|
PR GLOSSECTOMY <ONE-HALF TONGUE
|
Professional
|
Both
|
$4,581.68
|
|
|
Service Code
|
HCPCS 41120
|
| Min. Negotiated Rate |
$852.38 |
| Max. Negotiated Rate |
$2,739.78 |
| Rate for Payer: Cash Price |
$1,234.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,217.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,095.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,095.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,156.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,217.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,156.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,217.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,217.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$913.26
|
| Rate for Payer: Healthfirst Commercial |
$1,217.68
|
| Rate for Payer: Healthfirst Essential Plan |
$2,739.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,156.80
|
| Rate for Payer: Healthfirst QHP |
$1,217.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$852.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,217.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,035.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$852.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,217.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$913.26
|
| Rate for Payer: SOMOS Essential |
$913.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,217.68
|
|
|
PR GLOSSECTOMY PRTL W/UNI RADICAL NECK DSJ
|
Professional
|
Both
|
$9,291.00
|
|
|
Service Code
|
HCPCS 41135
|
| Min. Negotiated Rate |
$1,732.12 |
| Max. Negotiated Rate |
$5,567.53 |
| Rate for Payer: Cash Price |
$2,509.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,474.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,227.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,227.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,350.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,474.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,350.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,474.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,474.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,855.85
|
| Rate for Payer: Healthfirst Commercial |
$2,474.46
|
| Rate for Payer: Healthfirst Essential Plan |
$5,567.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,350.74
|
| Rate for Payer: Healthfirst QHP |
$2,474.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,732.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,474.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,103.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,732.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,474.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,855.85
|
| Rate for Payer: SOMOS Essential |
$1,855.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,474.46
|
|
|
PR GLSSC COMPL/TOT W/WOTRACHS W/O RAD NECK DSJ
|
Professional
|
Both
|
$9,380.88
|
|
|
Service Code
|
HCPCS 41140
|
| Min. Negotiated Rate |
$1,743.81 |
| Max. Negotiated Rate |
$5,605.11 |
| Rate for Payer: Cash Price |
$2,527.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,491.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,242.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,242.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,366.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,491.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,366.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,491.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,491.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,868.37
|
| Rate for Payer: Healthfirst Commercial |
$2,491.16
|
| Rate for Payer: Healthfirst Essential Plan |
$5,605.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,366.60
|
| Rate for Payer: Healthfirst QHP |
$2,491.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,743.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,491.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,117.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,743.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,491.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,868.37
|
| Rate for Payer: SOMOS Essential |
$1,868.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,491.16
|
|
|
PR GLSSC COMPL/TOT W/WO TRACHS W/UNI RAD NECK DSJ
|
Professional
|
Both
|
$11,813.13
|
|
|
Service Code
|
HCPCS 41145
|
| Min. Negotiated Rate |
$2,194.87 |
| Max. Negotiated Rate |
$7,054.94 |
| Rate for Payer: Cash Price |
$3,180.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,135.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,821.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,821.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,978.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,135.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,978.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,135.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,135.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,351.65
|
| Rate for Payer: Healthfirst Commercial |
$3,135.53
|
| Rate for Payer: Healthfirst Essential Plan |
$7,054.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,978.75
|
| Rate for Payer: Healthfirst QHP |
$3,135.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,194.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,135.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,665.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,194.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,135.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,351.65
|
| Rate for Payer: SOMOS Essential |
$2,351.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,135.53
|
|
|
PR GLSSC COMPOSIT RESCJ FLOOR SUPRAHYOID NCK DSJ
|
Professional
|
Both
|
$10,232.08
|
|
|
Service Code
|
HCPCS 41153
|
| Min. Negotiated Rate |
$1,914.70 |
| Max. Negotiated Rate |
$6,154.40 |
| Rate for Payer: Cash Price |
$2,769.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,735.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,461.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,461.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,598.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,735.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,598.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,735.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,735.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,051.47
|
| Rate for Payer: Healthfirst Commercial |
$2,735.29
|
| Rate for Payer: Healthfirst Essential Plan |
$6,154.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,598.53
|
| Rate for Payer: Healthfirst QHP |
$2,735.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,914.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,735.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,325.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,914.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,735.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,051.47
|
| Rate for Payer: SOMOS Essential |
$2,051.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,735.29
|
|
|
PR GLSSC COMPOSIT RESCJ FLR MNDBLR RESCJ & RAD NECK
|
Professional
|
Both
|
$12,818.09
|
|
|
Service Code
|
HCPCS 41155
|
| Min. Negotiated Rate |
$2,376.92 |
| Max. Negotiated Rate |
$7,640.10 |
| Rate for Payer: Cash Price |
$3,445.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,395.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,056.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,056.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,225.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,395.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,225.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,395.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,395.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,546.70
|
| Rate for Payer: Healthfirst Commercial |
$3,395.60
|
| Rate for Payer: Healthfirst Essential Plan |
$7,640.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,225.82
|
| Rate for Payer: Healthfirst QHP |
$3,395.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,376.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,395.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,886.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,376.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,395.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,546.70
|
| Rate for Payer: SOMOS Essential |
$2,546.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,395.60
|
|
|
PR GLSSC COMPOSIT W/RESCJ FLOOR & MANDIBULAR RESCJ
|
Professional
|
Both
|
$9,443.67
|
|
|
Service Code
|
HCPCS 41150
|
| Min. Negotiated Rate |
$1,758.62 |
| Max. Negotiated Rate |
$5,652.72 |
| Rate for Payer: Cash Price |
$2,547.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,512.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,261.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,261.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,386.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,512.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,386.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,512.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,512.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,884.24
|
| Rate for Payer: Healthfirst Commercial |
$2,512.32
|
| Rate for Payer: Healthfirst Essential Plan |
$5,652.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,386.70
|
| Rate for Payer: Healthfirst QHP |
$2,512.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,758.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,512.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,135.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,758.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,512.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,884.24
|
| Rate for Payer: SOMOS Essential |
$1,884.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,512.32
|
|
|
PR GONIOSCOPY SEPARATE PROCEDURE
|
Professional
|
Both
|
$80.71
|
|
|
Service Code
|
HCPCS 92020
|
| Min. Negotiated Rate |
$9.52 |
| Max. Negotiated Rate |
$49.27 |
| Rate for Payer: Amida Care Medicaid |
$9.52
|
| Rate for Payer: Cash Price |
$22.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.43
|
| Rate for Payer: Healthfirst Commercial |
$21.90
|
| Rate for Payer: Healthfirst Essential Plan |
$49.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.80
|
| Rate for Payer: Healthfirst QHP |
$21.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$21.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$18.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16.43
|
| Rate for Payer: SOMOS Essential |
$16.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.90
|
|
|
PR GONIOTOMY
|
Professional
|
Both
|
$3,431.09
|
|
|
Service Code
|
HCPCS 65820
|
| Min. Negotiated Rate |
$644.13 |
| Max. Negotiated Rate |
$2,070.41 |
| Rate for Payer: Cash Price |
$941.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$920.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$828.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$828.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$874.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$920.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$874.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$920.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$920.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$690.13
|
| Rate for Payer: Healthfirst Commercial |
$920.18
|
| Rate for Payer: Healthfirst Essential Plan |
$2,070.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$874.17
|
| Rate for Payer: Healthfirst QHP |
$920.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$644.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$920.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$782.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$644.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$920.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$690.13
|
| Rate for Payer: SOMOS Essential |
$690.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$920.18
|
|
|
PR GRAFT BONE MANDIBLE
|
Professional
|
Both
|
$3,289.41
|
|
|
Service Code
|
HCPCS 21215
|
| Min. Negotiated Rate |
$636.16 |
| Max. Negotiated Rate |
$2,044.80 |
| Rate for Payer: Cash Price |
$902.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$908.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$817.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$817.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$863.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$908.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$863.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$908.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$908.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$681.60
|
| Rate for Payer: Healthfirst Commercial |
$908.80
|
| Rate for Payer: Healthfirst Essential Plan |
$2,044.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$863.36
|
| Rate for Payer: Healthfirst QHP |
$908.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$636.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$908.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$772.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$636.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$908.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$681.60
|
| Rate for Payer: SOMOS Essential |
$681.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$908.80
|
|
|
PR GRAFT BONE NASAL/MAXILLARY/MALAR AREAS
|
Professional
|
Both
|
$3,170.72
|
|
|
Service Code
|
HCPCS 21210
|
| Min. Negotiated Rate |
$612.33 |
| Max. Negotiated Rate |
$1,968.21 |
| Rate for Payer: Cash Price |
$868.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$874.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$787.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$787.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$831.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$874.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$831.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$874.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$874.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$656.07
|
| Rate for Payer: Healthfirst Commercial |
$874.76
|
| Rate for Payer: Healthfirst Essential Plan |
$1,968.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$831.02
|
| Rate for Payer: Healthfirst QHP |
$874.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$612.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$874.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$743.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$612.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$874.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$656.07
|
| Rate for Payer: SOMOS Essential |
$656.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$874.76
|
|
|
PR GRAFT COMPOSITE W/PRIMARY CLOSURE DONOR AREA
|
Professional
|
Both
|
$2,991.66
|
|
|
Service Code
|
HCPCS 15760
|
| Min. Negotiated Rate |
$565.77 |
| Max. Negotiated Rate |
$1,818.54 |
| Rate for Payer: Cash Price |
$812.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$808.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$727.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$727.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$767.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$808.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$767.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$808.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$808.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$606.18
|
| Rate for Payer: Healthfirst Commercial |
$808.24
|
| Rate for Payer: Healthfirst Essential Plan |
$1,818.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$767.83
|
| Rate for Payer: Healthfirst QHP |
$808.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$565.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$808.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$687.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$565.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$808.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$606.18
|
| Rate for Payer: SOMOS Essential |
$606.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$808.24
|
|
|
PR GRAFT DERMA-FAT-FASCIA
|
Professional
|
Both
|
$2,900.21
|
|
|
Service Code
|
HCPCS 15770
|
| Min. Negotiated Rate |
$552.20 |
| Max. Negotiated Rate |
$1,774.91 |
| Rate for Payer: Cash Price |
$792.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$788.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$709.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$709.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$749.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$788.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$749.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$788.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$788.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$591.64
|
| Rate for Payer: Healthfirst Commercial |
$788.85
|
| Rate for Payer: Healthfirst Essential Plan |
$1,774.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$749.41
|
| Rate for Payer: Healthfirst QHP |
$788.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$552.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$788.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$670.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$552.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$788.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$591.64
|
| Rate for Payer: SOMOS Essential |
$591.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$788.85
|
|
|
PR GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR
|
Professional
|
Both
|
$2,446.08
|
|
|
Service Code
|
HCPCS 21235
|
| Min. Negotiated Rate |
$464.26 |
| Max. Negotiated Rate |
$1,492.27 |
| Rate for Payer: Cash Price |
$668.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$663.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$596.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$596.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$630.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$663.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$630.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$663.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$663.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$497.42
|
| Rate for Payer: Healthfirst Commercial |
$663.23
|
| Rate for Payer: Healthfirst Essential Plan |
$1,492.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$630.07
|
| Rate for Payer: Healthfirst QHP |
$663.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$464.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$663.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$563.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$464.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$663.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$497.42
|
| Rate for Payer: SOMOS Essential |
$497.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$663.23
|
|
|
PR GRAFT FACIAL NERVE PARALYSIS FREE FASCIAL GRAFT
|
Professional
|
Both
|
$4,372.80
|
|
|
Service Code
|
HCPCS 15840
|
| Min. Negotiated Rate |
$816.45 |
| Max. Negotiated Rate |
$2,624.31 |
| Rate for Payer: Cash Price |
$1,181.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,166.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,049.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,049.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,108.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,166.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,108.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,166.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,166.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$874.77
|
| Rate for Payer: Healthfirst Commercial |
$1,166.36
|
| Rate for Payer: Healthfirst Essential Plan |
$2,624.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,108.04
|
| Rate for Payer: Healthfirst QHP |
$1,166.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$816.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,166.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$991.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$816.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,166.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$874.77
|
| Rate for Payer: SOMOS Essential |
$874.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,166.36
|
|
|
PR GRAFT FACIAL NERVE PARALYSIS FREE MUSCLE GRAFT
|
Professional
|
Both
|
$7,761.60
|
|
|
Service Code
|
HCPCS 15841
|
| Min. Negotiated Rate |
$1,457.74 |
| Max. Negotiated Rate |
$4,685.60 |
| Rate for Payer: Cash Price |
$2,090.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,082.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,874.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,874.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,978.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,082.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,978.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,082.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,082.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,561.87
|
| Rate for Payer: Healthfirst Commercial |
$2,082.49
|
| Rate for Payer: Healthfirst Essential Plan |
$4,685.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,978.37
|
| Rate for Payer: Healthfirst QHP |
$2,082.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,457.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,082.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,770.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,457.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,082.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,561.87
|
| Rate for Payer: SOMOS Essential |
$1,561.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,082.49
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO 25 CC OR LESS
|
Professional
|
Both
|
$2,175.04
|
|
|
Service Code
|
HCPCS 15773
|
| Min. Negotiated Rate |
$412.54 |
| Max. Negotiated Rate |
$1,326.02 |
| Rate for Payer: Cash Price |
$590.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$589.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$530.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$530.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$559.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$589.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$559.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$589.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$589.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$442.00
|
| Rate for Payer: Healthfirst Commercial |
$589.34
|
| Rate for Payer: Healthfirst Essential Plan |
$1,326.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$559.87
|
| Rate for Payer: Healthfirst QHP |
$589.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$412.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$589.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$500.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$412.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$589.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$442.00
|
| Rate for Payer: SOMOS Essential |
$442.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$589.34
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO 50 CC OR LESS
|
Professional
|
Both
|
$2,224.11
|
|
|
Service Code
|
HCPCS 15771
|
| Min. Negotiated Rate |
$423.69 |
| Max. Negotiated Rate |
$1,361.86 |
| Rate for Payer: Cash Price |
$606.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$605.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$544.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$544.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$575.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$605.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$575.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$605.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$605.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$453.95
|
| Rate for Payer: Healthfirst Commercial |
$605.27
|
| Rate for Payer: Healthfirst Essential Plan |
$1,361.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$575.01
|
| Rate for Payer: Healthfirst QHP |
$605.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$423.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$605.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$514.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$423.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$605.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$453.95
|
| Rate for Payer: SOMOS Essential |
$453.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$605.27
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 25 CC
|
Professional
|
Both
|
$627.80
|
|
|
Service Code
|
HCPCS 15774
|
| Min. Negotiated Rate |
$117.85 |
| Max. Negotiated Rate |
$378.81 |
| Rate for Payer: Cash Price |
$166.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$168.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$151.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$151.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$159.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$168.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$159.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$168.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$168.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$126.27
|
| Rate for Payer: Healthfirst Commercial |
$168.36
|
| Rate for Payer: Healthfirst Essential Plan |
$378.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$159.94
|
| Rate for Payer: Healthfirst QHP |
$168.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$117.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$168.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$143.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$117.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$168.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$126.27
|
| Rate for Payer: SOMOS Essential |
$126.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$168.36
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 50 CC
|
Professional
|
Both
|
$643.37
|
|
|
Service Code
|
HCPCS 15772
|
| Min. Negotiated Rate |
$121.54 |
| Max. Negotiated Rate |
$390.67 |
| Rate for Payer: Cash Price |
$172.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$173.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$156.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$156.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$164.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$173.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$173.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$173.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$130.22
|
| Rate for Payer: Healthfirst Commercial |
$173.63
|
| Rate for Payer: Healthfirst Essential Plan |
$390.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$164.95
|
| Rate for Payer: Healthfirst QHP |
$173.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$121.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$173.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$147.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$121.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$173.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$130.22
|
| Rate for Payer: SOMOS Essential |
$130.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$173.63
|
|
|
PR GRAFTING OF AUTOLOGOUS SOFT TISS BY DIRECT EXC
|
Professional
|
Both
|
$2,108.61
|
|
|
Service Code
|
HCPCS 15769
|
| Min. Negotiated Rate |
$395.97 |
| Max. Negotiated Rate |
$1,272.76 |
| Rate for Payer: Cash Price |
$568.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$565.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$509.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$509.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$537.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$565.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$537.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$565.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$565.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$424.25
|
| Rate for Payer: Healthfirst Commercial |
$565.67
|
| Rate for Payer: Healthfirst Essential Plan |
$1,272.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$537.39
|
| Rate for Payer: Healthfirst QHP |
$565.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$395.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$565.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$480.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$395.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$565.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$424.25
|
| Rate for Payer: SOMOS Essential |
$424.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$565.67
|
|
|
PR GRAFT RIB CRTLG AUTOGENOUS FACE/CHIN/NOSE/EAR
|
Professional
|
Both
|
$3,240.86
|
|
|
Service Code
|
HCPCS 21230
|
| Min. Negotiated Rate |
$608.36 |
| Max. Negotiated Rate |
$1,955.43 |
| Rate for Payer: Cash Price |
$876.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$869.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$782.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$782.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$825.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$869.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$825.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$869.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$869.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$651.81
|
| Rate for Payer: Healthfirst Commercial |
$869.08
|
| Rate for Payer: Healthfirst Essential Plan |
$1,955.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$825.63
|
| Rate for Payer: Healthfirst QHP |
$869.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$608.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$869.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$738.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$608.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$869.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$651.81
|
| Rate for Payer: SOMOS Essential |
$651.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$869.08
|
|
|
PR GRAFT THIERSCH RCT INCONTINENCE &/PROLAPSE
|
Professional
|
Both
|
$2,805.92
|
|
|
Service Code
|
HCPCS 46753
|
| Min. Negotiated Rate |
$522.04 |
| Max. Negotiated Rate |
$1,677.98 |
| Rate for Payer: Cash Price |
$748.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$745.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$671.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$671.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$708.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$745.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$708.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$745.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$745.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$559.33
|
| Rate for Payer: Healthfirst Commercial |
$745.77
|
| Rate for Payer: Healthfirst Essential Plan |
$1,677.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$708.48
|
| Rate for Payer: Healthfirst QHP |
$745.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$522.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$745.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$633.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$522.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$745.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$559.33
|
| Rate for Payer: SOMOS Essential |
$559.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$745.77
|
|
|
PR GRF FACIAL NERVE PARALYSIS REGIONAL MUSCLE TR
|
Professional
|
Both
|
$4,630.12
|
|
|
Service Code
|
HCPCS 15845
|
| Min. Negotiated Rate |
$874.83 |
| Max. Negotiated Rate |
$2,811.96 |
| Rate for Payer: Cash Price |
$1,253.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,249.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,124.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,124.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,187.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,249.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,187.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,249.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,249.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$937.32
|
| Rate for Payer: Healthfirst Commercial |
$1,249.76
|
| Rate for Payer: Healthfirst Essential Plan |
$2,811.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,187.27
|
| Rate for Payer: Healthfirst QHP |
$1,249.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$874.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,249.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,062.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$874.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,249.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$937.32
|
| Rate for Payer: SOMOS Essential |
$937.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,249.76
|
|
|
PR GRF FACIAL NRV PALYSS FR MUSCLE FLAP MICROSURG
|
Professional
|
Both
|
$11,764.20
|
|
|
Service Code
|
HCPCS 15842
|
| Min. Negotiated Rate |
$2,203.74 |
| Max. Negotiated Rate |
$7,083.45 |
| Rate for Payer: Cash Price |
$3,163.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,148.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,833.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,833.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,990.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,148.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,990.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,148.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,148.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,361.15
|
| Rate for Payer: Healthfirst Commercial |
$3,148.20
|
| Rate for Payer: Healthfirst Essential Plan |
$7,083.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,990.79
|
| Rate for Payer: Healthfirst QHP |
$3,148.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,203.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,148.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,675.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,203.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,148.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,361.15
|
| Rate for Payer: SOMOS Essential |
$2,361.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,148.20
|
|
