|
PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Professional
|
Both
|
$643.79
|
|
|
Service Code
|
HCPCS 12031
|
| Min. Negotiated Rate |
$121.92 |
| Max. Negotiated Rate |
$391.88 |
| Rate for Payer: Cash Price |
$175.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$174.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$156.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$156.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$165.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$174.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$165.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$130.63
|
| Rate for Payer: Healthfirst Commercial |
$174.17
|
| Rate for Payer: Healthfirst Essential Plan |
$391.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$165.46
|
| Rate for Payer: Healthfirst QHP |
$174.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$121.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$174.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$148.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$121.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$174.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$130.63
|
| Rate for Payer: SOMOS Essential |
$130.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$174.17
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Professional
|
Both
|
$801.78
|
|
|
Service Code
|
HCPCS 12032
|
| Min. Negotiated Rate |
$153.20 |
| Max. Negotiated Rate |
$492.44 |
| Rate for Payer: Cash Price |
$219.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$218.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$196.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$207.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$218.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$207.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$218.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$218.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$164.15
|
| Rate for Payer: Healthfirst Commercial |
$218.86
|
| Rate for Payer: Healthfirst Essential Plan |
$492.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$207.92
|
| Rate for Payer: Healthfirst QHP |
$218.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$153.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$218.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$186.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$153.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$218.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$164.15
|
| Rate for Payer: SOMOS Essential |
$164.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$218.86
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E >30.0 CM
|
Professional
|
Both
|
$1,438.78
|
|
|
Service Code
|
HCPCS 12037
|
| Min. Negotiated Rate |
$270.18 |
| Max. Negotiated Rate |
$868.43 |
| Rate for Payer: Cash Price |
$389.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$385.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$347.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$347.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$366.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$385.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$366.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$385.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$385.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$289.48
|
| Rate for Payer: Healthfirst Commercial |
$385.97
|
| Rate for Payer: Healthfirst Essential Plan |
$868.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$366.67
|
| Rate for Payer: Healthfirst QHP |
$385.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$270.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$385.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$328.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$270.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$385.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$289.48
|
| Rate for Payer: SOMOS Essential |
$289.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$385.97
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Professional
|
Both
|
$873.88
|
|
|
Service Code
|
HCPCS 12034
|
| Min. Negotiated Rate |
$165.39 |
| Max. Negotiated Rate |
$531.61 |
| Rate for Payer: Cash Price |
$237.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$236.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$212.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$212.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$224.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$236.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$224.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$236.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$236.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$177.20
|
| Rate for Payer: Healthfirst Commercial |
$236.27
|
| Rate for Payer: Healthfirst Essential Plan |
$531.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$224.46
|
| Rate for Payer: Healthfirst QHP |
$236.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$165.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$236.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$200.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$165.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$236.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$177.20
|
| Rate for Payer: SOMOS Essential |
$177.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$236.27
|
|
|
PR REPAIR INTRINSIC MUSCLES HAND EACH MUSCLE
|
Professional
|
Both
|
$2,161.01
|
|
|
Service Code
|
HCPCS 26591
|
| Min. Negotiated Rate |
$402.49 |
| Max. Negotiated Rate |
$1,293.70 |
| Rate for Payer: Cash Price |
$585.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$574.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$517.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$517.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$546.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$574.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$546.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$574.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$574.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$431.24
|
| Rate for Payer: Healthfirst Commercial |
$574.98
|
| Rate for Payer: Healthfirst Essential Plan |
$1,293.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$546.23
|
| Rate for Payer: Healthfirst QHP |
$574.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$402.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$574.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$488.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$402.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$574.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$431.24
|
| Rate for Payer: SOMOS Essential |
$431.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$574.98
|
|
|
PR REPAIR IRIS CILIARY BODY
|
Professional
|
Both
|
$2,154.85
|
|
|
Service Code
|
HCPCS 66680
|
| Min. Negotiated Rate |
$466.71 |
| Max. Negotiated Rate |
$1,500.14 |
| Rate for Payer: Cash Price |
$592.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$666.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$600.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$600.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$633.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$666.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$633.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$666.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$666.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$500.05
|
| Rate for Payer: Healthfirst Commercial |
$666.73
|
| Rate for Payer: Healthfirst Essential Plan |
$1,500.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$633.39
|
| Rate for Payer: Healthfirst QHP |
$666.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$466.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$666.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$566.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$466.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$666.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$500.05
|
| Rate for Payer: SOMOS Essential |
$500.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$666.73
|
|
|
PR REPAIR ISOLATED PARTIAL PULM VENOUS RETURN
|
Professional
|
Both
|
$6,837.11
|
|
|
Service Code
|
HCPCS 33724
|
| Min. Negotiated Rate |
$1,259.84 |
| Max. Negotiated Rate |
$4,049.48 |
| Rate for Payer: Cash Price |
$1,816.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,799.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,619.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,619.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,709.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,799.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,709.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,799.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,799.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,349.83
|
| Rate for Payer: Healthfirst Commercial |
$1,799.77
|
| Rate for Payer: Healthfirst Essential Plan |
$4,049.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,709.78
|
| Rate for Payer: Healthfirst QHP |
$1,799.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,259.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,799.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,529.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,259.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,799.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,349.83
|
| Rate for Payer: SOMOS Essential |
$1,349.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,799.77
|
|
|
PR REPAIR LACERATION DIAPHRAGM ANY APPROACH
|
Professional
|
Both
|
$3,793.37
|
|
|
Service Code
|
HCPCS 39501
|
| Min. Negotiated Rate |
$706.36 |
| Max. Negotiated Rate |
$2,270.43 |
| Rate for Payer: Cash Price |
$1,020.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,009.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$908.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$908.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$958.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,009.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$958.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,009.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,009.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$756.81
|
| Rate for Payer: Healthfirst Commercial |
$1,009.08
|
| Rate for Payer: Healthfirst Essential Plan |
$2,270.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$958.63
|
| Rate for Payer: Healthfirst QHP |
$1,009.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$706.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,009.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$857.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$706.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,009.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$756.81
|
| Rate for Payer: SOMOS Essential |
$756.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,009.08
|
|
|
PR REPAIR LACERATION PALATE <2 CM
|
Professional
|
Both
|
$808.89
|
|
|
Service Code
|
HCPCS 42180
|
| Min. Negotiated Rate |
$153.19 |
| Max. Negotiated Rate |
$492.41 |
| Rate for Payer: Cash Price |
$220.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$218.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$196.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$207.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$218.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$207.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$218.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$218.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$164.14
|
| Rate for Payer: Healthfirst Commercial |
$218.85
|
| Rate for Payer: Healthfirst Essential Plan |
$492.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$207.91
|
| Rate for Payer: Healthfirst QHP |
$218.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$153.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$218.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$186.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$153.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$218.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$164.14
|
| Rate for Payer: SOMOS Essential |
$164.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$218.85
|
|
|
PR REPAIR LACERATION PALATE >2 CM/COMPLEX
|
Professional
|
Both
|
$1,113.88
|
|
|
Service Code
|
HCPCS 42182
|
| Min. Negotiated Rate |
$209.66 |
| Max. Negotiated Rate |
$673.92 |
| Rate for Payer: Cash Price |
$302.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$299.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$269.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$269.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$284.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$299.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$284.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$299.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$299.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$224.64
|
| Rate for Payer: Healthfirst Commercial |
$299.52
|
| Rate for Payer: Healthfirst Essential Plan |
$673.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$284.54
|
| Rate for Payer: Healthfirst QHP |
$299.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$209.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$299.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$254.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$209.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$299.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$224.64
|
| Rate for Payer: SOMOS Essential |
$224.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$299.52
|
|
|
PR REPAIR LATERAL COLLATERAL LIGAMENT ELBOW
|
Professional
|
Both
|
$3,161.34
|
|
|
Service Code
|
HCPCS 24343
|
| Min. Negotiated Rate |
$600.91 |
| Max. Negotiated Rate |
$1,931.51 |
| Rate for Payer: Cash Price |
$858.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$858.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$772.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$772.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$815.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$858.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$815.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$858.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$858.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$643.84
|
| Rate for Payer: Healthfirst Commercial |
$858.45
|
| Rate for Payer: Healthfirst Essential Plan |
$1,931.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$815.53
|
| Rate for Payer: Healthfirst QHP |
$858.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$600.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$858.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$729.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$600.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$858.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$643.84
|
| Rate for Payer: SOMOS Essential |
$643.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$858.45
|
|
|
PR REPAIR LIP FULL THICKNESS <HALF VERTICAL HEIGHT
|
Professional
|
Both
|
$1,575.11
|
|
|
Service Code
|
HCPCS 40652
|
| Min. Negotiated Rate |
$300.18 |
| Max. Negotiated Rate |
$964.87 |
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$428.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$385.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$385.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$407.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$428.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$407.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$428.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$428.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$321.62
|
| Rate for Payer: Healthfirst Commercial |
$428.83
|
| Rate for Payer: Healthfirst Essential Plan |
$964.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$407.39
|
| Rate for Payer: Healthfirst QHP |
$428.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$300.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$428.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$364.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$300.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$428.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$321.62
|
| Rate for Payer: SOMOS Essential |
$321.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$428.83
|
|
|
PR REPAIR LIP FULL THICKNESS VERMILION ONLY
|
Professional
|
Both
|
$1,383.31
|
|
|
Service Code
|
HCPCS 40650
|
| Min. Negotiated Rate |
$264.73 |
| Max. Negotiated Rate |
$850.93 |
| Rate for Payer: Cash Price |
$378.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$378.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$340.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$340.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$359.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$378.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$359.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$378.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$378.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$283.64
|
| Rate for Payer: Healthfirst Commercial |
$378.19
|
| Rate for Payer: Healthfirst Essential Plan |
$850.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$359.28
|
| Rate for Payer: Healthfirst QHP |
$378.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$264.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$378.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$321.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$264.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$378.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$283.64
|
| Rate for Payer: SOMOS Essential |
$283.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$378.19
|
|
|
PR REPAIR LUMBAR HERNIA
|
Professional
|
Both
|
$3,071.32
|
|
|
Service Code
|
HCPCS 49540
|
| Min. Negotiated Rate |
$565.87 |
| Max. Negotiated Rate |
$1,818.86 |
| Rate for Payer: Cash Price |
$809.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$808.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$727.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$727.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$767.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$808.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$767.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$808.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$808.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$606.28
|
| Rate for Payer: Healthfirst Commercial |
$808.38
|
| Rate for Payer: Healthfirst Essential Plan |
$1,818.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$767.96
|
| Rate for Payer: Healthfirst QHP |
$808.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$565.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$808.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$687.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$565.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$808.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$606.28
|
| Rate for Payer: SOMOS Essential |
$606.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$808.38
|
|
|
PR REPAIR LUNG HERNIA THROUGH CHEST WALL
|
Professional
|
Both
|
$4,216.00
|
|
|
Service Code
|
HCPCS 32800
|
| Min. Negotiated Rate |
$781.35 |
| Max. Negotiated Rate |
$2,511.49 |
| Rate for Payer: Cash Price |
$1,119.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,116.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,004.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,004.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,060.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,116.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,060.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,116.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,116.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$837.16
|
| Rate for Payer: Healthfirst Commercial |
$1,116.22
|
| Rate for Payer: Healthfirst Essential Plan |
$2,511.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,060.41
|
| Rate for Payer: Healthfirst QHP |
$1,116.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$781.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,116.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$948.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$781.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,116.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$837.16
|
| Rate for Payer: SOMOS Essential |
$837.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,116.22
|
|
|
PR REPAIR MACRODACTYLIA EACH DIGIT
|
Professional
|
Both
|
$6,358.49
|
|
|
Service Code
|
HCPCS 26590
|
| Min. Negotiated Rate |
$1,181.05 |
| Max. Negotiated Rate |
$3,796.22 |
| Rate for Payer: Cash Price |
$1,706.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,687.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,518.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,518.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,602.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,687.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,602.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,687.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,687.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,265.41
|
| Rate for Payer: Healthfirst Commercial |
$1,687.21
|
| Rate for Payer: Healthfirst Essential Plan |
$3,796.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,602.85
|
| Rate for Payer: Healthfirst QHP |
$1,687.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,181.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,687.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,434.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,181.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,687.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,265.41
|
| Rate for Payer: SOMOS Essential |
$1,265.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,687.21
|
|
|
PR REPAIR MEDIAL COLLATERAL LIGAMENT ELBOW
|
Professional
|
Both
|
$3,145.38
|
|
|
Service Code
|
HCPCS 24345
|
| Min. Negotiated Rate |
$595.21 |
| Max. Negotiated Rate |
$1,913.17 |
| Rate for Payer: Cash Price |
$854.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$850.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$765.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$765.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$807.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$850.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$807.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$850.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$850.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$637.73
|
| Rate for Payer: Healthfirst Commercial |
$850.30
|
| Rate for Payer: Healthfirst Essential Plan |
$1,913.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$807.78
|
| Rate for Payer: Healthfirst QHP |
$850.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$595.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$850.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$722.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$595.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$850.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$637.73
|
| Rate for Payer: SOMOS Essential |
$637.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$850.30
|
|
|
PR REPAIR MENINGOCELE < 5 CM DIAMETER
|
Professional
|
Both
|
$6,316.21
|
|
|
Service Code
|
HCPCS 63700
|
| Min. Negotiated Rate |
$1,160.17 |
| Max. Negotiated Rate |
$3,729.13 |
| Rate for Payer: Cash Price |
$1,672.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,657.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,491.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,491.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,574.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,657.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,574.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,657.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,657.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,243.04
|
| Rate for Payer: Healthfirst Commercial |
$1,657.39
|
| Rate for Payer: Healthfirst Essential Plan |
$3,729.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,574.52
|
| Rate for Payer: Healthfirst QHP |
$1,657.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,160.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,657.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,408.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,160.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,657.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,243.04
|
| Rate for Payer: SOMOS Essential |
$1,243.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,657.39
|
|
|
PR REPAIR MENINGOCELE > 5 CM DIAMETER
|
Professional
|
Both
|
$6,906.27
|
|
|
Service Code
|
HCPCS 63702
|
| Min. Negotiated Rate |
$1,268.52 |
| Max. Negotiated Rate |
$4,077.38 |
| Rate for Payer: Cash Price |
$1,826.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,812.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,630.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,630.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,721.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,812.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,721.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,812.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,812.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,359.13
|
| Rate for Payer: Healthfirst Commercial |
$1,812.17
|
| Rate for Payer: Healthfirst Essential Plan |
$4,077.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,721.56
|
| Rate for Payer: Healthfirst QHP |
$1,812.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,268.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,812.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,540.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,268.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,812.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,359.13
|
| Rate for Payer: SOMOS Essential |
$1,359.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,812.17
|
|
|
PR REPAIR MYELOMENINGOCELE < 5 CM DIAMETER
|
Professional
|
Both
|
$8,026.45
|
|
|
Service Code
|
HCPCS 63704
|
| Min. Negotiated Rate |
$1,474.07 |
| Max. Negotiated Rate |
$4,738.07 |
| Rate for Payer: Cash Price |
$2,124.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,105.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,895.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,895.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,000.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,105.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,000.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,105.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,105.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,579.36
|
| Rate for Payer: Healthfirst Commercial |
$2,105.81
|
| Rate for Payer: Healthfirst Essential Plan |
$4,738.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,000.52
|
| Rate for Payer: Healthfirst QHP |
$2,105.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,474.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,105.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,789.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,474.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,105.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,579.36
|
| Rate for Payer: SOMOS Essential |
$1,579.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,105.81
|
|
|
PR REPAIR MYELOMENINGOCELE > 5 CM DIAMETER
|
Professional
|
Both
|
$8,920.49
|
|
|
Service Code
|
HCPCS 63706
|
| Min. Negotiated Rate |
$1,635.10 |
| Max. Negotiated Rate |
$5,255.66 |
| Rate for Payer: Cash Price |
$2,357.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,335.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,102.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,102.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,219.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,335.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,219.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,335.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,335.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,751.89
|
| Rate for Payer: Healthfirst Commercial |
$2,335.85
|
| Rate for Payer: Healthfirst Essential Plan |
$5,255.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,219.06
|
| Rate for Payer: Healthfirst QHP |
$2,335.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,635.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,335.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,985.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,635.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,335.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,751.89
|
| Rate for Payer: SOMOS Essential |
$1,751.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,335.85
|
|
|
PR REPAIR NAIL BED
|
Professional
|
Both
|
$467.46
|
|
|
Service Code
|
HCPCS 11760
|
| Min. Negotiated Rate |
$87.58 |
| Max. Negotiated Rate |
$281.50 |
| Rate for Payer: Cash Price |
$126.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$125.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$112.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$112.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$118.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$125.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$118.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$93.83
|
| Rate for Payer: Healthfirst Commercial |
$125.11
|
| Rate for Payer: Healthfirst Essential Plan |
$281.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$118.85
|
| Rate for Payer: Healthfirst QHP |
$125.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$87.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$125.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$106.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$87.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$125.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$93.83
|
| Rate for Payer: SOMOS Essential |
$93.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$125.11
|
|
|
PR REPAIR NASAL SEPTAL PERFORATIONS
|
Professional
|
Both
|
$2,930.97
|
|
|
Service Code
|
HCPCS 30630
|
| Min. Negotiated Rate |
$539.99 |
| Max. Negotiated Rate |
$1,735.69 |
| Rate for Payer: Cash Price |
$788.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$771.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$694.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$694.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$732.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$771.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$732.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$771.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$771.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$578.57
|
| Rate for Payer: Healthfirst Commercial |
$771.42
|
| Rate for Payer: Healthfirst Essential Plan |
$1,735.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$732.85
|
| Rate for Payer: Healthfirst QHP |
$771.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$539.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$771.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$655.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$539.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$771.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$578.57
|
| Rate for Payer: SOMOS Essential |
$578.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$771.42
|
|
|
PR REPAIR NASAL VESTIBULAR STENOSIS
|
Professional
|
Both
|
$4,473.11
|
|
|
Service Code
|
HCPCS 30465
|
| Min. Negotiated Rate |
$826.60 |
| Max. Negotiated Rate |
$2,656.91 |
| Rate for Payer: Cash Price |
$1,205.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,180.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,062.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,062.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,121.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,180.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,121.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,180.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,180.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$885.64
|
| Rate for Payer: Healthfirst Commercial |
$1,180.85
|
| Rate for Payer: Healthfirst Essential Plan |
$2,656.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,121.81
|
| Rate for Payer: Healthfirst QHP |
$1,180.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$826.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,180.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,003.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$826.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,180.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$885.64
|
| Rate for Payer: SOMOS Essential |
$885.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,180.85
|
|
|
PR REPAIR NASOLABIAL FISTULA
|
Professional
|
Both
|
$2,894.33
|
|
|
Service Code
|
HCPCS 42260
|
| Min. Negotiated Rate |
$544.00 |
| Max. Negotiated Rate |
$1,748.57 |
| Rate for Payer: Cash Price |
$785.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$777.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$699.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$699.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$738.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$777.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$738.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$777.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$777.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$582.86
|
| Rate for Payer: Healthfirst Commercial |
$777.14
|
| Rate for Payer: Healthfirst Essential Plan |
$1,748.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$738.28
|
| Rate for Payer: Healthfirst QHP |
$777.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$544.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$777.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$660.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$544.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$777.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$582.86
|
| Rate for Payer: SOMOS Essential |
$582.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$777.14
|
|
