|
PR RENAL NDSC NEPHROS/PYELOSTOMY RMVL FB/CALCULUS
|
Professional
|
Both
|
$1,631.07
|
|
|
Service Code
|
HCPCS 50561
|
| Min. Negotiated Rate |
$308.84 |
| Max. Negotiated Rate |
$992.70 |
| Rate for Payer: Cash Price |
$445.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$441.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$397.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$397.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$419.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$441.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$419.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$441.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$441.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$330.90
|
| Rate for Payer: Healthfirst Commercial |
$441.20
|
| Rate for Payer: Healthfirst Essential Plan |
$992.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$419.14
|
| Rate for Payer: Healthfirst QHP |
$441.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$308.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$441.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$375.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$308.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$441.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$330.90
|
| Rate for Payer: SOMOS Essential |
$330.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$441.20
|
|
|
PR RENAL NDSC NEPHROST W/URETERAL CATH W/WO DILA
|
Professional
|
Both
|
$1,303.93
|
|
|
Service Code
|
HCPCS 50553
|
| Min. Negotiated Rate |
$246.11 |
| Max. Negotiated Rate |
$791.08 |
| Rate for Payer: Cash Price |
$354.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$351.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$316.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$316.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$334.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$351.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$334.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$351.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$351.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$263.69
|
| Rate for Payer: Healthfirst Commercial |
$351.59
|
| Rate for Payer: Healthfirst Essential Plan |
$791.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$334.01
|
| Rate for Payer: Healthfirst QHP |
$351.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$246.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$351.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$298.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$246.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$351.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$263.69
|
| Rate for Payer: SOMOS Essential |
$263.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$351.59
|
|
|
PR RENAL NDSC NEPHROTOMY W/BIOPSY
|
Professional
|
Both
|
$2,331.42
|
|
|
Service Code
|
HCPCS 50574
|
| Min. Negotiated Rate |
$442.25 |
| Max. Negotiated Rate |
$1,421.51 |
| Rate for Payer: Cash Price |
$635.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$631.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$568.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$568.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$600.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$631.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$600.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$631.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$631.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$473.83
|
| Rate for Payer: Healthfirst Commercial |
$631.78
|
| Rate for Payer: Healthfirst Essential Plan |
$1,421.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$600.19
|
| Rate for Payer: Healthfirst QHP |
$631.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$442.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$631.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$537.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$442.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$631.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$473.83
|
| Rate for Payer: SOMOS Essential |
$473.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$631.78
|
|
|
PR RENAL NDSC NEPHROTOMY W/WO IRRIGATION
|
Professional
|
Both
|
$2,027.48
|
|
|
Service Code
|
HCPCS 50570
|
| Min. Negotiated Rate |
$384.45 |
| Max. Negotiated Rate |
$1,235.72 |
| Rate for Payer: Cash Price |
$553.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$549.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$494.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$494.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$521.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$549.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$521.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$549.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$549.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$411.91
|
| Rate for Payer: Healthfirst Commercial |
$549.21
|
| Rate for Payer: Healthfirst Essential Plan |
$1,235.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$521.75
|
| Rate for Payer: Healthfirst QHP |
$549.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$384.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$549.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$466.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$384.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$549.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$411.91
|
| Rate for Payer: SOMOS Essential |
$411.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$549.21
|
|
|
PR REOPENING RECENT LAPAROTOMY
|
Professional
|
Both
|
$4,677.93
|
|
|
Service Code
|
HCPCS 49002
|
| Min. Negotiated Rate |
$867.44 |
| Max. Negotiated Rate |
$2,788.20 |
| Rate for Payer: Cash Price |
$1,248.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,239.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,115.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,115.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,177.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,239.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,177.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,239.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,239.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$929.40
|
| Rate for Payer: Healthfirst Commercial |
$1,239.20
|
| Rate for Payer: Healthfirst Essential Plan |
$2,788.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,177.24
|
| Rate for Payer: Healthfirst QHP |
$1,239.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$867.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,239.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,053.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$867.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,239.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$929.40
|
| Rate for Payer: SOMOS Essential |
$929.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,239.20
|
|
|
PR REPAIR ANAL FISTULA W/FIBRIN GLUE
|
Professional
|
Both
|
$806.16
|
|
|
Service Code
|
HCPCS 46706
|
| Min. Negotiated Rate |
$152.67 |
| Max. Negotiated Rate |
$490.73 |
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$218.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$196.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$207.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$218.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$207.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$218.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$218.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$163.57
|
| Rate for Payer: Healthfirst Commercial |
$218.10
|
| Rate for Payer: Healthfirst Essential Plan |
$490.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$207.19
|
| Rate for Payer: Healthfirst QHP |
$218.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$152.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$218.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$185.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$152.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$218.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$163.57
|
| Rate for Payer: SOMOS Essential |
$163.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$218.10
|
|
|
PR REPAIR ANORECTAL FISTULA PLUG
|
Professional
|
Both
|
$2,270.24
|
|
|
Service Code
|
HCPCS 46707
|
| Min. Negotiated Rate |
$426.39 |
| Max. Negotiated Rate |
$1,370.54 |
| Rate for Payer: Cash Price |
$609.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$609.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$548.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$548.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$578.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$609.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$578.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$609.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$609.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$456.85
|
| Rate for Payer: Healthfirst Commercial |
$609.13
|
| Rate for Payer: Healthfirst Essential Plan |
$1,370.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$578.67
|
| Rate for Payer: Healthfirst QHP |
$609.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$426.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$609.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$517.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$426.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$609.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$456.85
|
| Rate for Payer: SOMOS Essential |
$456.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$609.13
|
|
|
PR REPAIR ANTERIOR PALATE W/VOMER FLAP
|
Professional
|
Both
|
$3,212.79
|
|
|
Service Code
|
HCPCS 42235
|
| Min. Negotiated Rate |
$603.91 |
| Max. Negotiated Rate |
$1,941.14 |
| Rate for Payer: Cash Price |
$871.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$862.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$776.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$776.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$819.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$862.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$819.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$862.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$862.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$647.05
|
| Rate for Payer: Healthfirst Commercial |
$862.73
|
| Rate for Payer: Healthfirst Essential Plan |
$1,941.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$819.59
|
| Rate for Payer: Healthfirst QHP |
$862.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$603.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$862.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$733.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$603.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$862.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$647.05
|
| Rate for Payer: SOMOS Essential |
$647.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$862.73
|
|
|
PR REPAIR BLOOD VESSEL DIRECT HAND FINGER
|
Professional
|
Both
|
$3,324.48
|
|
|
Service Code
|
HCPCS 35207
|
| Min. Negotiated Rate |
$623.74 |
| Max. Negotiated Rate |
$2,004.88 |
| Rate for Payer: Cash Price |
$893.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$891.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$801.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$801.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$846.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$891.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$846.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$891.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$891.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$668.29
|
| Rate for Payer: Healthfirst Commercial |
$891.06
|
| Rate for Payer: Healthfirst Essential Plan |
$2,004.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$846.51
|
| Rate for Payer: Healthfirst QHP |
$891.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$623.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$891.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$757.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$623.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$891.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$668.29
|
| Rate for Payer: SOMOS Essential |
$668.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$891.06
|
|
|
PR REPAIR BLOOD VESSEL DIRECT NECK
|
Professional
|
Both
|
$4,148.13
|
|
|
Service Code
|
HCPCS 35201
|
| Min. Negotiated Rate |
$756.71 |
| Max. Negotiated Rate |
$2,432.27 |
| Rate for Payer: Cash Price |
$1,099.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,081.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$972.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$972.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,026.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,081.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,026.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,081.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,081.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$810.76
|
| Rate for Payer: Healthfirst Commercial |
$1,081.01
|
| Rate for Payer: Healthfirst Essential Plan |
$2,432.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,026.96
|
| Rate for Payer: Healthfirst QHP |
$1,081.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$756.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,081.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$918.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$756.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,081.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$810.76
|
| Rate for Payer: SOMOS Essential |
$810.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,081.01
|
|
|
PR REPAIR BLOOD VESSEL DIRECT UPPER EXTREMITY
|
Professional
|
Both
|
$3,478.97
|
|
|
Service Code
|
HCPCS 35206
|
| Min. Negotiated Rate |
$650.73 |
| Max. Negotiated Rate |
$2,091.62 |
| Rate for Payer: Cash Price |
$932.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$929.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$836.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$836.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$883.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$929.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$883.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$929.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$929.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$697.21
|
| Rate for Payer: Healthfirst Commercial |
$929.61
|
| Rate for Payer: Healthfirst Essential Plan |
$2,091.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$883.13
|
| Rate for Payer: Healthfirst QHP |
$929.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$650.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$929.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$790.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$650.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$929.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$697.21
|
| Rate for Payer: SOMOS Essential |
$697.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$929.61
|
|
|
PR REPAIR BLOOD VESSEL VEIN GRAFT INTRA-ABDOMINAL
|
Professional
|
Both
|
$7,805.53
|
|
|
Service Code
|
HCPCS 35251
|
| Min. Negotiated Rate |
$1,413.66 |
| Max. Negotiated Rate |
$4,543.92 |
| Rate for Payer: Cash Price |
$2,055.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,019.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,817.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,817.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,918.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,019.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,918.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,019.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,019.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,514.64
|
| Rate for Payer: Healthfirst Commercial |
$2,019.52
|
| Rate for Payer: Healthfirst Essential Plan |
$4,543.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,918.54
|
| Rate for Payer: Healthfirst QHP |
$2,019.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,413.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,019.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,716.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,413.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,019.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,514.64
|
| Rate for Payer: SOMOS Essential |
$1,514.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,019.52
|
|
|
PR REPAIR BLOOD VESSEL VEIN GRAFT LOWER EXTREMITY
|
Professional
|
Both
|
$4,528.02
|
|
|
Service Code
|
HCPCS 35256
|
| Min. Negotiated Rate |
$830.82 |
| Max. Negotiated Rate |
$2,670.50 |
| Rate for Payer: Cash Price |
$1,189.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,186.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,068.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,068.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,127.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,186.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,127.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,186.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,186.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$890.17
|
| Rate for Payer: Healthfirst Commercial |
$1,186.89
|
| Rate for Payer: Healthfirst Essential Plan |
$2,670.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,127.55
|
| Rate for Payer: Healthfirst QHP |
$1,186.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$830.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,186.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,008.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$830.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,186.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$890.17
|
| Rate for Payer: SOMOS Essential |
$890.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,186.89
|
|
|
PR REPAIR BLOOD VESSEL W/GRAFT OTHER/THAN VEIN NECK
|
Professional
|
Both
|
$4,359.43
|
|
|
Service Code
|
HCPCS 35261
|
| Min. Negotiated Rate |
$802.04 |
| Max. Negotiated Rate |
$2,577.98 |
| Rate for Payer: Cash Price |
$1,156.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,145.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,031.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,031.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,088.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,145.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,088.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,145.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,145.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$859.33
|
| Rate for Payer: Healthfirst Commercial |
$1,145.77
|
| Rate for Payer: Healthfirst Essential Plan |
$2,577.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,088.48
|
| Rate for Payer: Healthfirst QHP |
$1,145.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$802.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,145.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$973.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$802.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,145.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$859.33
|
| Rate for Payer: SOMOS Essential |
$859.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,145.77
|
|
|
PR REPAIR BLOOD VESSEL W/VEIN GRAFT NECK
|
Professional
|
Both
|
$5,436.87
|
|
|
Service Code
|
HCPCS 35231
|
| Min. Negotiated Rate |
$1,012.45 |
| Max. Negotiated Rate |
$3,254.31 |
| Rate for Payer: Cash Price |
$1,452.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,446.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,301.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,301.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,374.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,446.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,374.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,446.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,446.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,084.77
|
| Rate for Payer: Healthfirst Commercial |
$1,446.36
|
| Rate for Payer: Healthfirst Essential Plan |
$3,254.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,374.04
|
| Rate for Payer: Healthfirst QHP |
$1,446.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,012.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,446.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,229.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,012.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,446.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,084.77
|
| Rate for Payer: SOMOS Essential |
$1,084.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,446.36
|
|
|
PR REPAIR BLOOD VESSEL W/VEIN GRAFT UPPER EXTREMITY
|
Professional
|
Both
|
$4,411.12
|
|
|
Service Code
|
HCPCS 35236
|
| Min. Negotiated Rate |
$822.25 |
| Max. Negotiated Rate |
$2,642.94 |
| Rate for Payer: Cash Price |
$1,176.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,174.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,057.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,057.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,115.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,174.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,115.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,174.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,174.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$880.98
|
| Rate for Payer: Healthfirst Commercial |
$1,174.64
|
| Rate for Payer: Healthfirst Essential Plan |
$2,642.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,115.91
|
| Rate for Payer: Healthfirst QHP |
$1,174.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$822.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,174.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$998.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$822.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,174.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$880.98
|
| Rate for Payer: SOMOS Essential |
$880.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,174.64
|
|
|
PR REPAIR BROW PTOSIS
|
Professional
|
Both
|
$2,089.29
|
|
|
Service Code
|
HCPCS 67900
|
| Min. Negotiated Rate |
$397.90 |
| Max. Negotiated Rate |
$1,278.97 |
| Rate for Payer: Cash Price |
$574.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$568.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$511.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$511.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$540.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$568.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$540.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$568.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$568.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$426.32
|
| Rate for Payer: Healthfirst Commercial |
$568.43
|
| Rate for Payer: Healthfirst Essential Plan |
$1,278.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$540.01
|
| Rate for Payer: Healthfirst QHP |
$568.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$397.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$568.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$483.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$397.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$568.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$426.32
|
| Rate for Payer: SOMOS Essential |
$426.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$568.43
|
|
|
PR REPAIR CARDIAC WOUND W/CARDIOPULMONARY BYPASS
|
Professional
|
Both
|
$18,061.09
|
|
|
Service Code
|
HCPCS 33305
|
| Min. Negotiated Rate |
$3,323.98 |
| Max. Negotiated Rate |
$10,684.22 |
| Rate for Payer: Cash Price |
$4,814.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,748.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,273.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,273.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,511.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,748.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,511.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,748.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,748.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,561.41
|
| Rate for Payer: Healthfirst Commercial |
$4,748.54
|
| Rate for Payer: Healthfirst Essential Plan |
$10,684.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,511.11
|
| Rate for Payer: Healthfirst QHP |
$4,748.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,323.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,748.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4,036.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3,323.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,748.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,561.41
|
| Rate for Payer: SOMOS Essential |
$3,561.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,748.54
|
|
|
PR REPAIR CARDIAC WOUND W/O BYPASS
|
Professional
|
Both
|
$10,781.37
|
|
|
Service Code
|
HCPCS 33300
|
| Min. Negotiated Rate |
$1,996.05 |
| Max. Negotiated Rate |
$6,415.88 |
| Rate for Payer: Cash Price |
$2,875.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,851.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,566.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,566.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,708.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,851.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,708.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,851.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,851.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,138.62
|
| Rate for Payer: Healthfirst Commercial |
$2,851.50
|
| Rate for Payer: Healthfirst Essential Plan |
$6,415.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,708.93
|
| Rate for Payer: Healthfirst QHP |
$2,851.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,996.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,851.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,423.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,996.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,851.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,138.62
|
| Rate for Payer: SOMOS Essential |
$2,138.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,851.50
|
|
|
PR REPAIR CHOANAL ATRESIA INTRANASAL
|
Professional
|
Both
|
$3,225.95
|
|
|
Service Code
|
HCPCS 30540
|
| Min. Negotiated Rate |
$596.96 |
| Max. Negotiated Rate |
$1,918.80 |
| Rate for Payer: Cash Price |
$870.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$852.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$767.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$767.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$810.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$852.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$810.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$852.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$852.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$639.60
|
| Rate for Payer: Healthfirst Commercial |
$852.80
|
| Rate for Payer: Healthfirst Essential Plan |
$1,918.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$810.16
|
| Rate for Payer: Healthfirst QHP |
$852.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$596.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$852.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$724.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$596.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$852.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$639.60
|
| Rate for Payer: SOMOS Essential |
$639.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$852.80
|
|
|
PR REPAIR CHOANAL ATRESIA TRANSPALATINE
|
Professional
|
Both
|
$4,373.46
|
|
|
Service Code
|
HCPCS 30545
|
| Min. Negotiated Rate |
$807.63 |
| Max. Negotiated Rate |
$2,595.96 |
| Rate for Payer: Cash Price |
$1,177.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,153.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,038.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,038.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,096.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,153.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,096.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,153.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,153.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$865.32
|
| Rate for Payer: Healthfirst Commercial |
$1,153.76
|
| Rate for Payer: Healthfirst Essential Plan |
$2,595.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,096.07
|
| Rate for Payer: Healthfirst QHP |
$1,153.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$807.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,153.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$980.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$807.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,153.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$865.32
|
| Rate for Payer: SOMOS Essential |
$865.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,153.76
|
|
|
PR REPAIR CLEFT HAND
|
Professional
|
Both
|
$6,827.49
|
|
|
Service Code
|
HCPCS 26580
|
| Min. Negotiated Rate |
$1,273.45 |
| Max. Negotiated Rate |
$4,093.22 |
| Rate for Payer: Cash Price |
$1,838.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,819.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,637.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,637.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,728.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,819.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,728.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,819.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,819.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,364.41
|
| Rate for Payer: Healthfirst Commercial |
$1,819.21
|
| Rate for Payer: Healthfirst Essential Plan |
$4,093.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,728.25
|
| Rate for Payer: Healthfirst QHP |
$1,819.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,273.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,819.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,546.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,273.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,819.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,364.41
|
| Rate for Payer: SOMOS Essential |
$1,364.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,819.21
|
|
|
PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM
|
Professional
|
Both
|
$1,175.76
|
|
|
Service Code
|
HCPCS 13151
|
| Min. Negotiated Rate |
$222.47 |
| Max. Negotiated Rate |
$715.07 |
| Rate for Payer: Cash Price |
$318.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$317.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$286.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$286.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$301.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$317.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$301.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$317.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$317.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$238.36
|
| Rate for Payer: Healthfirst Commercial |
$317.81
|
| Rate for Payer: Healthfirst Essential Plan |
$715.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$301.92
|
| Rate for Payer: Healthfirst QHP |
$317.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$222.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$317.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$270.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$222.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$317.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$238.36
|
| Rate for Payer: SOMOS Essential |
$238.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$317.81
|
|
|
PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM
|
Professional
|
Both
|
$1,414.49
|
|
|
Service Code
|
HCPCS 13152
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$856.62 |
| Rate for Payer: Cash Price |
$383.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$380.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$342.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$342.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$361.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$380.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$361.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$380.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$380.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$285.54
|
| Rate for Payer: Healthfirst Commercial |
$380.72
|
| Rate for Payer: Healthfirst Essential Plan |
$856.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$361.68
|
| Rate for Payer: Healthfirst QHP |
$380.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$266.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$380.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$323.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$266.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$380.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$285.54
|
| Rate for Payer: SOMOS Essential |
$285.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$380.72
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM
|
Professional
|
Both
|
$1,017.38
|
|
|
Service Code
|
HCPCS 13131
|
| Min. Negotiated Rate |
$194.13 |
| Max. Negotiated Rate |
$623.99 |
| Rate for Payer: Cash Price |
$277.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$277.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$249.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$249.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$263.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$277.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$263.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$277.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$277.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$208.00
|
| Rate for Payer: Healthfirst Commercial |
$277.33
|
| Rate for Payer: Healthfirst Essential Plan |
$623.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$263.46
|
| Rate for Payer: Healthfirst QHP |
$277.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$194.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$277.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$235.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$194.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$277.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$208.00
|
| Rate for Payer: SOMOS Essential |
$208.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$277.33
|
|
