|
PR RPR RECRT FEM HRNA INCARCERATED
|
Professional
|
Both
|
$3,278.56
|
|
|
Service Code
|
HCPCS 49557
|
| Min. Negotiated Rate |
$604.98 |
| Max. Negotiated Rate |
$1,944.56 |
| Rate for Payer: Cash Price |
$872.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$864.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$777.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$777.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$821.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$864.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$821.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$864.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$864.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$648.19
|
| Rate for Payer: Healthfirst Commercial |
$864.25
|
| Rate for Payer: Healthfirst Essential Plan |
$1,944.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$821.04
|
| Rate for Payer: Healthfirst QHP |
$864.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$604.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$864.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$734.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$604.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$864.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$648.19
|
| Rate for Payer: SOMOS Essential |
$648.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$864.25
|
|
|
PR RPR RECRT INGUINAL HERNIA ANY AGE REDUCIBLE
|
Professional
|
Both
|
$2,865.91
|
|
|
Service Code
|
HCPCS 49520
|
| Min. Negotiated Rate |
$532.60 |
| Max. Negotiated Rate |
$1,711.91 |
| Rate for Payer: Cash Price |
$766.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$760.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$684.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$684.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$722.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$760.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$722.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$760.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$760.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$570.64
|
| Rate for Payer: Healthfirst Commercial |
$760.85
|
| Rate for Payer: Healthfirst Essential Plan |
$1,711.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$722.81
|
| Rate for Payer: Healthfirst QHP |
$760.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$532.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$760.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$646.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$532.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$760.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$570.64
|
| Rate for Payer: SOMOS Essential |
$570.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$760.85
|
|
|
PR RPR RECRT INGUN HERNIA ANY AGE INCARCERATED
|
Professional
|
Both
|
$3,244.47
|
|
|
Service Code
|
HCPCS 49521
|
| Min. Negotiated Rate |
$603.44 |
| Max. Negotiated Rate |
$1,939.63 |
| Rate for Payer: Cash Price |
$865.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$862.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$775.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$775.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$818.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$862.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$818.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$862.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$862.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$646.54
|
| Rate for Payer: Healthfirst Commercial |
$862.06
|
| Rate for Payer: Healthfirst Essential Plan |
$1,939.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$818.96
|
| Rate for Payer: Healthfirst QHP |
$862.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$603.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$862.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$732.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$603.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$862.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$646.54
|
| Rate for Payer: SOMOS Essential |
$646.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$862.06
|
|
|
PR RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID CRTX
|
Professional
|
Both
|
$1,174.92
|
|
|
Service Code
|
HCPCS 67101
|
| Min. Negotiated Rate |
$223.68 |
| Max. Negotiated Rate |
$718.97 |
| Rate for Payer: Cash Price |
$323.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$319.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$287.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$287.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$303.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$319.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$303.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$319.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$319.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$239.66
|
| Rate for Payer: Healthfirst Commercial |
$319.54
|
| Rate for Payer: Healthfirst Essential Plan |
$718.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$303.56
|
| Rate for Payer: Healthfirst QHP |
$319.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$223.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$319.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$271.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$223.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$319.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$239.66
|
| Rate for Payer: SOMOS Essential |
$239.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$319.54
|
|
|
PR RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID PC
|
Professional
|
Both
|
$1,133.97
|
|
|
Service Code
|
HCPCS 67105
|
| Min. Negotiated Rate |
$215.70 |
| Max. Negotiated Rate |
$693.32 |
| Rate for Payer: Cash Price |
$312.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$308.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$277.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$277.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$292.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$308.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$292.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$308.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$308.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$231.10
|
| Rate for Payer: Healthfirst Commercial |
$308.14
|
| Rate for Payer: Healthfirst Essential Plan |
$693.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$292.73
|
| Rate for Payer: Healthfirst QHP |
$308.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$215.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$308.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$261.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$215.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$308.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$231.10
|
| Rate for Payer: SOMOS Essential |
$231.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$308.14
|
|
|
PR RPR RETINAL DTCHMNT INJECTION AIR/OTHER GAS
|
Professional
|
Both
|
$3,351.43
|
|
|
Service Code
|
HCPCS 67110
|
| Min. Negotiated Rate |
$636.10 |
| Max. Negotiated Rate |
$2,044.60 |
| Rate for Payer: Cash Price |
$923.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$908.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$817.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$817.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$863.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$908.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$863.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$908.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$908.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$681.53
|
| Rate for Payer: Healthfirst Commercial |
$908.71
|
| Rate for Payer: Healthfirst Essential Plan |
$2,044.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$863.27
|
| Rate for Payer: Healthfirst QHP |
$908.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$636.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$908.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$772.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$636.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$908.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$681.53
|
| Rate for Payer: SOMOS Essential |
$681.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$908.71
|
|
|
PR RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH
|
Professional
|
Both
|
$4,865.74
|
|
|
Service Code
|
HCPCS 67108
|
| Min. Negotiated Rate |
$925.25 |
| Max. Negotiated Rate |
$2,974.01 |
| Rate for Payer: Cash Price |
$1,337.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,321.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,189.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,189.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,255.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,321.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,255.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,321.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,321.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$991.34
|
| Rate for Payer: Healthfirst Commercial |
$1,321.78
|
| Rate for Payer: Healthfirst Essential Plan |
$2,974.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,255.69
|
| Rate for Payer: Healthfirst QHP |
$1,321.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$925.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,321.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,123.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$925.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,321.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$991.34
|
| Rate for Payer: SOMOS Essential |
$991.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,321.78
|
|
|
PR RPR RPTD SPLEEN SPLENORRHAPHY W/WO PRTL SPLENECT
|
Professional
|
Both
|
$5,846.72
|
|
|
Service Code
|
HCPCS 38115
|
| Min. Negotiated Rate |
$1,080.07 |
| Max. Negotiated Rate |
$3,471.64 |
| Rate for Payer: Cash Price |
$1,554.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,542.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,388.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,388.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,465.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,542.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,465.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,542.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,542.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,157.21
|
| Rate for Payer: Healthfirst Commercial |
$1,542.95
|
| Rate for Payer: Healthfirst Essential Plan |
$3,471.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,465.80
|
| Rate for Payer: Healthfirst QHP |
$1,542.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,080.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,542.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,311.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,080.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,542.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,157.21
|
| Rate for Payer: SOMOS Essential |
$1,157.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,542.95
|
|
|
PR RPR SINUS VALSALVA ANEURYSM
|
Professional
|
Both
|
$6,892.52
|
|
|
Service Code
|
HCPCS 33720
|
| Min. Negotiated Rate |
$1,272.45 |
| Max. Negotiated Rate |
$4,090.03 |
| Rate for Payer: Cash Price |
$1,834.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,817.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,636.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,636.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,726.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,817.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,726.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,817.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,817.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,363.34
|
| Rate for Payer: Healthfirst Commercial |
$1,817.79
|
| Rate for Payer: Healthfirst Essential Plan |
$4,090.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,726.90
|
| Rate for Payer: Healthfirst QHP |
$1,817.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,272.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,817.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,545.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,272.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,817.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,363.34
|
| Rate for Payer: SOMOS Essential |
$1,363.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,817.79
|
|
|
PR RPR SINUS VALSALVA FISTULA
|
Professional
|
Both
|
$6,890.00
|
|
|
Service Code
|
HCPCS 33702
|
| Min. Negotiated Rate |
$1,271.70 |
| Max. Negotiated Rate |
$4,087.60 |
| Rate for Payer: Cash Price |
$1,833.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,816.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,635.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,635.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,725.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,816.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,725.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,816.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,816.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,362.53
|
| Rate for Payer: Healthfirst Commercial |
$1,816.71
|
| Rate for Payer: Healthfirst Essential Plan |
$4,087.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,725.87
|
| Rate for Payer: Healthfirst QHP |
$1,816.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,271.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,816.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,544.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,271.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,816.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,362.53
|
| Rate for Payer: SOMOS Essential |
$1,362.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,816.71
|
|
|
PR RPR SINUS VALSALVA FISTULA W/RPR V-SEPTAL DEFECT
|
Professional
|
Both
|
$9,125.31
|
|
|
Service Code
|
HCPCS 33710
|
| Min. Negotiated Rate |
$1,676.85 |
| Max. Negotiated Rate |
$5,389.88 |
| Rate for Payer: Cash Price |
$2,420.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,395.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,155.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,155.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,275.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,395.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,275.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,395.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,395.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,796.62
|
| Rate for Payer: Healthfirst Commercial |
$2,395.50
|
| Rate for Payer: Healthfirst Essential Plan |
$5,389.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,275.72
|
| Rate for Payer: Healthfirst QHP |
$2,395.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,676.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,395.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,036.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,676.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,395.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,796.62
|
| Rate for Payer: SOMOS Essential |
$1,796.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,395.50
|
|
|
PR RPR SMALL OMPHALOCELE W/PRIMARY CLOSURE
|
Professional
|
Both
|
$3,331.30
|
|
|
Service Code
|
HCPCS 49600
|
| Min. Negotiated Rate |
$618.76 |
| Max. Negotiated Rate |
$1,988.87 |
| Rate for Payer: Cash Price |
$889.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$883.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$795.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$795.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$839.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$883.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$839.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$883.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$883.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$662.96
|
| Rate for Payer: Healthfirst Commercial |
$883.94
|
| Rate for Payer: Healthfirst Essential Plan |
$1,988.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$839.74
|
| Rate for Payer: Healthfirst QHP |
$883.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$618.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$883.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$751.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$618.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$883.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$662.96
|
| Rate for Payer: SOMOS Essential |
$662.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$883.94
|
|
|
PR RPR SYMBLEPHARON CONJUNCTIVOPLASTY W/O GRAFT
|
Professional
|
Both
|
$1,893.71
|
|
|
Service Code
|
HCPCS 68330
|
| Min. Negotiated Rate |
$363.12 |
| Max. Negotiated Rate |
$1,167.16 |
| Rate for Payer: Cash Price |
$522.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$518.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$466.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$466.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$492.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$518.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$492.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$518.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$518.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$389.06
|
| Rate for Payer: Healthfirst Commercial |
$518.74
|
| Rate for Payer: Healthfirst Essential Plan |
$1,167.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$492.80
|
| Rate for Payer: Healthfirst QHP |
$518.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$363.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$518.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$440.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$363.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$518.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$389.06
|
| Rate for Payer: SOMOS Essential |
$389.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$518.74
|
|
|
PR RPR SYMBLEPHARON FR GRF CJNC/BUCCAL MUC MEMB
|
Professional
|
Both
|
$2,654.82
|
|
|
Service Code
|
HCPCS 68335
|
| Min. Negotiated Rate |
$506.72 |
| Max. Negotiated Rate |
$1,628.75 |
| Rate for Payer: Cash Price |
$732.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$723.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$651.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$651.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$687.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$723.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$687.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$723.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$723.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$542.92
|
| Rate for Payer: Healthfirst Commercial |
$723.89
|
| Rate for Payer: Healthfirst Essential Plan |
$1,628.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$687.70
|
| Rate for Payer: Healthfirst QHP |
$723.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$506.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$723.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$615.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$506.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$723.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$542.92
|
| Rate for Payer: SOMOS Essential |
$542.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$723.89
|
|
|
PR RPR TABDL LMPHADEC EXTNSV W/PEL AORTIC&RNL
|
Professional
|
Both
|
$4,527.04
|
|
|
Service Code
|
HCPCS 38780
|
| Min. Negotiated Rate |
$866.94 |
| Max. Negotiated Rate |
$2,786.60 |
| Rate for Payer: Cash Price |
$1,239.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,238.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,114.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,114.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,176.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,238.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,176.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,238.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,238.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$928.87
|
| Rate for Payer: Healthfirst Commercial |
$1,238.49
|
| Rate for Payer: Healthfirst Essential Plan |
$2,786.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,176.57
|
| Rate for Payer: Healthfirst QHP |
$1,238.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$866.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,238.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,052.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$866.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,238.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$928.87
|
| Rate for Payer: SOMOS Essential |
$928.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,238.49
|
|
|
PR RPR TDN FLXR FOOT 1/2 W/O FREE GRAFG EACH TENDON
|
Professional
|
Both
|
$1,386.88
|
|
|
Service Code
|
HCPCS 28200
|
| Min. Negotiated Rate |
$265.92 |
| Max. Negotiated Rate |
$854.73 |
| Rate for Payer: Cash Price |
$381.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$379.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$341.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$341.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$360.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$379.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$360.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$379.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$379.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$284.91
|
| Rate for Payer: Healthfirst Commercial |
$379.88
|
| Rate for Payer: Healthfirst Essential Plan |
$854.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$360.89
|
| Rate for Payer: Healthfirst QHP |
$379.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$265.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$379.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$322.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$265.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$379.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$284.91
|
| Rate for Payer: SOMOS Essential |
$284.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$379.88
|
|
|
PR RPR TDN/MUSC FLXR F/ARM&/WRIST SEC 1 EA TDN/MUS
|
Professional
|
Both
|
$2,820.34
|
|
|
Service Code
|
HCPCS 25263
|
| Min. Negotiated Rate |
$533.83 |
| Max. Negotiated Rate |
$1,715.89 |
| Rate for Payer: Cash Price |
$765.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$762.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$686.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$686.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$724.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$762.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$724.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$762.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$762.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$571.97
|
| Rate for Payer: Healthfirst Commercial |
$762.62
|
| Rate for Payer: Healthfirst Essential Plan |
$1,715.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$724.49
|
| Rate for Payer: Healthfirst QHP |
$762.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$533.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$762.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$648.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$533.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$762.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$571.97
|
| Rate for Payer: SOMOS Essential |
$571.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$762.62
|
|
|
PR RPR TDN/MUSC FLXR F/ARM&/WRISTSEC FR GRF EA
|
Professional
|
Both
|
$3,310.48
|
|
|
Service Code
|
HCPCS 25265
|
| Min. Negotiated Rate |
$631.74 |
| Max. Negotiated Rate |
$2,030.58 |
| Rate for Payer: Cash Price |
$906.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$902.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$812.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$812.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$857.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$902.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$857.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$902.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$902.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$676.86
|
| Rate for Payer: Healthfirst Commercial |
$902.48
|
| Rate for Payer: Healthfirst Essential Plan |
$2,030.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$857.36
|
| Rate for Payer: Healthfirst QHP |
$902.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$631.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$902.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$767.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$631.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$902.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$676.86
|
| Rate for Payer: SOMOS Essential |
$676.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$902.48
|
|
|
PR RPR TDN/MUSC FLXR F/ARM&/WRST PRIM 1 EA TDN/MU
|
Professional
|
Both
|
$2,815.68
|
|
|
Service Code
|
HCPCS 25260
|
| Min. Negotiated Rate |
$533.58 |
| Max. Negotiated Rate |
$1,715.09 |
| Rate for Payer: Cash Price |
$762.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$762.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$686.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$686.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$724.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$762.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$724.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$762.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$762.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$571.70
|
| Rate for Payer: Healthfirst Commercial |
$762.26
|
| Rate for Payer: Healthfirst Essential Plan |
$1,715.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$724.15
|
| Rate for Payer: Healthfirst QHP |
$762.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$533.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$762.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$647.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$533.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$762.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$571.70
|
| Rate for Payer: SOMOS Essential |
$571.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$762.26
|
|
|
PR RPR TDN/MUSC XTNSR F/ARM&/WRIST PRIM 1 EA TDN
|
Professional
|
Both
|
$2,190.13
|
|
|
Service Code
|
HCPCS 25270
|
| Min. Negotiated Rate |
$416.07 |
| Max. Negotiated Rate |
$1,337.38 |
| Rate for Payer: Cash Price |
$596.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$594.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$534.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$534.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$564.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$594.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$564.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$594.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$594.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$445.79
|
| Rate for Payer: Healthfirst Commercial |
$594.39
|
| Rate for Payer: Healthfirst Essential Plan |
$1,337.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$564.67
|
| Rate for Payer: Healthfirst QHP |
$594.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$416.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$594.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$505.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$416.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$594.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$445.79
|
| Rate for Payer: SOMOS Essential |
$445.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$594.39
|
|
|
PR RPR TDN/MUSC XTNSR F/ARM&/WRIST SEC 1 EA TDN/MU
|
Professional
|
Both
|
$2,494.35
|
|
|
Service Code
|
HCPCS 25272
|
| Min. Negotiated Rate |
$471.42 |
| Max. Negotiated Rate |
$1,515.26 |
| Rate for Payer: Cash Price |
$676.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$673.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$606.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$606.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$639.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$673.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$639.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$673.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$673.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$505.09
|
| Rate for Payer: Healthfirst Commercial |
$673.45
|
| Rate for Payer: Healthfirst Essential Plan |
$1,515.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$639.78
|
| Rate for Payer: Healthfirst QHP |
$673.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$471.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$673.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$572.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$471.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$673.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$505.09
|
| Rate for Payer: SOMOS Essential |
$505.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$673.45
|
|
|
PR RPR TDN/MUSC XTNSR F/ARM&/WRST SEC FR GRF EA TDN
|
Professional
|
Both
|
$2,934.61
|
|
|
Service Code
|
HCPCS 25274
|
| Min. Negotiated Rate |
$556.63 |
| Max. Negotiated Rate |
$1,789.15 |
| Rate for Payer: Cash Price |
$795.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$795.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$715.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$715.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$755.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$795.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$755.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$795.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$795.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$596.38
|
| Rate for Payer: Healthfirst Commercial |
$795.18
|
| Rate for Payer: Healthfirst Essential Plan |
$1,789.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$755.42
|
| Rate for Payer: Healthfirst QHP |
$795.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$556.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$795.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$675.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$556.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$795.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$596.38
|
| Rate for Payer: SOMOS Essential |
$596.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$795.18
|
|
|
PR RPR TENDON FLXR FOOT SEC W/FREE GRAFT EA TENDON
|
Professional
|
Both
|
$1,796.34
|
|
|
Service Code
|
HCPCS 28202
|
| Min. Negotiated Rate |
$347.12 |
| Max. Negotiated Rate |
$1,115.73 |
| Rate for Payer: Cash Price |
$493.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$495.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$446.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$446.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$471.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$495.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$471.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$495.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$495.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$371.91
|
| Rate for Payer: Healthfirst Commercial |
$495.88
|
| Rate for Payer: Healthfirst Essential Plan |
$1,115.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$471.09
|
| Rate for Payer: Healthfirst QHP |
$495.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$347.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$495.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$421.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$347.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$495.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$371.91
|
| Rate for Payer: SOMOS Essential |
$371.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$495.88
|
|
|
PR RPR TENDON SHEATH EXTENSOR F/ARM&/WRIST W/GRAFT
|
Professional
|
Both
|
$2,972.10
|
|
|
Service Code
|
HCPCS 25275
|
| Min. Negotiated Rate |
$562.91 |
| Max. Negotiated Rate |
$1,809.36 |
| Rate for Payer: Cash Price |
$806.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$804.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$723.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$723.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$763.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$804.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$763.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$804.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$804.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$603.12
|
| Rate for Payer: Healthfirst Commercial |
$804.16
|
| Rate for Payer: Healthfirst Essential Plan |
$1,809.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$763.95
|
| Rate for Payer: Healthfirst QHP |
$804.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$562.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$804.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$683.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$562.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$804.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$603.12
|
| Rate for Payer: SOMOS Essential |
$603.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$804.16
|
|
|
PR RPR TENDON XTNSR FOOT SEC W/FREE GRAFT EA TENDON
|
Professional
|
Both
|
$1,803.83
|
|
|
Service Code
|
HCPCS 28210
|
| Min. Negotiated Rate |
$340.32 |
| Max. Negotiated Rate |
$1,093.88 |
| Rate for Payer: Cash Price |
$493.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$486.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$437.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$437.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$461.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$486.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$461.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$486.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$486.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$364.63
|
| Rate for Payer: Healthfirst Commercial |
$486.17
|
| Rate for Payer: Healthfirst Essential Plan |
$1,093.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$461.86
|
| Rate for Payer: Healthfirst QHP |
$486.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$340.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$486.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$413.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$340.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$486.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$364.63
|
| Rate for Payer: SOMOS Essential |
$364.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$486.17
|
|
