|
PR FOREHEAD FLAP W/PRESERVATION VASCULAR PEDICLE
|
Professional
|
Both
|
$4,289.99
|
|
|
Service Code
|
HCPCS 15731
|
| Min. Negotiated Rate |
$808.23 |
| Max. Negotiated Rate |
$2,597.89 |
| Rate for Payer: Cash Price |
$1,162.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,154.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,039.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,039.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,096.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,154.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,096.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,154.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,154.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$865.97
|
| Rate for Payer: Healthfirst Commercial |
$1,154.62
|
| Rate for Payer: Healthfirst Essential Plan |
$2,597.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,096.89
|
| Rate for Payer: Healthfirst QHP |
$1,154.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$808.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,154.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$981.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$808.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,154.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$865.97
|
| Rate for Payer: SOMOS Essential |
$865.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,154.62
|
|
|
PR FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING
|
Professional
|
Both
|
$238.95
|
|
|
Service Code
|
HCPCS 54450
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$146.09 |
| Rate for Payer: Cash Price |
$64.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$64.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$61.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.70
|
| Rate for Payer: Healthfirst Commercial |
$64.93
|
| Rate for Payer: Healthfirst Essential Plan |
$146.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.68
|
| Rate for Payer: Healthfirst QHP |
$64.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$64.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.70
|
| Rate for Payer: SOMOS Essential |
$48.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.93
|
|
|
PR FRACTURE NASAL INFERIOR TURBINATE THERAPEUTIC
|
Professional
|
Both
|
$510.76
|
|
|
Service Code
|
HCPCS 30930
|
| Min. Negotiated Rate |
$96.44 |
| Max. Negotiated Rate |
$309.98 |
| Rate for Payer: Cash Price |
$139.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$137.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$123.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$130.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$137.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$130.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.33
|
| Rate for Payer: Healthfirst Commercial |
$137.77
|
| Rate for Payer: Healthfirst Essential Plan |
$309.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.88
|
| Rate for Payer: Healthfirst QHP |
$137.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$96.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$137.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$117.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$96.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$137.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$103.33
|
| Rate for Payer: SOMOS Essential |
$103.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.77
|
|
|
PR FREE FASCIAL FLAP W/MICROVASCULAR ANASTOMOSIS
|
Professional
|
Both
|
$9,754.26
|
|
|
Service Code
|
HCPCS 15758
|
| Min. Negotiated Rate |
$1,819.86 |
| Max. Negotiated Rate |
$5,849.55 |
| Rate for Payer: Cash Price |
$2,624.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,599.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,339.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,339.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,469.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,599.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,469.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,599.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,599.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,949.85
|
| Rate for Payer: Healthfirst Commercial |
$2,599.80
|
| Rate for Payer: Healthfirst Essential Plan |
$5,849.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,469.81
|
| Rate for Payer: Healthfirst QHP |
$2,599.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,819.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,599.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,209.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,819.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,599.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,949.85
|
| Rate for Payer: SOMOS Essential |
$1,949.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,599.80
|
|
|
PR FREE MUSCLE/MYOCUTANEOUS FLAP W/MVASC ANAST
|
Professional
|
Both
|
$9,889.95
|
|
|
Service Code
|
HCPCS 15756
|
| Min. Negotiated Rate |
$1,843.81 |
| Max. Negotiated Rate |
$5,926.52 |
| Rate for Payer: Cash Price |
$2,659.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,634.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,370.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,370.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,502.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,634.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,502.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,634.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,634.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,975.51
|
| Rate for Payer: Healthfirst Commercial |
$2,634.01
|
| Rate for Payer: Healthfirst Essential Plan |
$5,926.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,502.31
|
| Rate for Payer: Healthfirst QHP |
$2,634.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,843.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,634.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,238.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,843.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,634.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,975.51
|
| Rate for Payer: SOMOS Essential |
$1,975.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,634.01
|
|
|
PR FREE OSTQ FLAP W/MVASC ANAST METAR/GREAT TOE
|
Professional
|
Both
|
$11,654.13
|
|
|
Service Code
|
HCPCS 20969
|
| Min. Negotiated Rate |
$2,179.62 |
| Max. Negotiated Rate |
$7,005.94 |
| Rate for Payer: Cash Price |
$3,146.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,113.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,802.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,802.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,958.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,113.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,958.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,113.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,113.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,335.31
|
| Rate for Payer: Healthfirst Commercial |
$3,113.75
|
| Rate for Payer: Healthfirst Essential Plan |
$7,005.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,958.06
|
| Rate for Payer: Healthfirst QHP |
$3,113.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,179.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,113.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,646.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,179.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,113.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,335.31
|
| Rate for Payer: SOMOS Essential |
$2,335.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,113.75
|
|
|
PR FREE OSTQ FLAP W/MVASC ANASTOMOSIS ILIAC CREST
|
Professional
|
Both
|
$12,527.20
|
|
|
Service Code
|
HCPCS 20970
|
| Min. Negotiated Rate |
$2,344.27 |
| Max. Negotiated Rate |
$7,535.16 |
| Rate for Payer: Cash Price |
$3,367.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,348.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,014.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,014.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,181.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,348.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,181.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,348.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,348.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,511.72
|
| Rate for Payer: Healthfirst Commercial |
$3,348.96
|
| Rate for Payer: Healthfirst Essential Plan |
$7,535.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.51
|
| Rate for Payer: Healthfirst QHP |
$3,348.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,344.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,348.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,846.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,344.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,348.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,511.72
|
| Rate for Payer: SOMOS Essential |
$2,511.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,348.96
|
|
|
PR FREE OSTQ FLAP W/MVASC ANASTOMOSIS METATARSAL
|
Professional
|
Both
|
$12,492.69
|
|
|
Service Code
|
HCPCS 20972
|
| Min. Negotiated Rate |
$2,336.99 |
| Max. Negotiated Rate |
$7,511.76 |
| Rate for Payer: Cash Price |
$3,357.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,338.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,004.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,004.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,171.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,338.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,171.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,338.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,338.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,503.92
|
| Rate for Payer: Healthfirst Commercial |
$3,338.56
|
| Rate for Payer: Healthfirst Essential Plan |
$7,511.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,171.63
|
| Rate for Payer: Healthfirst QHP |
$3,338.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,336.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,338.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,837.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,336.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,338.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,503.92
|
| Rate for Payer: SOMOS Essential |
$2,503.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,338.56
|
|
|
PR FREE SKIN FLAP W/MICROVASCULAR ANASTOMOSIS
|
Professional
|
Both
|
$9,799.86
|
|
|
Service Code
|
HCPCS 15757
|
| Min. Negotiated Rate |
$1,827.40 |
| Max. Negotiated Rate |
$5,873.78 |
| Rate for Payer: Cash Price |
$2,635.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,610.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,349.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,349.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,480.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,610.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,480.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,610.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,610.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,957.93
|
| Rate for Payer: Healthfirst Commercial |
$2,610.57
|
| Rate for Payer: Healthfirst Essential Plan |
$5,873.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,480.04
|
| Rate for Payer: Healthfirst QHP |
$2,610.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,827.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,610.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,218.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,827.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,610.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,957.93
|
| Rate for Payer: SOMOS Essential |
$1,957.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,610.57
|
|
|
PR FRENOPLASTY SURG REVJ FRENUM EG W/Z-PLASTY
|
Professional
|
Both
|
$1,087.77
|
|
|
Service Code
|
HCPCS 41520
|
| Min. Negotiated Rate |
$205.69 |
| Max. Negotiated Rate |
$661.16 |
| Rate for Payer: Cash Price |
$295.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$293.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$264.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$264.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$279.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$293.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$279.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$293.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$293.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$220.39
|
| Rate for Payer: Healthfirst Commercial |
$293.85
|
| Rate for Payer: Healthfirst Essential Plan |
$661.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$279.16
|
| Rate for Payer: Healthfirst QHP |
$293.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$205.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$293.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$249.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$205.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$293.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$220.39
|
| Rate for Payer: SOMOS Essential |
$220.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$293.85
|
|
|
PR FRENULOTOMY PENIS
|
Professional
|
Both
|
$818.55
|
|
|
Service Code
|
HCPCS 54164
|
| Min. Negotiated Rate |
$158.14 |
| Max. Negotiated Rate |
$508.30 |
| Rate for Payer: Cash Price |
$226.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$225.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$203.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$203.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$214.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$225.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$214.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$169.43
|
| Rate for Payer: Healthfirst Commercial |
$225.91
|
| Rate for Payer: Healthfirst Essential Plan |
$508.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$214.61
|
| Rate for Payer: Healthfirst QHP |
$225.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$158.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$225.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$192.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$158.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$225.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$169.43
|
| Rate for Payer: SOMOS Essential |
$169.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$225.91
|
|
|
PR FRMJ DIRECT/TUBED PEDICLE W/WO TRANSFER TRUNK
|
Professional
|
Both
|
$3,203.69
|
|
|
Service Code
|
HCPCS 15570
|
| Min. Negotiated Rate |
$599.63 |
| Max. Negotiated Rate |
$1,927.37 |
| Rate for Payer: Cash Price |
$861.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$856.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$770.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$770.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$813.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$856.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$813.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$856.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$856.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$642.46
|
| Rate for Payer: Healthfirst Commercial |
$856.61
|
| Rate for Payer: Healthfirst Essential Plan |
$1,927.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$813.78
|
| Rate for Payer: Healthfirst QHP |
$856.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$599.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$856.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$728.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$599.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$856.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$642.46
|
| Rate for Payer: SOMOS Essential |
$642.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$856.61
|
|
|
PR FRMJ DIRECT/TUBED PEDICLE W/WOTR E/N/E/L/NTRORAL
|
Professional
|
Both
|
$2,746.45
|
|
|
Service Code
|
HCPCS 15576
|
| Min. Negotiated Rate |
$523.24 |
| Max. Negotiated Rate |
$1,681.85 |
| Rate for Payer: Cash Price |
$748.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$747.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$672.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$672.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$710.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$747.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$710.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$747.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$747.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$560.62
|
| Rate for Payer: Healthfirst Commercial |
$747.49
|
| Rate for Payer: Healthfirst Essential Plan |
$1,681.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$710.12
|
| Rate for Payer: Healthfirst QHP |
$747.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$523.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$747.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$635.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$523.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$747.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$560.62
|
| Rate for Payer: SOMOS Essential |
$560.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$747.49
|
|
|
PR FRMJ DIRECT/TUBE PEDICLE W/WO TR SCALP ARMS/LEGS
|
Professional
|
Both
|
$3,199.77
|
|
|
Service Code
|
HCPCS 15572
|
| Min. Negotiated Rate |
$605.04 |
| Max. Negotiated Rate |
$1,944.79 |
| Rate for Payer: Cash Price |
$867.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$864.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$777.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$777.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$821.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$864.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$821.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$864.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$864.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$648.26
|
| Rate for Payer: Healthfirst Commercial |
$864.35
|
| Rate for Payer: Healthfirst Essential Plan |
$1,944.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$821.13
|
| Rate for Payer: Healthfirst QHP |
$864.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$605.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$864.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$734.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$605.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$864.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$648.26
|
| Rate for Payer: SOMOS Essential |
$648.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$864.35
|
|
|
PR FRMJ DIR/TUBE PEDCL W/WOTR FH/CH/CH/M/N/AX/G/H/F
|
Professional
|
Both
|
$3,160.82
|
|
|
Service Code
|
HCPCS 15574
|
| Min. Negotiated Rate |
$586.80 |
| Max. Negotiated Rate |
$1,886.13 |
| Rate for Payer: Cash Price |
$865.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$838.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$754.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$754.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$796.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$838.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$796.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$838.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$838.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$628.71
|
| Rate for Payer: Healthfirst Commercial |
$838.28
|
| Rate for Payer: Healthfirst Essential Plan |
$1,886.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$796.37
|
| Rate for Payer: Healthfirst QHP |
$838.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$586.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$838.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$712.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$586.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$838.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$628.71
|
| Rate for Payer: SOMOS Essential |
$628.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$838.28
|
|
|
PR FR OSTQ FLAP W/MVASC ANAST GRT TOE W/WEB SPACE
|
Professional
|
Both
|
$13,197.17
|
|
|
Service Code
|
HCPCS 20973
|
| Min. Negotiated Rate |
$2,466.58 |
| Max. Negotiated Rate |
$7,928.30 |
| Rate for Payer: Cash Price |
$3,546.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,523.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,171.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,171.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,347.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,523.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,347.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,523.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,523.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,642.77
|
| Rate for Payer: Healthfirst Commercial |
$3,523.69
|
| Rate for Payer: Healthfirst Essential Plan |
$7,928.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,347.51
|
| Rate for Payer: Healthfirst QHP |
$3,523.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,466.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,523.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,995.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,466.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,523.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,642.77
|
| Rate for Payer: SOMOS Essential |
$2,642.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,523.69
|
|
|
PR FSTLJ SCLERA GLAUCOMA THERMOCAUT IRRIDEC
|
Professional
|
Both
|
$3,622.29
|
|
|
Service Code
|
HCPCS 66155
|
| Min. Negotiated Rate |
$687.49 |
| Max. Negotiated Rate |
$2,209.79 |
| Rate for Payer: Cash Price |
$998.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$982.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$883.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$883.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$933.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$982.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$933.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$982.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$982.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$736.60
|
| Rate for Payer: Healthfirst Commercial |
$982.13
|
| Rate for Payer: Healthfirst Essential Plan |
$2,209.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$933.02
|
| Rate for Payer: Healthfirst QHP |
$982.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$687.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$982.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$834.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$687.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$982.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$736.60
|
| Rate for Payer: SOMOS Essential |
$736.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$982.13
|
|
|
PR FSTLJ SCLERA GLAUCOMA TRABECULECT AB EXTERNO
|
Professional
|
Both
|
$4,504.15
|
|
|
Service Code
|
HCPCS 66170
|
| Min. Negotiated Rate |
$856.48 |
| Max. Negotiated Rate |
$2,752.97 |
| Rate for Payer: Cash Price |
$1,242.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,223.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,101.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,101.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,162.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,223.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,162.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,223.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,223.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$917.65
|
| Rate for Payer: Healthfirst Commercial |
$1,223.54
|
| Rate for Payer: Healthfirst Essential Plan |
$2,752.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,162.36
|
| Rate for Payer: Healthfirst QHP |
$1,223.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$856.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,223.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,040.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$856.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,223.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$917.65
|
| Rate for Payer: SOMOS Essential |
$917.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,223.54
|
|
|
PR FSTLJ SCLERA GLAUCOMA TREPHIN W/IRIDECTOMY
|
Professional
|
Both
|
$3,624.99
|
|
|
Service Code
|
HCPCS 66150
|
| Min. Negotiated Rate |
$688.00 |
| Max. Negotiated Rate |
$2,211.43 |
| Rate for Payer: Cash Price |
$999.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$982.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$884.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$884.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$933.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$982.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$933.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$982.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$982.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$737.14
|
| Rate for Payer: Healthfirst Commercial |
$982.86
|
| Rate for Payer: Healthfirst Essential Plan |
$2,211.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$933.72
|
| Rate for Payer: Healthfirst QHP |
$982.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$688.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$982.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$835.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$688.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$982.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$737.14
|
| Rate for Payer: SOMOS Essential |
$737.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$982.86
|
|
|
PR FSTLJ SCLERA GLC TRBEC AB EXTERNO SCARRING
|
Professional
|
Both
|
$4,922.09
|
|
|
Service Code
|
HCPCS 66172
|
| Min. Negotiated Rate |
$936.26 |
| Max. Negotiated Rate |
$3,009.40 |
| Rate for Payer: Cash Price |
$1,358.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,337.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,203.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,203.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,270.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,337.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,270.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,337.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,337.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,003.13
|
| Rate for Payer: Healthfirst Commercial |
$1,337.51
|
| Rate for Payer: Healthfirst Essential Plan |
$3,009.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,270.63
|
| Rate for Payer: Healthfirst QHP |
$1,337.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$936.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,337.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,136.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$936.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,337.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,003.13
|
| Rate for Payer: SOMOS Essential |
$1,003.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,337.51
|
|
|
PR FSTLJ SCLERA SCLERECTOMY PUNCH/SCISSORS IRIDECT
|
Professional
|
Both
|
$4,068.61
|
|
|
Service Code
|
HCPCS 66160
|
| Min. Negotiated Rate |
$771.68 |
| Max. Negotiated Rate |
$2,480.40 |
| Rate for Payer: Cash Price |
$1,120.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,102.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$992.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$992.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,047.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,102.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,047.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,102.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,102.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$826.80
|
| Rate for Payer: Healthfirst Commercial |
$1,102.40
|
| Rate for Payer: Healthfirst Essential Plan |
$2,480.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,047.28
|
| Rate for Payer: Healthfirst QHP |
$1,102.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$771.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,102.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$937.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$771.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,102.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$826.80
|
| Rate for Payer: SOMOS Essential |
$826.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,102.40
|
|
|
PR FTH/GF FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<
|
Professional
|
Both
|
$3,386.29
|
|
|
Service Code
|
HCPCS 15240
|
| Min. Negotiated Rate |
$645.43 |
| Max. Negotiated Rate |
$2,074.59 |
| Rate for Payer: Cash Price |
$927.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$922.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$829.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$829.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$875.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$922.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$875.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$922.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$922.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$691.53
|
| Rate for Payer: Healthfirst Commercial |
$922.04
|
| Rate for Payer: Healthfirst Essential Plan |
$2,074.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$875.94
|
| Rate for Payer: Healthfirst QHP |
$922.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$645.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$922.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$783.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$645.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$922.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$691.53
|
| Rate for Payer: SOMOS Essential |
$691.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$922.04
|
|
|
PR FTH/GFT FREE W/DIR CLSR N/E/E/L EA ADDL 20 SQ CM
|
Professional
|
Both
|
$576.87
|
|
|
Service Code
|
HCPCS 15261
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$347.13 |
| Rate for Payer: Cash Price |
$155.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$154.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$138.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$138.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$146.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$154.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$146.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$115.71
|
| Rate for Payer: Healthfirst Commercial |
$154.28
|
| Rate for Payer: Healthfirst Essential Plan |
$347.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$146.57
|
| Rate for Payer: Healthfirst QHP |
$154.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$108.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$154.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$131.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$108.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$154.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$115.71
|
| Rate for Payer: SOMOS Essential |
$115.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$154.28
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<
|
Professional
|
Both
|
$3,568.22
|
|
|
Service Code
|
HCPCS 15260
|
| Min. Negotiated Rate |
$681.67 |
| Max. Negotiated Rate |
$2,191.09 |
| Rate for Payer: Cash Price |
$976.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$973.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$876.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$876.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$925.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$973.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$925.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$973.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$973.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$730.37
|
| Rate for Payer: Healthfirst Commercial |
$973.82
|
| Rate for Payer: Healthfirst Essential Plan |
$2,191.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$925.13
|
| Rate for Payer: Healthfirst QHP |
$973.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$681.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$973.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$827.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$681.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$973.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$730.37
|
| Rate for Payer: SOMOS Essential |
$730.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$973.82
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE S/A/L 20 SQ CM/<
|
Professional
|
Both
|
$2,604.70
|
|
|
Service Code
|
HCPCS 15220
|
| Min. Negotiated Rate |
$495.09 |
| Max. Negotiated Rate |
$1,591.36 |
| Rate for Payer: Cash Price |
$712.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$707.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$636.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$636.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$671.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$707.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$671.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$707.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$707.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$530.45
|
| Rate for Payer: Healthfirst Commercial |
$707.27
|
| Rate for Payer: Healthfirst Essential Plan |
$1,591.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$671.91
|
| Rate for Payer: Healthfirst QHP |
$707.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$495.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$707.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$601.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$495.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$707.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$530.45
|
| Rate for Payer: SOMOS Essential |
$530.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$707.27
|
|
