|
PR RCM CELULR & SUBCELULR SKN IMGNG IMG ACQUISITION
|
Professional
|
Both
|
$551.85
|
|
|
Service Code
|
HCPCS 96932
|
| Min. Negotiated Rate |
$100.97 |
| Max. Negotiated Rate |
$324.54 |
| Rate for Payer: Cash Price |
$149.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$144.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$129.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$129.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$137.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$144.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$137.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$108.18
|
| Rate for Payer: Healthfirst Commercial |
$144.24
|
| Rate for Payer: Healthfirst Essential Plan |
$324.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$137.03
|
| Rate for Payer: Healthfirst QHP |
$144.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$100.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$144.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$122.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$100.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$144.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$108.18
|
| Rate for Payer: SOMOS Essential |
$108.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$144.24
|
|
|
PR RCM CELULR & SUBCELULR SKN IMGNG I&R 1ST LES
|
Professional
|
Both
|
$177.28
|
|
|
Service Code
|
HCPCS 96933
|
| Min. Negotiated Rate |
$33.09 |
| Max. Negotiated Rate |
$106.36 |
| Rate for Payer: Cash Price |
$47.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.45
|
| Rate for Payer: Healthfirst Commercial |
$47.27
|
| Rate for Payer: Healthfirst Essential Plan |
$106.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.91
|
| Rate for Payer: Healthfirst QHP |
$47.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.45
|
| Rate for Payer: SOMOS Essential |
$35.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.27
|
|
|
PR RCM CELULR & SUBCELULR SKN IMGNG I&R EA ADDL
|
Professional
|
Both
|
$167.93
|
|
|
Service Code
|
HCPCS 96936
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$103.25 |
| Rate for Payer: Cash Price |
$44.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.42
|
| Rate for Payer: Healthfirst Commercial |
$45.89
|
| Rate for Payer: Healthfirst Essential Plan |
$103.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.60
|
| Rate for Payer: Healthfirst QHP |
$45.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.42
|
| Rate for Payer: SOMOS Essential |
$34.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.89
|
|
|
PR RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY
|
Professional
|
Both
|
$1,540.04
|
|
|
Service Code
|
HCPCS 28313
|
| Min. Negotiated Rate |
$298.33 |
| Max. Negotiated Rate |
$958.90 |
| Rate for Payer: Cash Price |
$424.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$426.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$383.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$383.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$404.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$426.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$404.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$426.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$426.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$319.63
|
| Rate for Payer: Healthfirst Commercial |
$426.18
|
| Rate for Payer: Healthfirst Essential Plan |
$958.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$404.87
|
| Rate for Payer: Healthfirst QHP |
$426.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$298.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$426.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$362.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$298.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$426.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$319.63
|
| Rate for Payer: SOMOS Essential |
$319.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$426.18
|
|
|
PR RCNSTJ BIFRONTAL SUPERIOR-LAT ORB RIMS & LWR FHD
|
Professional
|
Both
|
$9,652.27
|
|
|
Service Code
|
HCPCS 21175
|
| Min. Negotiated Rate |
$1,801.23 |
| Max. Negotiated Rate |
$5,789.68 |
| Rate for Payer: Cash Price |
$2,589.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,573.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,315.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,315.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,444.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,573.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,444.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,573.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,573.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,929.89
|
| Rate for Payer: Healthfirst Commercial |
$2,573.19
|
| Rate for Payer: Healthfirst Essential Plan |
$5,789.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,444.53
|
| Rate for Payer: Healthfirst QHP |
$2,573.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,801.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,573.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,187.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,801.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,573.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,929.89
|
| Rate for Payer: SOMOS Essential |
$1,929.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,573.19
|
|
|
PR RCNSTJ COLTRL LIGM IPHAL JT 1 W/GRF EA JT
|
Professional
|
Both
|
$3,247.06
|
|
|
Service Code
|
HCPCS 26545
|
| Min. Negotiated Rate |
$603.37 |
| Max. Negotiated Rate |
$1,939.41 |
| Rate for Payer: Cash Price |
$878.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$861.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$775.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$775.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$818.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$861.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$818.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$861.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$861.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$646.47
|
| Rate for Payer: Healthfirst Commercial |
$861.96
|
| Rate for Payer: Healthfirst Essential Plan |
$1,939.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$818.86
|
| Rate for Payer: Healthfirst QHP |
$861.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$603.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$861.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$732.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$603.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$861.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$646.47
|
| Rate for Payer: SOMOS Essential |
$646.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$861.96
|
|
|
PR RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/LOCAL TISS
|
Professional
|
Both
|
$3,193.23
|
|
|
Service Code
|
HCPCS 26542
|
| Min. Negotiated Rate |
$595.27 |
| Max. Negotiated Rate |
$1,913.38 |
| Rate for Payer: Cash Price |
$862.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$850.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$765.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$765.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$807.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$850.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$807.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$850.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$850.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$637.79
|
| Rate for Payer: Healthfirst Commercial |
$850.39
|
| Rate for Payer: Healthfirst Essential Plan |
$1,913.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$807.87
|
| Rate for Payer: Healthfirst QHP |
$850.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$595.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$850.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$722.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$595.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$850.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$637.79
|
| Rate for Payer: SOMOS Essential |
$637.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$850.39
|
|
|
PR RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/TDN/FSCAL GRF
|
Professional
|
Both
|
$3,689.88
|
|
|
Service Code
|
HCPCS 26541
|
| Min. Negotiated Rate |
$689.35 |
| Max. Negotiated Rate |
$2,215.76 |
| Rate for Payer: Cash Price |
$997.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$984.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$886.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$886.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$935.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$984.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$935.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$984.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$984.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$738.59
|
| Rate for Payer: Healthfirst Commercial |
$984.78
|
| Rate for Payer: Healthfirst Essential Plan |
$2,215.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$935.54
|
| Rate for Payer: Healthfirst QHP |
$984.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$689.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$984.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$837.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$689.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$984.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$738.59
|
| Rate for Payer: SOMOS Essential |
$738.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$984.78
|
|
|
PR RCNSTJ CONTOURING BENIGN TUMOR CRNL BONES XTRC
|
Professional
|
Both
|
$3,246.92
|
|
|
Service Code
|
HCPCS 21181
|
| Min. Negotiated Rate |
$611.17 |
| Max. Negotiated Rate |
$1,964.47 |
| Rate for Payer: Cash Price |
$874.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$873.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$785.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$785.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$829.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$873.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$829.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$873.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$873.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$654.83
|
| Rate for Payer: Healthfirst Commercial |
$873.10
|
| Rate for Payer: Healthfirst Essential Plan |
$1,964.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$829.45
|
| Rate for Payer: Healthfirst QHP |
$873.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$611.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$873.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$742.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$611.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$873.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$654.83
|
| Rate for Payer: SOMOS Essential |
$654.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$873.10
|
|
|
PR RCNSTJ DISLC PATELLA W/PATELLECTOMY
|
Professional
|
Both
|
$3,326.68
|
|
|
Service Code
|
HCPCS 27424
|
| Min. Negotiated Rate |
$627.60 |
| Max. Negotiated Rate |
$2,017.28 |
| Rate for Payer: Cash Price |
$898.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$896.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$806.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$806.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$851.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$896.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$851.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$896.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$896.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$672.43
|
| Rate for Payer: Healthfirst Commercial |
$896.57
|
| Rate for Payer: Healthfirst Essential Plan |
$2,017.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$851.74
|
| Rate for Payer: Healthfirst QHP |
$896.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$627.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$896.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$762.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$627.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$896.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$672.43
|
| Rate for Payer: SOMOS Essential |
$672.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$896.57
|
|
|
PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL
|
Professional
|
Both
|
$3,287.80
|
|
|
Service Code
|
HCPCS 27422
|
| Min. Negotiated Rate |
$621.73 |
| Max. Negotiated Rate |
$1,998.40 |
| Rate for Payer: Cash Price |
$889.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$888.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$799.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$799.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$843.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$888.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$843.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$888.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$888.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$666.13
|
| Rate for Payer: Healthfirst Commercial |
$888.18
|
| Rate for Payer: Healthfirst Essential Plan |
$1,998.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$843.77
|
| Rate for Payer: Healthfirst QHP |
$888.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$621.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$888.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$754.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$621.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$888.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$666.13
|
| Rate for Payer: SOMOS Essential |
$666.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$888.18
|
|
|
PR RCNSTJ DISLOCATING PATELLA
|
Professional
|
Both
|
$3,309.46
|
|
|
Service Code
|
HCPCS 27420
|
| Min. Negotiated Rate |
$623.86 |
| Max. Negotiated Rate |
$2,005.27 |
| Rate for Payer: Cash Price |
$900.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$891.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$802.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$802.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$846.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$891.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$846.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$891.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$891.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$668.42
|
| Rate for Payer: Healthfirst Commercial |
$891.23
|
| Rate for Payer: Healthfirst Essential Plan |
$2,005.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$846.67
|
| Rate for Payer: Healthfirst QHP |
$891.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$623.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$891.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$757.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$623.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$891.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$668.42
|
| Rate for Payer: SOMOS Essential |
$668.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$891.23
|
|
|
PR RCNSTJ EYELID FULL THICKNESS LOWER EYELID 1 STG
|
Professional
|
Both
|
$3,796.10
|
|
|
Service Code
|
HCPCS 67973
|
| Min. Negotiated Rate |
$722.83 |
| Max. Negotiated Rate |
$2,323.37 |
| Rate for Payer: Cash Price |
$1,044.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,032.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$929.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$929.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$980.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,032.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$980.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,032.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,032.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$774.46
|
| Rate for Payer: Healthfirst Commercial |
$1,032.61
|
| Rate for Payer: Healthfirst Essential Plan |
$2,323.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$980.98
|
| Rate for Payer: Healthfirst QHP |
$1,032.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$722.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,032.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$877.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$722.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,032.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$774.46
|
| Rate for Payer: SOMOS Essential |
$774.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,032.61
|
|
|
PR RCNSTJ EYELID FULL THICKNESS SECOND STAGE
|
Professional
|
Both
|
$2,804.87
|
|
|
Service Code
|
HCPCS 67975
|
| Min. Negotiated Rate |
$534.08 |
| Max. Negotiated Rate |
$1,716.68 |
| Rate for Payer: Cash Price |
$770.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$762.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$686.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$686.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$724.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$762.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$724.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$762.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$762.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$572.23
|
| Rate for Payer: Healthfirst Commercial |
$762.97
|
| Rate for Payer: Healthfirst Essential Plan |
$1,716.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$724.82
|
| Rate for Payer: Healthfirst QHP |
$762.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$534.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$762.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$648.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$534.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$762.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$572.23
|
| Rate for Payer: SOMOS Essential |
$572.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$762.97
|
|
|
PR RCNSTJ EYELID FULL THICKNESS <TWO-THIRDS 1 STG
|
Professional
|
Both
|
$2,958.73
|
|
|
Service Code
|
HCPCS 67971
|
| Min. Negotiated Rate |
$562.44 |
| Max. Negotiated Rate |
$1,807.83 |
| Rate for Payer: Cash Price |
$812.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$803.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$723.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$723.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$763.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$803.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$763.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$803.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$803.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$602.61
|
| Rate for Payer: Healthfirst Commercial |
$803.48
|
| Rate for Payer: Healthfirst Essential Plan |
$1,807.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$763.31
|
| Rate for Payer: Healthfirst QHP |
$803.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$562.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$803.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$682.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$562.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$803.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$602.61
|
| Rate for Payer: SOMOS Essential |
$602.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$803.48
|
|
|
PR RCNSTJ EYELID FULL THICKNESS UPPER EYELID 1 STG
|
Professional
|
Both
|
$3,781.40
|
|
|
Service Code
|
HCPCS 67974
|
| Min. Negotiated Rate |
$720.10 |
| Max. Negotiated Rate |
$2,314.60 |
| Rate for Payer: Cash Price |
$1,041.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,028.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$925.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$925.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$977.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,028.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$977.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,028.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,028.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$771.53
|
| Rate for Payer: Healthfirst Commercial |
$1,028.71
|
| Rate for Payer: Healthfirst Essential Plan |
$2,314.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$977.27
|
| Rate for Payer: Healthfirst QHP |
$1,028.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$720.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,028.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$874.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$720.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,028.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$771.53
|
| Rate for Payer: SOMOS Essential |
$771.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,028.71
|
|
|
PR RCNSTJ FOREHEAD &/ SUPRAORBITAL RIMS W/AUTOGRAFT
|
Professional
|
Both
|
$7,415.10
|
|
|
Service Code
|
HCPCS 21180
|
| Min. Negotiated Rate |
$1,387.33 |
| Max. Negotiated Rate |
$4,459.27 |
| Rate for Payer: Cash Price |
$1,991.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,981.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,783.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,783.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,882.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,981.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,882.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,981.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,981.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,486.42
|
| Rate for Payer: Healthfirst Commercial |
$1,981.90
|
| Rate for Payer: Healthfirst Essential Plan |
$4,459.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,882.81
|
| Rate for Payer: Healthfirst QHP |
$1,981.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,387.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,981.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,684.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,387.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,981.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,486.42
|
| Rate for Payer: SOMOS Essential |
$1,486.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,981.90
|
|
|
PR RCNSTJ FOREHEAD &/ SUPRAORB RIMS W/ALGRF/PROSTC
|
Professional
|
Both
|
$6,638.59
|
|
|
Service Code
|
HCPCS 21179
|
| Min. Negotiated Rate |
$1,242.82 |
| Max. Negotiated Rate |
$3,994.78 |
| Rate for Payer: Cash Price |
$1,784.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,775.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,597.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,597.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,686.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,775.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,686.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,775.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,775.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,331.60
|
| Rate for Payer: Healthfirst Commercial |
$1,775.46
|
| Rate for Payer: Healthfirst Essential Plan |
$3,994.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,686.69
|
| Rate for Payer: Healthfirst QHP |
$1,775.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,242.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,775.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,509.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,242.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,775.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,331.60
|
| Rate for Payer: SOMOS Essential |
$1,331.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,775.46
|
|
|
PR RCNSTJ LAT COLTRL LIGM ELBOW W/TENDON GRAFT
|
Professional
|
Both
|
$4,801.09
|
|
|
Service Code
|
HCPCS 24344
|
| Min. Negotiated Rate |
$921.41 |
| Max. Negotiated Rate |
$2,961.68 |
| Rate for Payer: Cash Price |
$1,322.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,316.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,184.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,184.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,250.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,316.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,250.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,316.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,316.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$987.23
|
| Rate for Payer: Healthfirst Commercial |
$1,316.30
|
| Rate for Payer: Healthfirst Essential Plan |
$2,961.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,250.48
|
| Rate for Payer: Healthfirst QHP |
$1,316.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$921.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,316.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,118.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$921.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,316.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$987.23
|
| Rate for Payer: SOMOS Essential |
$987.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,316.30
|
|
|
PR RCNSTJ MANDIBLE/MAXL ENDOSTEAL IMPLANT COMPLETE
|
Professional
|
Both
|
$4,620.28
|
|
|
Service Code
|
HCPCS 21249
|
| Min. Negotiated Rate |
$887.54 |
| Max. Negotiated Rate |
$2,852.80 |
| Rate for Payer: Cash Price |
$1,262.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,267.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,141.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,141.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,204.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,267.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,204.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,267.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,267.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$950.93
|
| Rate for Payer: Healthfirst Commercial |
$1,267.91
|
| Rate for Payer: Healthfirst Essential Plan |
$2,852.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,204.51
|
| Rate for Payer: Healthfirst QHP |
$1,267.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$887.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,267.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,077.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$887.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,267.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$950.93
|
| Rate for Payer: SOMOS Essential |
$950.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,267.91
|
|
|
PR RCNSTJ MANDIBLE/MAXL ENDOSTEAL IMPLANT PARTIAL
|
Professional
|
Both
|
$3,306.73
|
|
|
Service Code
|
HCPCS 21248
|
| Min. Negotiated Rate |
$637.25 |
| Max. Negotiated Rate |
$2,048.31 |
| Rate for Payer: Cash Price |
$905.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$910.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$819.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$819.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$864.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$910.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$864.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$910.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$910.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$682.77
|
| Rate for Payer: Healthfirst Commercial |
$910.36
|
| Rate for Payer: Healthfirst Essential Plan |
$2,048.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$864.84
|
| Rate for Payer: Healthfirst QHP |
$910.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$637.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$910.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$773.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$637.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$910.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$682.77
|
| Rate for Payer: SOMOS Essential |
$682.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$910.36
|
|
|
PR RCNSTJ MDFC OTH/THN LEFORT OSTEOT & BONE GRAFTS
|
Professional
|
Both
|
$6,657.81
|
|
|
Service Code
|
HCPCS 21188
|
| Min. Negotiated Rate |
$1,253.51 |
| Max. Negotiated Rate |
$4,029.14 |
| Rate for Payer: Cash Price |
$1,801.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,790.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,611.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,611.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,701.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,790.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,701.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,790.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,790.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,343.05
|
| Rate for Payer: Healthfirst Commercial |
$1,790.73
|
| Rate for Payer: Healthfirst Essential Plan |
$4,029.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,701.19
|
| Rate for Payer: Healthfirst QHP |
$1,790.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,253.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,790.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,522.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,253.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,790.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,343.05
|
| Rate for Payer: SOMOS Essential |
$1,343.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,790.73
|
|
|
PR RCNSTJ MEDIAL COLTRL LIGM ELBW W/TDN GRF
|
Professional
|
Both
|
$4,887.05
|
|
|
Service Code
|
HCPCS 24346
|
| Min. Negotiated Rate |
$921.41 |
| Max. Negotiated Rate |
$2,961.68 |
| Rate for Payer: Cash Price |
$1,322.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,316.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,184.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,184.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,250.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,316.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,250.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,316.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,316.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$987.23
|
| Rate for Payer: Healthfirst Commercial |
$1,316.30
|
| Rate for Payer: Healthfirst Essential Plan |
$2,961.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,250.48
|
| Rate for Payer: Healthfirst QHP |
$1,316.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$921.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,316.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,118.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$921.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,316.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$987.23
|
| Rate for Payer: SOMOS Essential |
$987.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,316.30
|
|
|
PR RCNSTJ MIDFACE LEFORT I 1 PIECE W/BONE GRAFTS
|
Professional
|
Both
|
$6,515.60
|
|
|
Service Code
|
HCPCS 21145
|
| Min. Negotiated Rate |
$1,230.48 |
| Max. Negotiated Rate |
$3,955.12 |
| Rate for Payer: Cash Price |
$1,765.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,757.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,582.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,582.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,669.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,757.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,669.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,757.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,757.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,318.37
|
| Rate for Payer: Healthfirst Commercial |
$1,757.83
|
| Rate for Payer: Healthfirst Essential Plan |
$3,955.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,669.94
|
| Rate for Payer: Healthfirst QHP |
$1,757.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,230.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,757.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,494.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,230.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,757.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,318.37
|
| Rate for Payer: SOMOS Essential |
$1,318.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,757.83
|
|
|
PR RCNSTJ MIDFACE LEFORT I 1 PIECE W/O BONE GRAFT
|
Professional
|
Both
|
$5,612.11
|
|
|
Service Code
|
HCPCS 21141
|
| Min. Negotiated Rate |
$1,060.69 |
| Max. Negotiated Rate |
$3,409.36 |
| Rate for Payer: Cash Price |
$1,522.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,515.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,363.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,363.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,439.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,515.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,439.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,515.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,515.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,136.45
|
| Rate for Payer: Healthfirst Commercial |
$1,515.27
|
| Rate for Payer: Healthfirst Essential Plan |
$3,409.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,439.51
|
| Rate for Payer: Healthfirst QHP |
$1,515.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,060.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,515.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,287.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,060.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,515.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,136.45
|
| Rate for Payer: SOMOS Essential |
$1,136.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,515.27
|
|
