|
PR EXC LOCAL MALIGNANT TUMOR STOMACH
|
Professional
|
Both
|
$5,519.64
|
|
|
Service Code
|
HCPCS 43611
|
| Min. Negotiated Rate |
$1,024.51 |
| Max. Negotiated Rate |
$3,293.08 |
| Rate for Payer: Cash Price |
$1,476.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,463.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,317.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,317.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,390.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,463.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,390.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,463.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,463.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,097.69
|
| Rate for Payer: Healthfirst Commercial |
$1,463.59
|
| Rate for Payer: Healthfirst Essential Plan |
$3,293.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,390.41
|
| Rate for Payer: Healthfirst QHP |
$1,463.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,024.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,463.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,244.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,024.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,463.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,097.69
|
| Rate for Payer: SOMOS Essential |
$1,097.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,463.59
|
|
|
PR EXC LOCAL ULCER/BENIGN TUMOR STOMACH
|
Professional
|
Both
|
$4,415.50
|
|
|
Service Code
|
HCPCS 43610
|
| Min. Negotiated Rate |
$814.16 |
| Max. Negotiated Rate |
$2,616.93 |
| Rate for Payer: Cash Price |
$1,174.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,163.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,046.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,046.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,104.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,163.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,104.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,163.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,163.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$872.31
|
| Rate for Payer: Healthfirst Commercial |
$1,163.08
|
| Rate for Payer: Healthfirst Essential Plan |
$2,616.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,104.93
|
| Rate for Payer: Healthfirst QHP |
$1,163.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$814.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,163.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$988.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$814.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,163.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$872.31
|
| Rate for Payer: SOMOS Essential |
$872.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,163.08
|
|
|
PR EXCLUSION LAA OPEN TM STRNT/THRCM ANY METHOD
|
Professional
|
Both
|
$575.61
|
|
|
Service Code
|
HCPCS 33268
|
| Min. Negotiated Rate |
$105.54 |
| Max. Negotiated Rate |
$339.23 |
| Rate for Payer: Cash Price |
$151.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$150.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$135.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$143.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$143.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.08
|
| Rate for Payer: Healthfirst Commercial |
$150.77
|
| Rate for Payer: Healthfirst Essential Plan |
$339.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$143.23
|
| Rate for Payer: Healthfirst QHP |
$150.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$150.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$128.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$113.08
|
| Rate for Payer: SOMOS Essential |
$113.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150.77
|
|
|
PR EXCLUSION L ATR APPENDAGE THORACOSCOPIC ANY METH
|
Professional
|
Both
|
$3,639.06
|
|
|
Service Code
|
HCPCS 33269
|
| Min. Negotiated Rate |
$682.22 |
| Max. Negotiated Rate |
$2,192.85 |
| Rate for Payer: Cash Price |
$979.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$974.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$877.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$877.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$925.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$974.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$925.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$974.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$974.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$730.95
|
| Rate for Payer: Healthfirst Commercial |
$974.60
|
| Rate for Payer: Healthfirst Essential Plan |
$2,192.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$925.87
|
| Rate for Payer: Healthfirst QHP |
$974.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$682.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$974.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$828.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$682.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$974.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$730.95
|
| Rate for Payer: SOMOS Essential |
$730.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$974.60
|
|
|
PR EXCLUSION LEFT ATRIAL APPENDAGE OPEN ANY METHOD
|
Professional
|
Both
|
$4,606.35
|
|
|
Service Code
|
HCPCS 33267
|
| Min. Negotiated Rate |
$855.61 |
| Max. Negotiated Rate |
$2,750.18 |
| Rate for Payer: Cash Price |
$1,229.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,222.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,100.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,100.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,161.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,222.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,161.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,222.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,222.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$916.73
|
| Rate for Payer: Healthfirst Commercial |
$1,222.30
|
| Rate for Payer: Healthfirst Essential Plan |
$2,750.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,161.18
|
| Rate for Payer: Healthfirst QHP |
$1,222.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$855.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,222.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,038.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$855.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,222.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$916.73
|
| Rate for Payer: SOMOS Essential |
$916.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,222.30
|
|
|
PR EXCLUSION SM INT FROM PELVIS MESH/PROSTH/TISS
|
Professional
|
Both
|
$4,320.30
|
|
|
Service Code
|
HCPCS 44700
|
| Min. Negotiated Rate |
$807.61 |
| Max. Negotiated Rate |
$2,595.89 |
| Rate for Payer: Cash Price |
$1,170.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,153.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,038.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,038.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,096.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,153.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,096.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,153.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,153.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$865.30
|
| Rate for Payer: Healthfirst Commercial |
$1,153.73
|
| Rate for Payer: Healthfirst Essential Plan |
$2,595.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,096.04
|
| Rate for Payer: Healthfirst QHP |
$1,153.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$807.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,153.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$980.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$807.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,153.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$865.30
|
| Rate for Payer: SOMOS Essential |
$865.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,153.73
|
|
|
PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Professional
|
Both
|
$3,475.54
|
|
|
Service Code
|
HCPCS 44800
|
| Min. Negotiated Rate |
$647.18 |
| Max. Negotiated Rate |
$2,080.24 |
| Rate for Payer: Cash Price |
$934.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$924.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$832.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$832.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$878.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$924.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$878.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$924.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$924.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$693.41
|
| Rate for Payer: Healthfirst Commercial |
$924.55
|
| Rate for Payer: Healthfirst Essential Plan |
$2,080.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$878.32
|
| Rate for Payer: Healthfirst QHP |
$924.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$647.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$924.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$785.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$647.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$924.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$693.41
|
| Rate for Payer: SOMOS Essential |
$693.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$924.55
|
|
|
PR EXC MUCOSA VESTIBULE MOUTH AS DON GRF
|
Professional
|
Both
|
$1,140.37
|
|
|
Service Code
|
HCPCS 40818
|
| Min. Negotiated Rate |
$214.19 |
| Max. Negotiated Rate |
$688.48 |
| Rate for Payer: Cash Price |
$309.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$305.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$275.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$275.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$290.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$305.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$290.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$305.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$305.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$229.49
|
| Rate for Payer: Healthfirst Commercial |
$305.99
|
| Rate for Payer: Healthfirst Essential Plan |
$688.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$290.69
|
| Rate for Payer: Healthfirst QHP |
$305.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$214.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$305.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$260.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$214.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$305.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$229.49
|
| Rate for Payer: SOMOS Essential |
$229.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$305.99
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA CUTAN NRV
|
Professional
|
Both
|
$1,791.58
|
|
|
Service Code
|
HCPCS 64788
|
| Min. Negotiated Rate |
$340.52 |
| Max. Negotiated Rate |
$1,094.54 |
| Rate for Payer: Cash Price |
$490.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$486.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$437.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$437.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$462.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$486.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$462.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$486.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$486.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$364.85
|
| Rate for Payer: Healthfirst Commercial |
$486.46
|
| Rate for Payer: Healthfirst Essential Plan |
$1,094.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$462.14
|
| Rate for Payer: Healthfirst QHP |
$486.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$340.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$486.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$413.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$340.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$486.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$364.85
|
| Rate for Payer: SOMOS Essential |
$364.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$486.46
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA EXTNSV
|
Professional
|
Both
|
$4,796.19
|
|
|
Service Code
|
HCPCS 64792
|
| Min. Negotiated Rate |
$905.72 |
| Max. Negotiated Rate |
$2,911.23 |
| Rate for Payer: Cash Price |
$1,302.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,293.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,164.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,164.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,229.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,293.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,229.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,293.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,293.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$970.41
|
| Rate for Payer: Healthfirst Commercial |
$1,293.88
|
| Rate for Payer: Healthfirst Essential Plan |
$2,911.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,229.19
|
| Rate for Payer: Healthfirst QHP |
$1,293.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$905.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,293.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,099.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$905.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,293.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$970.41
|
| Rate for Payer: SOMOS Essential |
$970.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,293.88
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA MAJOR PRPH NRV
|
Professional
|
Both
|
$3,837.16
|
|
|
Service Code
|
HCPCS 64790
|
| Min. Negotiated Rate |
$722.73 |
| Max. Negotiated Rate |
$2,323.06 |
| Rate for Payer: Cash Price |
$1,032.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,032.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$929.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$929.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$980.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,032.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$980.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,032.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,032.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$774.35
|
| Rate for Payer: Healthfirst Commercial |
$1,032.47
|
| Rate for Payer: Healthfirst Essential Plan |
$2,323.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$980.85
|
| Rate for Payer: Healthfirst QHP |
$1,032.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$722.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,032.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$877.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$722.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,032.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$774.35
|
| Rate for Payer: SOMOS Essential |
$774.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,032.47
|
|
|
PR EXC NEUROMA CUTAN NRV SURGLY IDENTIFIABLE
|
Professional
|
Both
|
$1,882.58
|
|
|
Service Code
|
HCPCS 64774
|
| Min. Negotiated Rate |
$357.81 |
| Max. Negotiated Rate |
$1,150.11 |
| Rate for Payer: Cash Price |
$512.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$511.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$460.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$460.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$485.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$511.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$485.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$511.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$511.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$383.37
|
| Rate for Payer: Healthfirst Commercial |
$511.16
|
| Rate for Payer: Healthfirst Essential Plan |
$1,150.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$485.60
|
| Rate for Payer: Healthfirst QHP |
$511.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$357.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$511.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$434.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$357.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$511.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$383.37
|
| Rate for Payer: SOMOS Essential |
$383.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$511.16
|
|
|
PR EXC NEUROMA DIGITAL NERVE 1 OR BOTH SAME DIGIT
|
Professional
|
Both
|
$1,731.35
|
|
|
Service Code
|
HCPCS 64776
|
| Min. Negotiated Rate |
$332.28 |
| Max. Negotiated Rate |
$1,068.05 |
| Rate for Payer: Cash Price |
$480.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$474.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$427.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$427.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$450.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$474.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$450.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$474.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$474.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$356.02
|
| Rate for Payer: Healthfirst Commercial |
$474.69
|
| Rate for Payer: Healthfirst Essential Plan |
$1,068.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$450.96
|
| Rate for Payer: Healthfirst QHP |
$474.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$332.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$474.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$403.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$332.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$474.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$356.02
|
| Rate for Payer: SOMOS Essential |
$356.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$474.69
|
|
|
PR EXC NEUROMA HAND/FOOT EA NRV XCP SM DGT
|
Professional
|
Both
|
$945.88
|
|
|
Service Code
|
HCPCS 64783
|
| Min. Negotiated Rate |
$175.60 |
| Max. Negotiated Rate |
$564.43 |
| Rate for Payer: Cash Price |
$251.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$250.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$225.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$225.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$238.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$250.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$238.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$250.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$188.15
|
| Rate for Payer: Healthfirst Commercial |
$250.86
|
| Rate for Payer: Healthfirst Essential Plan |
$564.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$238.32
|
| Rate for Payer: Healthfirst QHP |
$250.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$175.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$250.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$213.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$175.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$250.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$188.15
|
| Rate for Payer: SOMOS Essential |
$188.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$250.86
|
|
|
PR EXC NEUROMA HAND/FOOT XCP DIGITAL NERVE
|
Professional
|
Both
|
$1,955.91
|
|
|
Service Code
|
HCPCS 64782
|
| Min. Negotiated Rate |
$376.18 |
| Max. Negotiated Rate |
$1,209.15 |
| Rate for Payer: Cash Price |
$534.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$537.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$483.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$483.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$510.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$537.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$510.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$537.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$537.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$403.05
|
| Rate for Payer: Healthfirst Commercial |
$537.40
|
| Rate for Payer: Healthfirst Essential Plan |
$1,209.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$510.53
|
| Rate for Payer: Healthfirst QHP |
$537.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$376.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$537.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$456.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$376.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$537.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$403.05
|
| Rate for Payer: SOMOS Essential |
$403.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$537.40
|
|
|
PR EXC NEUROMA MAJOR PERIPHERAL NRV XCP SCIATIC
|
Professional
|
Both
|
$3,192.53
|
|
|
Service Code
|
HCPCS 64784
|
| Min. Negotiated Rate |
$604.00 |
| Max. Negotiated Rate |
$1,941.43 |
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$862.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$776.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$776.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$819.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$862.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$819.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$862.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$862.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$647.14
|
| Rate for Payer: Healthfirst Commercial |
$862.86
|
| Rate for Payer: Healthfirst Essential Plan |
$1,941.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$819.72
|
| Rate for Payer: Healthfirst QHP |
$862.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$604.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$862.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$733.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$604.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$862.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$647.14
|
| Rate for Payer: SOMOS Essential |
$647.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$862.86
|
|
|
PR EXC OSS TUBEROSITIES DENTOALVEOLAR STRUXS
|
Professional
|
Both
|
$1,595.62
|
|
|
Service Code
|
HCPCS 41823
|
| Min. Negotiated Rate |
$305.26 |
| Max. Negotiated Rate |
$981.18 |
| Rate for Payer: Cash Price |
$436.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$436.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$392.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$392.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$414.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$436.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$414.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$436.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$436.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$327.06
|
| Rate for Payer: Healthfirst Commercial |
$436.08
|
| Rate for Payer: Healthfirst Essential Plan |
$981.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$414.28
|
| Rate for Payer: Healthfirst QHP |
$436.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$305.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$436.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$370.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$305.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$436.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$327.06
|
| Rate for Payer: SOMOS Essential |
$327.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$436.08
|
|
|
PR EXC PENILE PLAQUE GRAFT &/5 CM LENGTH
|
Professional
|
Both
|
$3,342.01
|
|
|
Service Code
|
HCPCS 54111
|
| Min. Negotiated Rate |
$636.31 |
| Max. Negotiated Rate |
$2,045.30 |
| Rate for Payer: Cash Price |
$914.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$909.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$818.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$818.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$863.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$909.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$863.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$909.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$909.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$681.76
|
| Rate for Payer: Healthfirst Commercial |
$909.02
|
| Rate for Payer: Healthfirst Essential Plan |
$2,045.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$863.57
|
| Rate for Payer: Healthfirst QHP |
$909.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$636.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$909.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$772.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$636.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$909.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$681.76
|
| Rate for Payer: SOMOS Essential |
$681.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$909.02
|
|
|
PR EXC PENILE PLAQUE GRAFT > 5 CM LENGTH
|
Professional
|
Both
|
$3,917.10
|
|
|
Service Code
|
HCPCS 54112
|
| Min. Negotiated Rate |
$745.86 |
| Max. Negotiated Rate |
$2,397.40 |
| Rate for Payer: Cash Price |
$1,071.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,065.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$958.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$958.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,012.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,065.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,012.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,065.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,065.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$799.13
|
| Rate for Payer: Healthfirst Commercial |
$1,065.51
|
| Rate for Payer: Healthfirst Essential Plan |
$2,397.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,012.23
|
| Rate for Payer: Healthfirst QHP |
$1,065.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$745.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,065.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$905.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$745.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,065.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$799.13
|
| Rate for Payer: SOMOS Essential |
$799.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,065.51
|
|
|
PR EXC PRESAC/SACROCOCCYGEAL TUMOR
|
Professional
|
Both
|
$9,687.37
|
|
|
Service Code
|
HCPCS 49215
|
| Min. Negotiated Rate |
$1,815.97 |
| Max. Negotiated Rate |
$5,837.06 |
| Rate for Payer: Cash Price |
$2,636.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,594.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,334.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,334.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,464.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,594.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,464.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,594.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,594.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,945.69
|
| Rate for Payer: Healthfirst Commercial |
$2,594.25
|
| Rate for Payer: Healthfirst Essential Plan |
$5,837.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,464.54
|
| Rate for Payer: Healthfirst QHP |
$2,594.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,815.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,594.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,205.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,815.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,594.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,945.69
|
| Rate for Payer: SOMOS Essential |
$1,945.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,594.25
|
|
|
PR EXC PRTD TUM/PRTD GLND LAT DSJ&PRSRV FACIAL NR
|
Professional
|
Both
|
$4,569.78
|
|
|
Service Code
|
HCPCS 42415
|
| Min. Negotiated Rate |
$857.48 |
| Max. Negotiated Rate |
$2,756.18 |
| Rate for Payer: Cash Price |
$1,237.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,224.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,102.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,102.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,163.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,224.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,163.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,224.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,224.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$918.73
|
| Rate for Payer: Healthfirst Commercial |
$1,224.97
|
| Rate for Payer: Healthfirst Essential Plan |
$2,756.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,163.72
|
| Rate for Payer: Healthfirst QHP |
$1,224.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$857.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,224.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,041.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$857.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,224.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$918.73
|
| Rate for Payer: SOMOS Essential |
$918.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,224.97
|
|
|
PR EXC PRTD TUM/PRTD GLND LAT LOBE W/O NRV DSJ
|
Professional
|
Both
|
$2,741.80
|
|
|
Service Code
|
HCPCS 42410
|
| Min. Negotiated Rate |
$512.56 |
| Max. Negotiated Rate |
$1,647.52 |
| Rate for Payer: Cash Price |
$741.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$732.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$659.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$659.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$695.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$732.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$695.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$732.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$732.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$549.17
|
| Rate for Payer: Healthfirst Commercial |
$732.23
|
| Rate for Payer: Healthfirst Essential Plan |
$1,647.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$695.62
|
| Rate for Payer: Healthfirst QHP |
$732.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$512.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$732.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$622.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$512.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$732.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$549.17
|
| Rate for Payer: SOMOS Essential |
$549.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$732.23
|
|
|
PR EXC PRTD TUM/PRTD GLND TOT DSJ&PRSRV FACIAL NR
|
Professional
|
Both
|
$5,117.77
|
|
|
Service Code
|
HCPCS 42420
|
| Min. Negotiated Rate |
$959.23 |
| Max. Negotiated Rate |
$3,083.24 |
| Rate for Payer: Cash Price |
$1,382.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,370.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,233.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,233.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,301.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,370.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,301.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,370.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,370.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,027.75
|
| Rate for Payer: Healthfirst Commercial |
$1,370.33
|
| Rate for Payer: Healthfirst Essential Plan |
$3,083.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,301.81
|
| Rate for Payer: Healthfirst QHP |
$1,370.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$959.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,370.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,164.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$959.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,370.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,027.75
|
| Rate for Payer: SOMOS Essential |
$1,027.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,370.33
|
|
|
PR EXC PRTD TUM/PRTD GLND TOT W/UNI RAD NCK DSJ
|
Professional
|
Both
|
$5,831.21
|
|
|
Service Code
|
HCPCS 42426
|
| Min. Negotiated Rate |
$1,093.27 |
| Max. Negotiated Rate |
$3,514.07 |
| Rate for Payer: Cash Price |
$1,573.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,561.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,405.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,405.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,483.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,561.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,483.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,561.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,561.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,171.36
|
| Rate for Payer: Healthfirst Commercial |
$1,561.81
|
| Rate for Payer: Healthfirst Essential Plan |
$3,514.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,483.72
|
| Rate for Payer: Healthfirst QHP |
$1,561.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,093.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,561.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,327.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,093.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,561.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,171.36
|
| Rate for Payer: SOMOS Essential |
$1,171.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,561.81
|
|
|
PR EXC RCT PROCIDENTIA W/ANAST ABDL & PRNL APPROACH
|
Professional
|
Both
|
$5,496.44
|
|
|
Service Code
|
HCPCS 45135
|
| Min. Negotiated Rate |
$1,034.73 |
| Max. Negotiated Rate |
$3,325.91 |
| Rate for Payer: Cash Price |
$1,490.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,478.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,330.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,330.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,404.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,478.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,404.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,478.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,478.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,108.63
|
| Rate for Payer: Healthfirst Commercial |
$1,478.18
|
| Rate for Payer: Healthfirst Essential Plan |
$3,325.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,404.27
|
| Rate for Payer: Healthfirst QHP |
$1,478.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,034.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,478.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,256.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,034.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,478.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,108.63
|
| Rate for Payer: SOMOS Essential |
$1,108.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,478.18
|
|
