|
PR RCNSTJ SUPERIOR-LATERAL ORBITAL RIM & LOWER FHD
|
Professional
|
Both
|
$10,147.10
|
|
|
Service Code
|
HCPCS 21172
|
| Min. Negotiated Rate |
$1,849.00 |
| Max. Negotiated Rate |
$5,943.22 |
| Rate for Payer: Cash Price |
$2,677.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,641.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,377.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,377.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,509.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,641.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,509.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,641.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,641.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,981.07
|
| Rate for Payer: Healthfirst Commercial |
$2,641.43
|
| Rate for Payer: Healthfirst Essential Plan |
$5,943.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,509.36
|
| Rate for Payer: Healthfirst QHP |
$2,641.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,849.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,641.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,245.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,849.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,641.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,981.07
|
| Rate for Payer: SOMOS Essential |
$1,981.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,641.43
|
|
|
PR RCNSTJ TDN PULLEY EA TDN W/TDN/FSCAL GRF SPX
|
Professional
|
Both
|
$3,364.62
|
|
|
Service Code
|
HCPCS 26502
|
| Min. Negotiated Rate |
$623.75 |
| Max. Negotiated Rate |
$2,004.91 |
| Rate for Payer: Cash Price |
$906.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$891.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$801.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$801.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$846.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$891.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$846.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$891.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$891.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$668.30
|
| Rate for Payer: Healthfirst Commercial |
$891.07
|
| Rate for Payer: Healthfirst Essential Plan |
$2,004.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$846.52
|
| Rate for Payer: Healthfirst QHP |
$891.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$623.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$891.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$757.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$623.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$891.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$668.30
|
| Rate for Payer: SOMOS Essential |
$668.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$891.07
|
|
|
PR RCNSTJ TENDON PULLEY EACH W/LOCAL TISSUES SPX
|
Professional
|
Both
|
$2,937.06
|
|
|
Service Code
|
HCPCS 26500
|
| Min. Negotiated Rate |
$568.06 |
| Max. Negotiated Rate |
$1,825.92 |
| Rate for Payer: Cash Price |
$825.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$811.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$730.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$730.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$770.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$811.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$770.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$811.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$811.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$608.64
|
| Rate for Payer: Healthfirst Commercial |
$811.52
|
| Rate for Payer: Healthfirst Essential Plan |
$1,825.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$770.94
|
| Rate for Payer: Healthfirst QHP |
$811.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$568.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$811.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$689.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$568.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$811.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$608.64
|
| Rate for Payer: SOMOS Essential |
$608.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$811.52
|
|
|
PR RCNSTJ TOE MACRODACTYLY REQUIRING BONE RESECTION
|
Professional
|
Both
|
$1,998.54
|
|
|
Service Code
|
HCPCS 28341
|
| Min. Negotiated Rate |
$385.22 |
| Max. Negotiated Rate |
$1,238.22 |
| Rate for Payer: Cash Price |
$552.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$550.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$495.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$495.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$522.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$550.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$522.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$550.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$550.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$412.74
|
| Rate for Payer: Healthfirst Commercial |
$550.32
|
| Rate for Payer: Healthfirst Essential Plan |
$1,238.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$522.80
|
| Rate for Payer: Healthfirst QHP |
$550.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$385.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$550.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$467.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$385.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$550.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$412.74
|
| Rate for Payer: SOMOS Essential |
$412.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$550.32
|
|
|
PR RCNSTJ TOE MACRODACTYLY SOFT TISSUE RESECTION
|
Professional
|
Both
|
$1,682.84
|
|
|
Service Code
|
HCPCS 28340
|
| Min. Negotiated Rate |
$324.35 |
| Max. Negotiated Rate |
$1,042.56 |
| Rate for Payer: Cash Price |
$465.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$463.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$417.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$417.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$440.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$463.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$440.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$463.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$463.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$347.52
|
| Rate for Payer: Healthfirst Commercial |
$463.36
|
| Rate for Payer: Healthfirst Essential Plan |
$1,042.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$440.19
|
| Rate for Payer: Healthfirst QHP |
$463.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$324.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$463.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$393.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$324.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$463.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$347.52
|
| Rate for Payer: SOMOS Essential |
$347.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$463.36
|
|
|
PR RCNSTJ TOE SYNDACTYLY W/WO SKIN GRAFT EACH WEB
|
Professional
|
Both
|
$1,492.37
|
|
|
Service Code
|
HCPCS 28345
|
| Min. Negotiated Rate |
$289.40 |
| Max. Negotiated Rate |
$930.22 |
| Rate for Payer: Cash Price |
$414.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$413.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$372.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$372.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$392.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$413.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$392.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$413.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$413.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$310.07
|
| Rate for Payer: Healthfirst Commercial |
$413.43
|
| Rate for Payer: Healthfirst Essential Plan |
$930.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$392.76
|
| Rate for Payer: Healthfirst QHP |
$413.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$289.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$413.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$351.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$289.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$413.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$310.07
|
| Rate for Payer: SOMOS Essential |
$310.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$413.43
|
|
|
PR RCNSTJ XTRNL AUD CANAL CONGENITAL ATRESIA 1 STG
|
Professional
|
Both
|
$6,782.41
|
|
|
Service Code
|
HCPCS 69320
|
| Min. Negotiated Rate |
$1,258.42 |
| Max. Negotiated Rate |
$4,044.94 |
| Rate for Payer: Cash Price |
$1,826.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,797.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,617.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,617.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,707.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,797.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,707.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,797.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,797.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,348.31
|
| Rate for Payer: Healthfirst Commercial |
$1,797.75
|
| Rate for Payer: Healthfirst Essential Plan |
$4,044.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,707.86
|
| Rate for Payer: Healthfirst QHP |
$1,797.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,258.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,797.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,528.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,258.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,797.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,348.31
|
| Rate for Payer: SOMOS Essential |
$1,348.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,797.75
|
|
|
PR RCNSTJ ZYGMTC ARCH/GLENOID FOSSA W/BONE CARTLG
|
Professional
|
Both
|
$5,642.81
|
|
|
Service Code
|
HCPCS 21255
|
| Min. Negotiated Rate |
$1,063.01 |
| Max. Negotiated Rate |
$3,416.83 |
| Rate for Payer: Cash Price |
$1,528.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,518.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,366.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,366.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,442.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,518.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,442.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,518.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,518.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,138.94
|
| Rate for Payer: Healthfirst Commercial |
$1,518.59
|
| Rate for Payer: Healthfirst Essential Plan |
$3,416.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,442.66
|
| Rate for Payer: Healthfirst QHP |
$1,518.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,063.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,518.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,290.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,063.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,518.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,138.94
|
| Rate for Payer: SOMOS Essential |
$1,138.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,518.59
|
|
|
PR RDCTJ CRANIOMEGALIC CRANIO&RECNSTJ W/WO GRAFT
|
Professional
|
Both
|
$9,496.48
|
|
|
Service Code
|
HCPCS 62117
|
| Min. Negotiated Rate |
$1,732.51 |
| Max. Negotiated Rate |
$5,568.80 |
| Rate for Payer: Cash Price |
$2,500.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,475.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,227.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,227.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,351.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,475.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,351.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,475.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,475.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,856.27
|
| Rate for Payer: Healthfirst Commercial |
$2,475.02
|
| Rate for Payer: Healthfirst Essential Plan |
$5,568.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,351.27
|
| Rate for Payer: Healthfirst QHP |
$2,475.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,732.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,475.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,103.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,732.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,475.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,856.27
|
| Rate for Payer: SOMOS Essential |
$1,856.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,475.02
|
|
|
PR RDCTJ CRANIOMEGALIC SKULL W/O GRAFT/CRANIOPLASTY
|
Professional
|
Both
|
$8,116.99
|
|
|
Service Code
|
HCPCS 62115
|
| Min. Negotiated Rate |
$1,490.06 |
| Max. Negotiated Rate |
$4,789.46 |
| Rate for Payer: Cash Price |
$2,147.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,128.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,915.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,915.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,022.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,128.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,022.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,128.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,128.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,596.49
|
| Rate for Payer: Healthfirst Commercial |
$2,128.65
|
| Rate for Payer: Healthfirst Essential Plan |
$4,789.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,022.22
|
| Rate for Payer: Healthfirst QHP |
$2,128.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,490.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,128.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,809.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,490.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,128.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,596.49
|
| Rate for Payer: SOMOS Essential |
$1,596.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,128.65
|
|
|
PR RDCTJ FHD CNTRG & PROSTHETIC MATRL/BONE GRAFT
|
Professional
|
Both
|
$4,000.47
|
|
|
Service Code
|
HCPCS 21138
|
| Min. Negotiated Rate |
$752.92 |
| Max. Negotiated Rate |
$2,420.10 |
| Rate for Payer: Cash Price |
$1,078.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,075.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$968.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$968.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,021.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,075.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,021.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,075.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,075.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$806.70
|
| Rate for Payer: Healthfirst Commercial |
$1,075.60
|
| Rate for Payer: Healthfirst Essential Plan |
$2,420.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,021.82
|
| Rate for Payer: Healthfirst QHP |
$1,075.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$752.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,075.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$914.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$752.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,075.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$806.70
|
| Rate for Payer: SOMOS Essential |
$806.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,075.60
|
|
|
PR RDCTJ FHD CNTRG & SETBACK ANT FRONTAL SINUS WALL
|
Professional
|
Both
|
$4,768.93
|
|
|
Service Code
|
HCPCS 21139
|
| Min. Negotiated Rate |
$893.26 |
| Max. Negotiated Rate |
$2,871.20 |
| Rate for Payer: Cash Price |
$1,282.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,276.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,148.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,148.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,212.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,276.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,212.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,276.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,276.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$957.07
|
| Rate for Payer: Healthfirst Commercial |
$1,276.09
|
| Rate for Payer: Healthfirst Essential Plan |
$2,871.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,212.29
|
| Rate for Payer: Healthfirst QHP |
$1,276.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$893.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,276.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,084.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$893.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,276.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$957.07
|
| Rate for Payer: SOMOS Essential |
$957.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,276.09
|
|
|
PR RDCTJ PROCIDENTIA UNDER ANES SEPARATE PROCEDURE
|
Professional
|
Both
|
$959.21
|
|
|
Service Code
|
HCPCS 45900
|
| Min. Negotiated Rate |
$178.89 |
| Max. Negotiated Rate |
$575.01 |
| Rate for Payer: Cash Price |
$256.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$255.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$230.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$230.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$242.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$255.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$242.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$255.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$255.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.67
|
| Rate for Payer: Healthfirst Commercial |
$255.56
|
| Rate for Payer: Healthfirst Essential Plan |
$575.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$242.78
|
| Rate for Payer: Healthfirst QHP |
$255.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$178.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$255.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$217.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$178.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$255.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$191.67
|
| Rate for Payer: SOMOS Essential |
$191.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$255.56
|
|
|
PR RDCTJ TORSION TSTIS W/WO FIXJ CLAT TESTIS
|
Professional
|
Both
|
$1,904.49
|
|
|
Service Code
|
HCPCS 54600
|
| Min. Negotiated Rate |
$363.54 |
| Max. Negotiated Rate |
$1,168.52 |
| Rate for Payer: Cash Price |
$523.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$519.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$467.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$467.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$493.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$519.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$493.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$519.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$519.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$389.50
|
| Rate for Payer: Healthfirst Commercial |
$519.34
|
| Rate for Payer: Healthfirst Essential Plan |
$1,168.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$493.37
|
| Rate for Payer: Healthfirst QHP |
$519.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$363.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$519.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$441.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$363.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$519.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$389.50
|
| Rate for Payer: SOMOS Essential |
$389.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$519.34
|
|
|
PR RDCTJ VOLVULUS INTUSSUSCEPTION INT HRNA LAPT
|
Professional
|
Both
|
$4,216.52
|
|
|
Service Code
|
HCPCS 44050
|
| Min. Negotiated Rate |
$781.81 |
| Max. Negotiated Rate |
$2,512.96 |
| Rate for Payer: Cash Price |
$1,125.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,116.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,005.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,005.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,061.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,116.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,061.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,116.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,116.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$837.65
|
| Rate for Payer: Healthfirst Commercial |
$1,116.87
|
| Rate for Payer: Healthfirst Essential Plan |
$2,512.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,061.03
|
| Rate for Payer: Healthfirst QHP |
$1,116.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$781.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,116.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$949.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$781.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,116.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$837.65
|
| Rate for Payer: SOMOS Essential |
$837.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,116.87
|
|
|
PR REALIGNMENT EXTENSOR TENDON HAND EACH TENDON
|
Professional
|
Both
|
$2,958.48
|
|
|
Service Code
|
HCPCS 26437
|
| Min. Negotiated Rate |
$549.55 |
| Max. Negotiated Rate |
$1,766.41 |
| Rate for Payer: Cash Price |
$797.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$785.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$706.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$706.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$745.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$785.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$745.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$785.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$785.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$588.80
|
| Rate for Payer: Healthfirst Commercial |
$785.07
|
| Rate for Payer: Healthfirst Essential Plan |
$1,766.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$745.82
|
| Rate for Payer: Healthfirst QHP |
$785.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$549.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$785.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$667.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$549.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$785.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$588.80
|
| Rate for Payer: SOMOS Essential |
$588.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$785.07
|
|
|
PR RECIPIENT NEPHRECTOMY SEPARATE PROCEDURE
|
Professional
|
Both
|
$4,325.86
|
|
|
Service Code
|
HCPCS 50340
|
| Min. Negotiated Rate |
$809.58 |
| Max. Negotiated Rate |
$2,602.22 |
| Rate for Payer: Cash Price |
$1,161.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,156.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,040.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,040.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,098.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,156.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,098.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,156.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,156.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$867.40
|
| Rate for Payer: Healthfirst Commercial |
$1,156.54
|
| Rate for Payer: Healthfirst Essential Plan |
$2,602.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,098.71
|
| Rate for Payer: Healthfirst QHP |
$1,156.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$809.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,156.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$983.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$809.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,156.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$867.40
|
| Rate for Payer: SOMOS Essential |
$867.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,156.54
|
|
|
PR RECON, CTA FOR SURG PLAN
|
Professional
|
Both
|
$185.50
|
|
|
Service Code
|
HCPCS G0288
|
| Min. Negotiated Rate |
$39.16 |
| Max. Negotiated Rate |
$125.89 |
| Rate for Payer: Cash Price |
$53.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$55.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$53.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.96
|
| Rate for Payer: Healthfirst Commercial |
$55.95
|
| Rate for Payer: Healthfirst Essential Plan |
$125.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$53.15
|
| Rate for Payer: Healthfirst QHP |
$55.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$55.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.96
|
| Rate for Payer: SOMOS Essential |
$41.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.95
|
|
|
PR RECONSTRUCTION CLEFT FOOT
|
Professional
|
Both
|
$4,862.90
|
|
|
Service Code
|
HCPCS 28360
|
| Min. Negotiated Rate |
$914.65 |
| Max. Negotiated Rate |
$2,939.94 |
| Rate for Payer: Cash Price |
$1,312.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,306.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,175.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,175.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,241.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,306.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,241.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,306.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,306.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$979.98
|
| Rate for Payer: Healthfirst Commercial |
$1,306.64
|
| Rate for Payer: Healthfirst Essential Plan |
$2,939.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,241.31
|
| Rate for Payer: Healthfirst QHP |
$1,306.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$914.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,306.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,110.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$914.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,306.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$979.98
|
| Rate for Payer: SOMOS Essential |
$979.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,306.64
|
|
|
PR RECONSTRUCTION COMPLEX CARDIAC ANOMALY
|
Professional
|
Both
|
$15,247.05
|
|
|
Service Code
|
HCPCS 33622
|
| Min. Negotiated Rate |
$2,798.58 |
| Max. Negotiated Rate |
$8,995.43 |
| Rate for Payer: Cash Price |
$4,042.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,997.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,598.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,598.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,798.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,997.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,798.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,997.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,997.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,998.48
|
| Rate for Payer: Healthfirst Commercial |
$3,997.97
|
| Rate for Payer: Healthfirst Essential Plan |
$8,995.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,798.07
|
| Rate for Payer: Healthfirst QHP |
$3,997.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,798.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,997.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,398.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,798.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,997.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,998.48
|
| Rate for Payer: SOMOS Essential |
$2,998.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,997.97
|
|
|
PR RECONSTRUCTION EXTERNAL AUDITORY CANAL SPX
|
Professional
|
Both
|
$4,869.17
|
|
|
Service Code
|
HCPCS 69310
|
| Min. Negotiated Rate |
$904.08 |
| Max. Negotiated Rate |
$2,905.97 |
| Rate for Payer: Cash Price |
$1,312.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,291.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,162.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,162.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,226.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,291.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,226.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,291.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,291.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$968.65
|
| Rate for Payer: Healthfirst Commercial |
$1,291.54
|
| Rate for Payer: Healthfirst Essential Plan |
$2,905.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,226.96
|
| Rate for Payer: Healthfirst QHP |
$1,291.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$904.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,291.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,097.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$904.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,291.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$968.65
|
| Rate for Payer: SOMOS Essential |
$968.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,291.54
|
|
|
PR RECONSTRUCTION NAIL BED W/GRAFT
|
Professional
|
Both
|
$783.69
|
|
|
Service Code
|
HCPCS 11762
|
| Min. Negotiated Rate |
$151.09 |
| Max. Negotiated Rate |
$485.64 |
| Rate for Payer: Cash Price |
$215.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$215.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$194.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$194.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$205.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$215.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$205.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$215.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$215.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$161.88
|
| Rate for Payer: Healthfirst Commercial |
$215.84
|
| Rate for Payer: Healthfirst Essential Plan |
$485.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$205.05
|
| Rate for Payer: Healthfirst QHP |
$215.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$151.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$215.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$183.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$151.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$215.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$161.88
|
| Rate for Payer: SOMOS Essential |
$161.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$215.84
|
|
|
PR RECONSTRUCTION ORBIT W/OSTEOTOMIES & BONE GRAFTS
|
Professional
|
Both
|
$5,415.03
|
|
|
Service Code
|
HCPCS 21256
|
| Min. Negotiated Rate |
$1,019.38 |
| Max. Negotiated Rate |
$3,276.56 |
| Rate for Payer: Cash Price |
$1,461.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,456.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,310.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,310.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,383.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,456.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,383.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,456.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,456.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,092.19
|
| Rate for Payer: Healthfirst Commercial |
$1,456.25
|
| Rate for Payer: Healthfirst Essential Plan |
$3,276.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,383.44
|
| Rate for Payer: Healthfirst QHP |
$1,456.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,019.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,456.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,237.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,019.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,456.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,092.19
|
| Rate for Payer: SOMOS Essential |
$1,092.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,456.25
|
|
|
PR RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC
|
Professional
|
Both
|
$4,311.86
|
|
|
Service Code
|
HCPCS 23420
|
| Min. Negotiated Rate |
$812.85 |
| Max. Negotiated Rate |
$2,612.74 |
| Rate for Payer: Cash Price |
$1,164.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,161.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,045.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,045.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,103.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,161.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,103.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,161.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,161.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$870.91
|
| Rate for Payer: Healthfirst Commercial |
$1,161.22
|
| Rate for Payer: Healthfirst Essential Plan |
$2,612.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,103.16
|
| Rate for Payer: Healthfirst QHP |
$1,161.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$812.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,161.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$987.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$812.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,161.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$870.91
|
| Rate for Payer: SOMOS Essential |
$870.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,161.22
|
|
|
PR RECONSTRUCTION TOE POLYDACTYLY
|
Professional
|
Both
|
$1,157.17
|
|
|
Service Code
|
HCPCS 28344
|
| Min. Negotiated Rate |
$223.95 |
| Max. Negotiated Rate |
$719.84 |
| Rate for Payer: Cash Price |
$321.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$319.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$287.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$287.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$303.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$319.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$303.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$319.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$319.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$239.95
|
| Rate for Payer: Healthfirst Commercial |
$319.93
|
| Rate for Payer: Healthfirst Essential Plan |
$719.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$303.93
|
| Rate for Payer: Healthfirst QHP |
$319.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$223.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$319.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$271.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$223.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$319.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$239.95
|
| Rate for Payer: SOMOS Essential |
$239.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$319.93
|
|
