|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM
|
Professional
|
Both
|
$1,272.43
|
|
|
Service Code
|
HCPCS 13132
|
| Min. Negotiated Rate |
$240.41 |
| Max. Negotiated Rate |
$772.76 |
| Rate for Payer: Cash Price |
$345.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$343.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$309.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$309.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$326.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$343.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$326.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$343.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$343.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$257.59
|
| Rate for Payer: Healthfirst Commercial |
$343.45
|
| Rate for Payer: Healthfirst Essential Plan |
$772.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$326.28
|
| Rate for Payer: Healthfirst QHP |
$343.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$240.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$343.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$291.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$240.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$343.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$257.59
|
| Rate for Payer: SOMOS Essential |
$257.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$343.45
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<
|
Professional
|
Both
|
$524.97
|
|
|
Service Code
|
HCPCS 13133
|
| Min. Negotiated Rate |
$99.16 |
| Max. Negotiated Rate |
$318.74 |
| Rate for Payer: Cash Price |
$143.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$141.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$127.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$127.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$134.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$141.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$134.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$141.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$141.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$106.25
|
| Rate for Payer: Healthfirst Commercial |
$141.66
|
| Rate for Payer: Healthfirst Essential Plan |
$318.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$134.58
|
| Rate for Payer: Healthfirst QHP |
$141.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$99.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$141.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$120.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$99.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$141.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$106.25
|
| Rate for Payer: SOMOS Essential |
$106.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$141.66
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM
|
Professional
|
Both
|
$982.63
|
|
|
Service Code
|
HCPCS 13120
|
| Min. Negotiated Rate |
$184.86 |
| Max. Negotiated Rate |
$594.20 |
| Rate for Payer: Cash Price |
$266.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$264.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$237.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$237.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$250.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$264.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$250.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$264.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$198.07
|
| Rate for Payer: Healthfirst Commercial |
$264.09
|
| Rate for Payer: Healthfirst Essential Plan |
$594.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$250.89
|
| Rate for Payer: Healthfirst QHP |
$264.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$184.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$264.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$224.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$184.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$264.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$198.07
|
| Rate for Payer: SOMOS Essential |
$198.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$264.09
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Professional
|
Both
|
$1,078.49
|
|
|
Service Code
|
HCPCS 13121
|
| Min. Negotiated Rate |
$206.23 |
| Max. Negotiated Rate |
$662.89 |
| Rate for Payer: Cash Price |
$295.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$294.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$265.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$265.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$279.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$294.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$279.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$294.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$294.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$220.97
|
| Rate for Payer: Healthfirst Commercial |
$294.62
|
| Rate for Payer: Healthfirst Essential Plan |
$662.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$279.89
|
| Rate for Payer: Healthfirst QHP |
$294.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$206.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$294.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$250.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$206.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$294.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$220.97
|
| Rate for Payer: SOMOS Essential |
$220.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$294.62
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Professional
|
Both
|
$354.13
|
|
|
Service Code
|
HCPCS 13122
|
| Min. Negotiated Rate |
$65.55 |
| Max. Negotiated Rate |
$210.69 |
| Rate for Payer: Cash Price |
$95.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$93.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$84.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$84.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$88.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$93.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$88.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$70.23
|
| Rate for Payer: Healthfirst Commercial |
$93.64
|
| Rate for Payer: Healthfirst Essential Plan |
$210.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$88.96
|
| Rate for Payer: Healthfirst QHP |
$93.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$65.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$93.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$79.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$65.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$93.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$70.23
|
| Rate for Payer: SOMOS Essential |
$70.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$93.64
|
|
|
PR REPAIR COMPLEX TRUNK 1.1-2.5 CM
|
Professional
|
Both
|
$847.84
|
|
|
Service Code
|
HCPCS 13100
|
| Min. Negotiated Rate |
$161.22 |
| Max. Negotiated Rate |
$518.22 |
| Rate for Payer: Cash Price |
$230.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$230.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$207.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$207.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$218.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$230.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$218.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$230.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$230.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$172.74
|
| Rate for Payer: Healthfirst Commercial |
$230.32
|
| Rate for Payer: Healthfirst Essential Plan |
$518.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$218.80
|
| Rate for Payer: Healthfirst QHP |
$230.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$161.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$230.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$195.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$161.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$230.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$172.74
|
| Rate for Payer: SOMOS Essential |
$172.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$230.32
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Professional
|
Both
|
$1,043.60
|
|
|
Service Code
|
HCPCS 13101
|
| Min. Negotiated Rate |
$197.29 |
| Max. Negotiated Rate |
$634.14 |
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$281.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$253.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$253.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$267.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$281.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$267.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$281.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$281.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$211.38
|
| Rate for Payer: Healthfirst Commercial |
$281.84
|
| Rate for Payer: Healthfirst Essential Plan |
$634.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$267.75
|
| Rate for Payer: Healthfirst QHP |
$281.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$197.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$281.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$239.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$197.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$281.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$211.38
|
| Rate for Payer: SOMOS Essential |
$211.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$281.84
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Professional
|
Both
|
$306.50
|
|
|
Service Code
|
HCPCS 13102
|
| Min. Negotiated Rate |
$57.58 |
| Max. Negotiated Rate |
$185.06 |
| Rate for Payer: Cash Price |
$82.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$82.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$78.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$82.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$78.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.69
|
| Rate for Payer: Healthfirst Commercial |
$82.25
|
| Rate for Payer: Healthfirst Essential Plan |
$185.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$78.14
|
| Rate for Payer: Healthfirst QHP |
$82.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$82.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$82.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$61.69
|
| Rate for Payer: SOMOS Essential |
$61.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.25
|
|
|
PR REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/<
|
Professional
|
Both
|
$584.92
|
|
|
Service Code
|
HCPCS 13153
|
| Min. Negotiated Rate |
$110.24 |
| Max. Negotiated Rate |
$354.35 |
| Rate for Payer: Cash Price |
$157.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$141.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$149.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$149.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$118.12
|
| Rate for Payer: Healthfirst Commercial |
$157.49
|
| Rate for Payer: Healthfirst Essential Plan |
$354.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$149.62
|
| Rate for Payer: Healthfirst QHP |
$157.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$110.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$157.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$133.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$110.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$118.12
|
| Rate for Payer: SOMOS Essential |
$118.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
|
|
PR REPAIR CONGENITAL AV FISTULA HEAD & NECK
|
Professional
|
Both
|
$3,492.27
|
|
|
Service Code
|
HCPCS 35180
|
| Min. Negotiated Rate |
$642.20 |
| Max. Negotiated Rate |
$2,064.22 |
| Rate for Payer: Cash Price |
$926.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$917.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$825.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$825.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$871.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$917.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$871.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$917.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$917.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$688.07
|
| Rate for Payer: Healthfirst Commercial |
$917.43
|
| Rate for Payer: Healthfirst Essential Plan |
$2,064.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$871.56
|
| Rate for Payer: Healthfirst QHP |
$917.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$642.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$917.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$779.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$642.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$917.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$688.07
|
| Rate for Payer: SOMOS Essential |
$688.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$917.43
|
|
|
PR REPAIR CONGENITAL PSEUDARTHROSIS TIBIA
|
Professional
|
Both
|
$4,597.29
|
|
|
Service Code
|
HCPCS 27727
|
| Min. Negotiated Rate |
$863.93 |
| Max. Negotiated Rate |
$2,776.91 |
| Rate for Payer: Cash Price |
$1,240.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,234.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,110.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,110.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,172.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,234.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,172.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,234.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,234.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$925.63
|
| Rate for Payer: Healthfirst Commercial |
$1,234.18
|
| Rate for Payer: Healthfirst Essential Plan |
$2,776.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,172.47
|
| Rate for Payer: Healthfirst QHP |
$1,234.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$863.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,234.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,049.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$863.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,234.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$925.63
|
| Rate for Payer: SOMOS Essential |
$925.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,234.18
|
|
|
PR REPAIR DEFECT W/AUTOGRAFT RADIUS&ULNA
|
Professional
|
Both
|
$4,965.56
|
|
|
Service Code
|
HCPCS 25426
|
| Min. Negotiated Rate |
$931.97 |
| Max. Negotiated Rate |
$2,995.63 |
| Rate for Payer: Cash Price |
$1,338.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,331.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,198.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,198.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,264.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,331.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,264.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,331.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,331.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$998.54
|
| Rate for Payer: Healthfirst Commercial |
$1,331.39
|
| Rate for Payer: Healthfirst Essential Plan |
$2,995.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,264.82
|
| Rate for Payer: Healthfirst QHP |
$1,331.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$931.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,331.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,131.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$931.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,331.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$998.54
|
| Rate for Payer: SOMOS Essential |
$998.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,331.39
|
|
|
PR REPAIR DEFECT W/AUTOGRAFT RADIUS/ULNA
|
Professional
|
Both
|
$4,269.02
|
|
|
Service Code
|
HCPCS 25425
|
| Min. Negotiated Rate |
$802.08 |
| Max. Negotiated Rate |
$2,578.12 |
| Rate for Payer: Cash Price |
$1,151.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,145.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,031.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,031.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,088.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,145.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,088.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,145.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,145.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$859.37
|
| Rate for Payer: Healthfirst Commercial |
$1,145.83
|
| Rate for Payer: Healthfirst Essential Plan |
$2,578.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,088.54
|
| Rate for Payer: Healthfirst QHP |
$1,145.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$802.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,145.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$973.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$802.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,145.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$859.37
|
| Rate for Payer: SOMOS Essential |
$859.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,145.83
|
|
|
PR REPAIR DISLOCATING PERONEAL TENDON W/FIB OSTEOT
|
Professional
|
Both
|
$2,636.69
|
|
|
Service Code
|
HCPCS 27676
|
| Min. Negotiated Rate |
$504.27 |
| Max. Negotiated Rate |
$1,620.86 |
| Rate for Payer: Cash Price |
$722.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$720.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$648.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$648.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$684.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$720.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$684.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$720.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$720.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$540.28
|
| Rate for Payer: Healthfirst Commercial |
$720.38
|
| Rate for Payer: Healthfirst Essential Plan |
$1,620.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$684.36
|
| Rate for Payer: Healthfirst QHP |
$720.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$504.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$720.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$612.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$504.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$720.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$540.28
|
| Rate for Payer: SOMOS Essential |
$540.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$720.38
|
|
|
PR REPAIR ECTROPION EXCISION TARSAL WEDGE
|
Professional
|
Both
|
$1,771.32
|
|
|
Service Code
|
HCPCS 67916
|
| Min. Negotiated Rate |
$339.85 |
| Max. Negotiated Rate |
$1,092.38 |
| Rate for Payer: Cash Price |
$488.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$485.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$436.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$436.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$461.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$485.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$461.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$485.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$485.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$364.12
|
| Rate for Payer: Healthfirst Commercial |
$485.50
|
| Rate for Payer: Healthfirst Essential Plan |
$1,092.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$461.23
|
| Rate for Payer: Healthfirst QHP |
$485.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$339.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$485.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$412.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$339.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$485.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$364.12
|
| Rate for Payer: SOMOS Essential |
$364.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$485.50
|
|
|
PR REPAIR ECTROPION EXTENSIVE
|
Professional
|
Both
|
$1,883.04
|
|
|
Service Code
|
HCPCS 67917
|
| Min. Negotiated Rate |
$359.18 |
| Max. Negotiated Rate |
$1,154.50 |
| Rate for Payer: Cash Price |
$518.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$513.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$461.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$461.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$487.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$513.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$487.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$513.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$513.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$384.83
|
| Rate for Payer: Healthfirst Commercial |
$513.11
|
| Rate for Payer: Healthfirst Essential Plan |
$1,154.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$487.45
|
| Rate for Payer: Healthfirst QHP |
$513.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$359.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$513.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$436.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$359.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$513.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$384.83
|
| Rate for Payer: SOMOS Essential |
$384.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$513.11
|
|
|
PR REPAIR ECTROPION SUTURE
|
Professional
|
Both
|
$1,360.94
|
|
|
Service Code
|
HCPCS 67914
|
| Min. Negotiated Rate |
$261.21 |
| Max. Negotiated Rate |
$839.61 |
| Rate for Payer: Cash Price |
$377.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$373.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$335.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$335.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$354.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$373.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$354.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$373.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$373.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$279.87
|
| Rate for Payer: Healthfirst Commercial |
$373.16
|
| Rate for Payer: Healthfirst Essential Plan |
$839.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$354.50
|
| Rate for Payer: Healthfirst QHP |
$373.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$261.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$373.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$317.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$261.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$373.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$279.87
|
| Rate for Payer: SOMOS Essential |
$279.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$373.16
|
|
|
PR REPAIR ECTROPION THERMOCAUTERIZATION
|
Professional
|
Both
|
$829.78
|
|
|
Service Code
|
HCPCS 67915
|
| Min. Negotiated Rate |
$157.77 |
| Max. Negotiated Rate |
$507.11 |
| Rate for Payer: Cash Price |
$229.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$225.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$202.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$202.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$214.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$225.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$214.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$169.03
|
| Rate for Payer: Healthfirst Commercial |
$225.38
|
| Rate for Payer: Healthfirst Essential Plan |
$507.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$214.11
|
| Rate for Payer: Healthfirst QHP |
$225.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$157.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$225.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$191.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$157.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$225.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$169.03
|
| Rate for Payer: SOMOS Essential |
$169.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$225.38
|
|
|
PR REPAIR ENTEROCELE ABDOMINAL APPROACH SPX
|
Professional
|
Both
|
$3,544.59
|
|
|
Service Code
|
HCPCS 57270
|
| Min. Negotiated Rate |
$657.37 |
| Max. Negotiated Rate |
$2,112.97 |
| Rate for Payer: Cash Price |
$954.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$939.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$845.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$845.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$892.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$939.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$892.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$939.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$939.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$704.33
|
| Rate for Payer: Healthfirst Commercial |
$939.10
|
| Rate for Payer: Healthfirst Essential Plan |
$2,112.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$892.14
|
| Rate for Payer: Healthfirst QHP |
$939.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$657.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$939.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$798.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$657.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$939.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$704.33
|
| Rate for Payer: SOMOS Essential |
$704.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$939.10
|
|
|
PR REPAIR ENTEROCELE VAGINAL APPROACH SPX
|
Professional
|
Both
|
$2,203.92
|
|
|
Service Code
|
HCPCS 57268
|
| Min. Negotiated Rate |
$412.06 |
| Max. Negotiated Rate |
$1,324.46 |
| Rate for Payer: Cash Price |
$597.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$588.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$529.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$529.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$559.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$588.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$559.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$588.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$588.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$441.49
|
| Rate for Payer: Healthfirst Commercial |
$588.65
|
| Rate for Payer: Healthfirst Essential Plan |
$1,324.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$559.22
|
| Rate for Payer: Healthfirst QHP |
$588.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$412.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$588.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$500.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$412.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$588.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$441.49
|
| Rate for Payer: SOMOS Essential |
$441.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$588.65
|
|
|
PR REPAIR ENTROPION EXCISION TARSAL WEDGE
|
Professional
|
Both
|
$1,772.75
|
|
|
Service Code
|
HCPCS 67923
|
| Min. Negotiated Rate |
$339.69 |
| Max. Negotiated Rate |
$1,091.86 |
| Rate for Payer: Cash Price |
$488.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$485.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$436.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$436.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$461.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$485.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$461.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$485.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$485.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$363.95
|
| Rate for Payer: Healthfirst Commercial |
$485.27
|
| Rate for Payer: Healthfirst Essential Plan |
$1,091.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$461.01
|
| Rate for Payer: Healthfirst QHP |
$485.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$339.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$485.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$412.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$339.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$485.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$363.95
|
| Rate for Payer: SOMOS Essential |
$363.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$485.27
|
|
|
PR REPAIR ENTROPION EXTENSIVE
|
Professional
|
Both
|
$1,879.01
|
|
|
Service Code
|
HCPCS 67924
|
| Min. Negotiated Rate |
$359.72 |
| Max. Negotiated Rate |
$1,156.25 |
| Rate for Payer: Cash Price |
$517.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$513.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$462.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$462.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$488.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$513.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$488.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$513.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$513.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$385.42
|
| Rate for Payer: Healthfirst Commercial |
$513.89
|
| Rate for Payer: Healthfirst Essential Plan |
$1,156.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$488.20
|
| Rate for Payer: Healthfirst QHP |
$513.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$359.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$513.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$436.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$359.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$513.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$385.42
|
| Rate for Payer: SOMOS Essential |
$385.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$513.89
|
|
|
PR REPAIR ENTROPION SUTURE
|
Professional
|
Both
|
$1,291.92
|
|
|
Service Code
|
HCPCS 67921
|
| Min. Negotiated Rate |
$247.68 |
| Max. Negotiated Rate |
$796.12 |
| Rate for Payer: Cash Price |
$357.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$353.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$318.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$318.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$336.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$353.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$336.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$353.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$353.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$265.37
|
| Rate for Payer: Healthfirst Commercial |
$353.83
|
| Rate for Payer: Healthfirst Essential Plan |
$796.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$336.14
|
| Rate for Payer: Healthfirst QHP |
$353.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$247.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$353.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$300.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$247.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$353.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$265.37
|
| Rate for Payer: SOMOS Essential |
$265.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$353.83
|
|
|
PR REPAIR ENTROPION THERMOCAUTERIZATION
|
Professional
|
Both
|
$831.22
|
|
|
Service Code
|
HCPCS 67922
|
| Min. Negotiated Rate |
$159.12 |
| Max. Negotiated Rate |
$511.47 |
| Rate for Payer: Cash Price |
$229.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$227.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$204.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$204.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$215.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$227.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$215.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$227.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$227.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$170.49
|
| Rate for Payer: Healthfirst Commercial |
$227.32
|
| Rate for Payer: Healthfirst Essential Plan |
$511.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$215.95
|
| Rate for Payer: Healthfirst QHP |
$227.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$159.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$227.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$193.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$159.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$227.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$170.49
|
| Rate for Payer: SOMOS Essential |
$170.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.32
|
|
|
PR REPAIR EXTENSOR TENDON DISTAL INSERTION W/GRAFT
|
Professional
|
Both
|
$3,096.73
|
|
|
Service Code
|
HCPCS 26434
|
| Min. Negotiated Rate |
$573.97 |
| Max. Negotiated Rate |
$1,844.89 |
| Rate for Payer: Cash Price |
$834.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$819.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$737.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$737.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$778.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$819.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$778.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$819.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$819.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$614.96
|
| Rate for Payer: Healthfirst Commercial |
$819.95
|
| Rate for Payer: Healthfirst Essential Plan |
$1,844.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$778.95
|
| Rate for Payer: Healthfirst QHP |
$819.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$573.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$819.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$696.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$573.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$819.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$614.96
|
| Rate for Payer: SOMOS Essential |
$614.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$819.95
|
|
