|
PR EXC LACRIMAL GLAND TUMOR W/OSTEOTOMY
|
Professional
|
Both
|
$5,074.02
|
|
|
Service Code
|
HCPCS 68550
|
| Min. Negotiated Rate |
$955.28 |
| Max. Negotiated Rate |
$3,070.53 |
| Rate for Payer: Cash Price |
$1,393.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,364.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,228.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,228.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,296.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,364.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,296.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,364.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,364.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,023.51
|
| Rate for Payer: Healthfirst Commercial |
$1,364.68
|
| Rate for Payer: Healthfirst Essential Plan |
$3,070.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,296.45
|
| Rate for Payer: Healthfirst QHP |
$1,364.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$955.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,364.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,159.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$955.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,364.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,023.51
|
| Rate for Payer: SOMOS Essential |
$1,023.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,364.68
|
|
|
PR EXC LESION ESOPHAGUS W/PRIM RPR THRC/ABDL APPR
|
Professional
|
Both
|
$4,498.66
|
|
|
Service Code
|
HCPCS 43101
|
| Min. Negotiated Rate |
$831.17 |
| Max. Negotiated Rate |
$2,671.63 |
| Rate for Payer: Cash Price |
$1,197.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,187.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,068.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,068.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,128.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,187.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,128.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,187.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,187.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$890.54
|
| Rate for Payer: Healthfirst Commercial |
$1,187.39
|
| Rate for Payer: Healthfirst Essential Plan |
$2,671.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,128.02
|
| Rate for Payer: Healthfirst QHP |
$1,187.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$831.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,187.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,009.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$831.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,187.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$890.54
|
| Rate for Payer: SOMOS Essential |
$890.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,187.39
|
|
|
PR EXC LESION ESOPHOGUS W/PRIM RPR CERVICAL APPR
|
Professional
|
Both
|
$2,744.95
|
|
|
Service Code
|
HCPCS 43100
|
| Min. Negotiated Rate |
$516.71 |
| Max. Negotiated Rate |
$1,660.84 |
| Rate for Payer: Cash Price |
$746.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$738.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$664.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$664.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$701.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$738.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$701.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$738.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$738.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$553.61
|
| Rate for Payer: Healthfirst Commercial |
$738.15
|
| Rate for Payer: Healthfirst Essential Plan |
$1,660.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$701.24
|
| Rate for Payer: Healthfirst QHP |
$738.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$516.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$738.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$627.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$516.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$738.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$553.61
|
| Rate for Payer: SOMOS Essential |
$553.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$738.15
|
|
|
PR EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE
|
Professional
|
Both
|
$651.70
|
|
|
Service Code
|
HCPCS 67840
|
| Min. Negotiated Rate |
$123.07 |
| Max. Negotiated Rate |
$395.60 |
| Rate for Payer: Cash Price |
$178.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$175.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$158.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$158.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$167.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$175.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$167.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$131.87
|
| Rate for Payer: Healthfirst Commercial |
$175.82
|
| Rate for Payer: Healthfirst Essential Plan |
$395.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$167.03
|
| Rate for Payer: Healthfirst QHP |
$175.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$123.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$175.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$149.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$123.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$175.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$131.87
|
| Rate for Payer: SOMOS Essential |
$131.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$175.82
|
|
|
PR EXC LESION MUCOSA&SBMCSL VESTIBULE CPLX EXC MUSC
|
Professional
|
Both
|
$1,291.19
|
|
|
Service Code
|
HCPCS 40816
|
| Min. Negotiated Rate |
$247.16 |
| Max. Negotiated Rate |
$794.43 |
| Rate for Payer: Cash Price |
$354.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$353.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$317.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$317.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$335.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$353.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$335.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$353.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$353.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$264.81
|
| Rate for Payer: Healthfirst Commercial |
$353.08
|
| Rate for Payer: Healthfirst Essential Plan |
$794.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$335.43
|
| Rate for Payer: Healthfirst QHP |
$353.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$247.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$353.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$300.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$247.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$353.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$264.81
|
| Rate for Payer: SOMOS Essential |
$264.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$353.08
|
|
|
PR EXC LESION MUCOSA & SBMCSL VESTIBULE CPLX RPR
|
Professional
|
Both
|
$1,206.10
|
|
|
Service Code
|
HCPCS 40814
|
| Min. Negotiated Rate |
$230.01 |
| Max. Negotiated Rate |
$739.30 |
| Rate for Payer: Cash Price |
$328.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$328.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$295.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$295.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$312.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$328.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$312.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$328.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$328.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$246.44
|
| Rate for Payer: Healthfirst Commercial |
$328.58
|
| Rate for Payer: Healthfirst Essential Plan |
$739.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$312.15
|
| Rate for Payer: Healthfirst QHP |
$328.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$230.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$328.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$279.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$230.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$328.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$246.44
|
| Rate for Payer: SOMOS Essential |
$246.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$328.58
|
|
|
PR EXC LESION MUCOSA & SBMCSL VESTIBULE SMPL RPR
|
Professional
|
Both
|
$780.54
|
|
|
Service Code
|
HCPCS 40812
|
| Min. Negotiated Rate |
$146.50 |
| Max. Negotiated Rate |
$470.88 |
| Rate for Payer: Cash Price |
$210.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$209.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$188.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$198.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$209.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$198.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$156.96
|
| Rate for Payer: Healthfirst Commercial |
$209.28
|
| Rate for Payer: Healthfirst Essential Plan |
$470.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$198.82
|
| Rate for Payer: Healthfirst QHP |
$209.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$146.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$209.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$177.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$146.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$209.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$156.96
|
| Rate for Payer: SOMOS Essential |
$156.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$209.28
|
|
|
PR EXC LESION PALATE UVULA W/LOCAL FLAP CLOSURE
|
Professional
|
Both
|
$1,401.54
|
|
|
Service Code
|
HCPCS 42107
|
| Min. Negotiated Rate |
$262.99 |
| Max. Negotiated Rate |
$845.33 |
| Rate for Payer: Cash Price |
$374.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$375.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$338.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$338.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$356.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$375.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$356.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$375.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$375.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$281.77
|
| Rate for Payer: Healthfirst Commercial |
$375.70
|
| Rate for Payer: Healthfirst Essential Plan |
$845.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$356.92
|
| Rate for Payer: Healthfirst QHP |
$375.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$262.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$375.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$319.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$262.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$375.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$281.77
|
| Rate for Payer: SOMOS Essential |
$281.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$375.70
|
|
|
PR EXC LESION PALATE UVULA W/O CLOSURE
|
Professional
|
Both
|
$578.06
|
|
|
Service Code
|
HCPCS 42104
|
| Min. Negotiated Rate |
$109.77 |
| Max. Negotiated Rate |
$352.85 |
| Rate for Payer: Cash Price |
$158.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$156.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$141.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$148.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$156.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$148.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$156.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$117.61
|
| Rate for Payer: Healthfirst Commercial |
$156.82
|
| Rate for Payer: Healthfirst Essential Plan |
$352.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$148.98
|
| Rate for Payer: Healthfirst QHP |
$156.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$109.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$156.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$133.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$109.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$156.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$117.61
|
| Rate for Payer: SOMOS Essential |
$117.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$156.82
|
|
|
PR EXC LESION PALATE UVULA W/SMPL PRIM CLOSURE
|
Professional
|
Both
|
$691.32
|
|
|
Service Code
|
HCPCS 42106
|
| Min. Negotiated Rate |
$130.16 |
| Max. Negotiated Rate |
$418.37 |
| Rate for Payer: Cash Price |
$185.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$185.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$167.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$176.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$185.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$176.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$185.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.46
|
| Rate for Payer: Healthfirst Commercial |
$185.94
|
| Rate for Payer: Healthfirst Essential Plan |
$418.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$176.64
|
| Rate for Payer: Healthfirst QHP |
$185.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$130.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$185.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$158.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$130.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$185.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$139.46
|
| Rate for Payer: SOMOS Essential |
$139.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$185.94
|
|
|
PR EXC LESION SPERMATIC CORD SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,059.82
|
|
|
Service Code
|
HCPCS 55520
|
| Min. Negotiated Rate |
$385.96 |
| Max. Negotiated Rate |
$1,240.58 |
| Rate for Payer: Cash Price |
$553.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$551.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$496.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$496.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$523.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$551.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$523.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$551.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$551.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$413.53
|
| Rate for Payer: Healthfirst Commercial |
$551.37
|
| Rate for Payer: Healthfirst Essential Plan |
$1,240.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$523.80
|
| Rate for Payer: Healthfirst QHP |
$551.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$385.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$551.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$468.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$385.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$551.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$413.53
|
| Rate for Payer: SOMOS Essential |
$413.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$551.37
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Professional
|
Both
|
$1,401.09
|
|
|
Service Code
|
HCPCS 26160
|
| Min. Negotiated Rate |
$267.08 |
| Max. Negotiated Rate |
$858.47 |
| Rate for Payer: Cash Price |
$382.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$381.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$343.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$343.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$362.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$381.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$362.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$381.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$381.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$286.15
|
| Rate for Payer: Healthfirst Commercial |
$381.54
|
| Rate for Payer: Healthfirst Essential Plan |
$858.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$362.46
|
| Rate for Payer: Healthfirst QHP |
$381.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$267.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$381.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$324.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$267.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$381.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$286.15
|
| Rate for Payer: SOMOS Essential |
$286.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$381.54
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Professional
|
Both
|
$1,298.05
|
|
|
Service Code
|
HCPCS 28090
|
| Min. Negotiated Rate |
$250.75 |
| Max. Negotiated Rate |
$805.97 |
| Rate for Payer: Cash Price |
$358.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$358.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$322.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$322.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$340.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$358.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$340.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$358.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$358.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$268.66
|
| Rate for Payer: Healthfirst Commercial |
$358.21
|
| Rate for Payer: Healthfirst Essential Plan |
$805.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$340.30
|
| Rate for Payer: Healthfirst QHP |
$358.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$250.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$358.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$304.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$250.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$358.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$268.66
|
| Rate for Payer: SOMOS Essential |
$268.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$358.21
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT TOE EA
|
Professional
|
Both
|
$1,141.04
|
|
|
Service Code
|
HCPCS 28092
|
| Min. Negotiated Rate |
$221.60 |
| Max. Negotiated Rate |
$712.28 |
| Rate for Payer: Cash Price |
$317.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$316.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$284.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$284.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$300.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$316.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$300.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$316.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$316.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$237.43
|
| Rate for Payer: Healthfirst Commercial |
$316.57
|
| Rate for Payer: Healthfirst Essential Plan |
$712.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$300.74
|
| Rate for Payer: Healthfirst QHP |
$316.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$221.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$316.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$269.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$221.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$316.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$237.43
|
| Rate for Payer: SOMOS Essential |
$237.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$316.57
|
|
|
PR EXC LESION TONGUE W/CLSR ANTERIOR TWO-THIRDS
|
Professional
|
Both
|
$1,042.48
|
|
|
Service Code
|
HCPCS 41112
|
| Min. Negotiated Rate |
$197.50 |
| Max. Negotiated Rate |
$634.84 |
| Rate for Payer: Cash Price |
$283.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$282.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$253.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$253.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$268.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$282.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$268.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$282.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$211.61
|
| Rate for Payer: Healthfirst Commercial |
$282.15
|
| Rate for Payer: Healthfirst Essential Plan |
$634.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$268.04
|
| Rate for Payer: Healthfirst QHP |
$282.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$197.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$282.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$239.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$197.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$282.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$211.61
|
| Rate for Payer: SOMOS Essential |
$211.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$282.15
|
|
|
PR EXC LESION TONGUE W/CLSR POSTERIOR ONE-THIRD
|
Professional
|
Both
|
$1,131.27
|
|
|
Service Code
|
HCPCS 41113
|
| Min. Negotiated Rate |
$213.86 |
| Max. Negotiated Rate |
$687.42 |
| Rate for Payer: Cash Price |
$306.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$305.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$274.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$274.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$290.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$305.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$290.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$305.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$305.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$229.14
|
| Rate for Payer: Healthfirst Commercial |
$305.52
|
| Rate for Payer: Healthfirst Essential Plan |
$687.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$290.24
|
| Rate for Payer: Healthfirst QHP |
$305.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$213.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$305.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$259.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$213.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$305.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$229.14
|
| Rate for Payer: SOMOS Essential |
$229.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$305.52
|
|
|
PR EXC LESION TONGUE W/CLSR W/LOCAL TONGUE FLAP
|
Professional
|
Both
|
$2,682.82
|
|
|
Service Code
|
HCPCS 41114
|
| Min. Negotiated Rate |
$503.10 |
| Max. Negotiated Rate |
$1,617.12 |
| Rate for Payer: Cash Price |
$726.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$718.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$646.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$646.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$682.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$718.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$682.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$718.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$718.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$539.04
|
| Rate for Payer: Healthfirst Commercial |
$718.72
|
| Rate for Payer: Healthfirst Essential Plan |
$1,617.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$682.78
|
| Rate for Payer: Healthfirst QHP |
$718.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$503.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$718.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$610.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$503.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$718.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$539.04
|
| Rate for Payer: SOMOS Essential |
$539.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$718.72
|
|
|
PR EXC LESION/TUMOR DENTALVEOLAR STRUX W/CMPLX RPR
|
Professional
|
Both
|
$1,218.49
|
|
|
Service Code
|
HCPCS 41827
|
| Min. Negotiated Rate |
$235.68 |
| Max. Negotiated Rate |
$757.53 |
| Rate for Payer: Cash Price |
$333.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$336.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$303.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$303.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$319.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$336.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$319.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$336.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$336.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$252.51
|
| Rate for Payer: Healthfirst Commercial |
$336.68
|
| Rate for Payer: Healthfirst Essential Plan |
$757.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$319.85
|
| Rate for Payer: Healthfirst QHP |
$336.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$235.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$336.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$286.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$235.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$336.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$252.51
|
| Rate for Payer: SOMOS Essential |
$252.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$336.68
|
|
|
PR EXC LESION/TUMOR DENTOALVEOLAR STRUX W/O RPR
|
Professional
|
Both
|
$517.79
|
|
|
Service Code
|
HCPCS 41825
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$317.56 |
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$141.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$127.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$127.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$134.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$141.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$134.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$141.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$141.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.86
|
| Rate for Payer: Healthfirst Commercial |
$141.14
|
| Rate for Payer: Healthfirst Essential Plan |
$317.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$134.08
|
| Rate for Payer: Healthfirst QHP |
$141.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$141.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$119.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$141.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.86
|
| Rate for Payer: SOMOS Essential |
$105.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$141.14
|
|
|
PR EXC LESION/TUMOR DENTOALVEOLAR STRUX W/SMPL RPR
|
Professional
|
Both
|
$836.01
|
|
|
Service Code
|
HCPCS 41826
|
| Min. Negotiated Rate |
$158.05 |
| Max. Negotiated Rate |
$508.03 |
| Rate for Payer: Cash Price |
$225.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$225.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$203.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$203.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$214.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$225.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$214.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$169.34
|
| Rate for Payer: Healthfirst Commercial |
$225.79
|
| Rate for Payer: Healthfirst Essential Plan |
$508.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$214.50
|
| Rate for Payer: Healthfirst QHP |
$225.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$158.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$225.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$191.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$158.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$225.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$169.34
|
| Rate for Payer: SOMOS Essential |
$169.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$225.79
|
|
|
PR EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR
|
Professional
|
Both
|
$528.64
|
|
|
Service Code
|
HCPCS 40810
|
| Min. Negotiated Rate |
$99.22 |
| Max. Negotiated Rate |
$318.94 |
| Rate for Payer: Cash Price |
$143.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$141.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$127.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$127.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$134.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$141.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$134.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$141.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$141.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$106.31
|
| Rate for Payer: Healthfirst Commercial |
$141.75
|
| Rate for Payer: Healthfirst Essential Plan |
$318.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$134.66
|
| Rate for Payer: Healthfirst QHP |
$141.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$99.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$141.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$120.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$99.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$141.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$106.31
|
| Rate for Payer: SOMOS Essential |
$106.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$141.75
|
|
|
PR EXC LIP FULL THKNS RCNSTJ W/CROSS LIP FLAP
|
Professional
|
Both
|
$2,711.56
|
|
|
Service Code
|
HCPCS 40527
|
| Min. Negotiated Rate |
$511.29 |
| Max. Negotiated Rate |
$1,643.42 |
| Rate for Payer: Cash Price |
$737.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$730.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$657.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$657.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$693.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$730.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$693.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$730.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$730.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$547.81
|
| Rate for Payer: Healthfirst Commercial |
$730.41
|
| Rate for Payer: Healthfirst Essential Plan |
$1,643.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$693.89
|
| Rate for Payer: Healthfirst QHP |
$730.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$511.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$730.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$620.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$511.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$730.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$547.81
|
| Rate for Payer: SOMOS Essential |
$547.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$730.41
|
|
|
PR EXC LIP FULL THKNS RCNSTJ W/LOCAL FLAP
|
Professional
|
Both
|
$2,392.08
|
|
|
Service Code
|
HCPCS 40525
|
| Min. Negotiated Rate |
$449.15 |
| Max. Negotiated Rate |
$1,443.71 |
| Rate for Payer: Cash Price |
$649.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$641.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$577.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$577.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$609.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$641.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$609.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$641.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$641.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$481.24
|
| Rate for Payer: Healthfirst Commercial |
$641.65
|
| Rate for Payer: Healthfirst Essential Plan |
$1,443.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$609.57
|
| Rate for Payer: Healthfirst QHP |
$641.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$449.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$641.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$545.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$449.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$641.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$481.24
|
| Rate for Payer: SOMOS Essential |
$481.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$641.65
|
|
|
PR EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR
|
Professional
|
Both
|
$1,498.84
|
|
|
Service Code
|
HCPCS 40510
|
| Min. Negotiated Rate |
$284.72 |
| Max. Negotiated Rate |
$915.16 |
| Rate for Payer: Cash Price |
$409.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$406.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$366.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$366.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$386.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$406.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$386.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$406.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$406.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$305.06
|
| Rate for Payer: Healthfirst Commercial |
$406.74
|
| Rate for Payer: Healthfirst Essential Plan |
$915.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$386.40
|
| Rate for Payer: Healthfirst QHP |
$406.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$284.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$406.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$345.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$284.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$406.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$305.06
|
| Rate for Payer: SOMOS Essential |
$305.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$406.74
|
|
|
PR EXC LIP V-EXC W/PRIM DIR LINR CLSR
|
Professional
|
Both
|
$1,550.19
|
|
|
Service Code
|
HCPCS 40520
|
| Min. Negotiated Rate |
$293.50 |
| Max. Negotiated Rate |
$943.38 |
| Rate for Payer: Cash Price |
$419.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$419.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$377.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$377.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$398.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$419.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$398.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$419.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$419.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$314.46
|
| Rate for Payer: Healthfirst Commercial |
$419.28
|
| Rate for Payer: Healthfirst Essential Plan |
$943.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$398.32
|
| Rate for Payer: Healthfirst QHP |
$419.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$293.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$419.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$356.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$293.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$419.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$314.46
|
| Rate for Payer: SOMOS Essential |
$314.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$419.28
|
|
