
|
|
Service Code
|
HCPCS 11450
|
| Min. Negotiated Rate |
$219.82 |
| Max. Negotiated Rate |
$706.57 |
| Rate for Payer: Cash Price |
$314.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$314.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$282.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$282.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$298.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$314.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$298.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$314.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$314.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$235.52
|
| Rate for Payer: Healthfirst Commercial |
$314.03
|
| Rate for Payer: Healthfirst Essential Plan |
$706.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$298.33
|
| Rate for Payer: Healthfirst QHP |
$314.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$219.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$314.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$266.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$219.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$314.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$235.52
|
| Rate for Payer: SOMOS Essential |
$235.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$314.03
|
|
|
PR EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR
|
Professional
|
Both
|
$1,476.44
|
|
|
Service Code
|
HCPCS 11463
|
| Min. Negotiated Rate |
$274.51 |
| Max. Negotiated Rate |
$882.36 |
| Rate for Payer: Cash Price |
$397.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$392.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$352.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$352.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$372.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$392.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$372.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$392.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$392.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$294.12
|
| Rate for Payer: Healthfirst Commercial |
$392.16
|
| Rate for Payer: Healthfirst Essential Plan |
$882.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$372.55
|
| Rate for Payer: Healthfirst QHP |
$392.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$274.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$392.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$333.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$274.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$392.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$294.12
|
| Rate for Payer: SOMOS Essential |
$294.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$392.16
|
|
|
PR EXCISION HIDRADENITIS INGUINAL SMPL/INTRM RPR
|
Professional
|
Both
|
$1,098.41
|
|
|
Service Code
|
HCPCS 11462
|
| Min. Negotiated Rate |
$210.40 |
| Max. Negotiated Rate |
$676.28 |
| Rate for Payer: Cash Price |
$299.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$300.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$270.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$270.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$285.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$300.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$285.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$300.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$225.43
|
| Rate for Payer: Healthfirst Commercial |
$300.57
|
| Rate for Payer: Healthfirst Essential Plan |
$676.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$285.54
|
| Rate for Payer: Healthfirst QHP |
$300.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$210.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$300.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$255.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$210.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$300.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$225.43
|
| Rate for Payer: SOMOS Essential |
$225.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$300.57
|
|
|
PR EXCISION H/P/P/U COMPLEX REPAIR
|
Professional
|
Both
|
$1,534.19
|
|
|
Service Code
|
HCPCS 11471
|
| Min. Negotiated Rate |
$290.32 |
| Max. Negotiated Rate |
$933.19 |
| Rate for Payer: Cash Price |
$416.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$414.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$373.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$373.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$394.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$414.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$394.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$414.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$414.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$311.06
|
| Rate for Payer: Healthfirst Commercial |
$414.75
|
| Rate for Payer: Healthfirst Essential Plan |
$933.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$394.01
|
| Rate for Payer: Healthfirst QHP |
$414.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$290.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$414.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$352.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$290.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$414.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$311.06
|
| Rate for Payer: SOMOS Essential |
$311.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$414.75
|
|
|
PR EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR
|
Professional
|
Both
|
$1,267.32
|
|
|
Service Code
|
HCPCS 11470
|
| Min. Negotiated Rate |
$238.98 |
| Max. Negotiated Rate |
$768.15 |
| Rate for Payer: Cash Price |
$342.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$341.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$307.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$307.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$324.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$341.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$324.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$341.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$341.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$256.05
|
| Rate for Payer: Healthfirst Commercial |
$341.40
|
| Rate for Payer: Healthfirst Essential Plan |
$768.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$324.33
|
| Rate for Payer: Healthfirst QHP |
$341.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$238.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$341.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$290.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$238.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$341.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$256.05
|
| Rate for Payer: SOMOS Essential |
$256.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$341.40
|
|
|
PR EXCISION HYDROCELE BILATERAL
|
Professional
|
Both
|
$2,154.99
|
|
|
Service Code
|
HCPCS 55041
|
| Min. Negotiated Rate |
$410.70 |
| Max. Negotiated Rate |
$1,320.12 |
| Rate for Payer: Cash Price |
$592.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$586.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$528.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$528.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$557.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$586.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$557.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$586.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$586.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$440.04
|
| Rate for Payer: Healthfirst Commercial |
$586.72
|
| Rate for Payer: Healthfirst Essential Plan |
$1,320.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$557.38
|
| Rate for Payer: Healthfirst QHP |
$586.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$410.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$586.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$498.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$410.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$586.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$440.04
|
| Rate for Payer: SOMOS Essential |
$440.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$586.72
|
|
|
PR EXCISION HYDROCELE UNILATERAL
|
Professional
|
Both
|
$1,428.00
|
|
|
Service Code
|
HCPCS 55040
|
| Min. Negotiated Rate |
$273.50 |
| Max. Negotiated Rate |
$879.10 |
| Rate for Payer: Cash Price |
$393.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$390.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$351.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$351.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$371.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$390.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$371.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$390.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$390.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$293.03
|
| Rate for Payer: Healthfirst Commercial |
$390.71
|
| Rate for Payer: Healthfirst Essential Plan |
$879.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$371.17
|
| Rate for Payer: Healthfirst QHP |
$390.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$273.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$390.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$332.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$273.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$390.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$293.03
|
| Rate for Payer: SOMOS Essential |
$293.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$390.71
|
|
|
PR EXCISION INFECTED GRAFT ABDOMEN
|
Professional
|
Both
|
$8,455.37
|
|
|
Service Code
|
HCPCS 35907
|
| Min. Negotiated Rate |
$1,557.56 |
| Max. Negotiated Rate |
$5,006.43 |
| Rate for Payer: Cash Price |
$2,247.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,225.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,002.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,002.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,113.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,225.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,113.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,225.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,225.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,668.81
|
| Rate for Payer: Healthfirst Commercial |
$2,225.08
|
| Rate for Payer: Healthfirst Essential Plan |
$5,006.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,113.83
|
| Rate for Payer: Healthfirst QHP |
$2,225.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,557.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,225.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,891.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,557.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,225.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,668.81
|
| Rate for Payer: SOMOS Essential |
$1,668.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,225.08
|
|
|
PR EXCISION INFECTED GRAFT EXTREMITY
|
Professional
|
Both
|
$2,507.19
|
|
|
Service Code
|
HCPCS 35903
|
| Min. Negotiated Rate |
$459.42 |
| Max. Negotiated Rate |
$1,476.70 |
| Rate for Payer: Cash Price |
$666.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$656.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$590.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$590.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$623.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$656.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$623.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$656.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$656.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$492.23
|
| Rate for Payer: Healthfirst Commercial |
$656.31
|
| Rate for Payer: Healthfirst Essential Plan |
$1,476.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$623.49
|
| Rate for Payer: Healthfirst QHP |
$656.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$459.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$656.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$557.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$459.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$656.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$492.23
|
| Rate for Payer: SOMOS Essential |
$492.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$656.31
|
|
|
PR EXCISION INFECTED GRAFT THORAX
|
Professional
|
Both
|
$7,476.53
|
|
|
Service Code
|
HCPCS 35905
|
| Min. Negotiated Rate |
$1,369.61 |
| Max. Negotiated Rate |
$4,402.33 |
| Rate for Payer: Cash Price |
$1,979.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,956.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,760.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,760.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,858.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,956.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,858.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,956.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,956.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,467.44
|
| Rate for Payer: Healthfirst Commercial |
$1,956.59
|
| Rate for Payer: Healthfirst Essential Plan |
$4,402.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,858.76
|
| Rate for Payer: Healthfirst QHP |
$1,956.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,369.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,956.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,663.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,369.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,956.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,467.44
|
| Rate for Payer: SOMOS Essential |
$1,467.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,956.59
|
|
|
PR EXCISION INFECTED NECK GRAFT
|
Professional
|
Both
|
$2,115.33
|
|
|
Service Code
|
HCPCS 35901
|
| Min. Negotiated Rate |
$391.64 |
| Max. Negotiated Rate |
$1,258.83 |
| Rate for Payer: Cash Price |
$564.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$559.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$503.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$503.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$531.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$559.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$531.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$559.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$559.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$419.61
|
| Rate for Payer: Healthfirst Commercial |
$559.48
|
| Rate for Payer: Healthfirst Essential Plan |
$1,258.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$531.51
|
| Rate for Payer: Healthfirst QHP |
$559.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$391.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$559.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$475.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$391.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$559.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$419.61
|
| Rate for Payer: SOMOS Essential |
$419.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$559.48
|
|
|
PR EXCISION INFERIOR TURBINATE PARTIAL/COMPLETE
|
Professional
|
Both
|
$1,820.74
|
|
|
Service Code
|
HCPCS 30130
|
| Min. Negotiated Rate |
$337.62 |
| Max. Negotiated Rate |
$1,085.22 |
| Rate for Payer: Cash Price |
$491.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$482.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$434.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$434.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$458.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$482.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$458.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$482.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$482.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$361.74
|
| Rate for Payer: Healthfirst Commercial |
$482.32
|
| Rate for Payer: Healthfirst Essential Plan |
$1,085.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$458.20
|
| Rate for Payer: Healthfirst QHP |
$482.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$337.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$482.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$409.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$337.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$482.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$361.74
|
| Rate for Payer: SOMOS Essential |
$361.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$482.32
|
|
