|
PR SURG TX ANAL FISTULA INTERSPHINCTERIC
|
Professional
|
Both
|
$1,840.51
|
|
|
Service Code
|
HCPCS 46275
|
| Min. Negotiated Rate |
$349.34 |
| Max. Negotiated Rate |
$1,122.88 |
| Rate for Payer: Cash Price |
$500.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$499.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$449.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$449.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$474.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$499.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$474.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$499.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$499.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$374.30
|
| Rate for Payer: Healthfirst Commercial |
$499.06
|
| Rate for Payer: Healthfirst Essential Plan |
$1,122.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$474.11
|
| Rate for Payer: Healthfirst QHP |
$499.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$349.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$499.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$424.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$349.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$499.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$374.30
|
| Rate for Payer: SOMOS Essential |
$374.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$499.06
|
|
|
PR SURG TX ANAL FISTULA SUBQ
|
Professional
|
Both
|
$1,764.53
|
|
|
Service Code
|
HCPCS 46270
|
| Min. Negotiated Rate |
$334.78 |
| Max. Negotiated Rate |
$1,076.09 |
| Rate for Payer: Cash Price |
$478.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$478.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$430.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$430.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$454.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$478.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$454.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$478.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$478.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$358.69
|
| Rate for Payer: Healthfirst Commercial |
$478.26
|
| Rate for Payer: Healthfirst Essential Plan |
$1,076.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$454.35
|
| Rate for Payer: Healthfirst QHP |
$478.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$334.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$478.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$406.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$334.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$478.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$358.69
|
| Rate for Payer: SOMOS Essential |
$358.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$478.26
|
|
|
PR SURG VENTRICULAR RSTRJ PX W/PROSTC PATCH PFRMD
|
Professional
|
Both
|
$12,982.55
|
|
|
Service Code
|
HCPCS 33548
|
| Min. Negotiated Rate |
$2,390.36 |
| Max. Negotiated Rate |
$7,683.30 |
| Rate for Payer: Cash Price |
$3,446.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,414.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,073.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,244.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,414.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,244.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,414.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,414.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,561.10
|
| Rate for Payer: Healthfirst Commercial |
$3,414.80
|
| Rate for Payer: Healthfirst Essential Plan |
$7,683.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,244.06
|
| Rate for Payer: Healthfirst QHP |
$3,414.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,390.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,414.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,902.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,390.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,414.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,561.10
|
| Rate for Payer: SOMOS Essential |
$2,561.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,414.80
|
|
|
PR SUTR DIGITAL NRV HAND/FOOT EA DGTAL NRV
|
Professional
|
Both
|
$1,443.86
|
|
|
Service Code
|
HCPCS 64832
|
| Min. Negotiated Rate |
$268.46 |
| Max. Negotiated Rate |
$862.92 |
| Rate for Payer: Cash Price |
$387.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$383.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$345.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$345.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$364.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$383.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$364.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$383.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$287.64
|
| Rate for Payer: Healthfirst Commercial |
$383.52
|
| Rate for Payer: Healthfirst Essential Plan |
$862.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$364.34
|
| Rate for Payer: Healthfirst QHP |
$383.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$268.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$383.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$325.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$268.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$383.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$287.64
|
| Rate for Payer: SOMOS Essential |
$287.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$383.52
|
|
|
PR SUTR ESOPHGL WND/INJ CRV APPR
|
Professional
|
Both
|
$4,452.21
|
|
|
Service Code
|
HCPCS 43410
|
| Min. Negotiated Rate |
$838.45 |
| Max. Negotiated Rate |
$2,695.01 |
| Rate for Payer: Cash Price |
$1,207.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,197.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,078.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,078.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,137.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,197.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,137.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,197.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,197.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$898.34
|
| Rate for Payer: Healthfirst Commercial |
$1,197.78
|
| Rate for Payer: Healthfirst Essential Plan |
$2,695.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,137.89
|
| Rate for Payer: Healthfirst QHP |
$1,197.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$838.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,197.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,018.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$838.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,197.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$898.34
|
| Rate for Payer: SOMOS Essential |
$898.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,197.78
|
|
|
PR SUTR ESOPHGL WND/INJ TTHRC/TABDL APPR
|
Professional
|
Both
|
$11,495.02
|
|
|
Service Code
|
HCPCS 43415
|
| Min. Negotiated Rate |
$2,113.01 |
| Max. Negotiated Rate |
$6,791.81 |
| Rate for Payer: Cash Price |
$3,066.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,018.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,716.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,716.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,867.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,018.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,867.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,018.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,018.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,263.93
|
| Rate for Payer: Healthfirst Commercial |
$3,018.58
|
| Rate for Payer: Healthfirst Essential Plan |
$6,791.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,867.65
|
| Rate for Payer: Healthfirst QHP |
$3,018.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,113.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,018.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,565.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,113.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,018.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,263.93
|
| Rate for Payer: SOMOS Essential |
$2,263.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,018.58
|
|
|
PR SUTR INFRAPATELLAR TDN 2 RCNSTJ W/FSCAL/TDN GRF
|
Professional
|
Both
|
$3,632.90
|
|
|
Service Code
|
HCPCS 27381
|
| Min. Negotiated Rate |
$682.30 |
| Max. Negotiated Rate |
$2,193.12 |
| Rate for Payer: Cash Price |
$981.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$974.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$877.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$877.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$925.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$974.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$925.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$974.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$974.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$731.04
|
| Rate for Payer: Healthfirst Commercial |
$974.72
|
| Rate for Payer: Healthfirst Essential Plan |
$2,193.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$925.98
|
| Rate for Payer: Healthfirst QHP |
$974.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$682.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$974.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$828.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$682.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$974.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$731.04
|
| Rate for Payer: SOMOS Essential |
$731.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$974.72
|
|
|
PR SUTR LG INTESTINE 1/MULT PERFORAT W/COLOSTOMY
|
Professional
|
Both
|
$5,780.18
|
|
|
Service Code
|
HCPCS 44605
|
| Min. Negotiated Rate |
$1,066.88 |
| Max. Negotiated Rate |
$3,429.27 |
| Rate for Payer: Cash Price |
$1,531.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,524.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,371.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,371.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,447.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,524.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,447.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,524.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,524.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,143.09
|
| Rate for Payer: Healthfirst Commercial |
$1,524.12
|
| Rate for Payer: Healthfirst Essential Plan |
$3,429.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,447.91
|
| Rate for Payer: Healthfirst QHP |
$1,524.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,066.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,524.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,295.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,066.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,524.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,143.09
|
| Rate for Payer: SOMOS Essential |
$1,143.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,524.12
|
|
|
PR SUTR LG INTESTINE 1/MULT PERFORAT W/O COLOSTOMY
|
Professional
|
Both
|
$4,715.55
|
|
|
Service Code
|
HCPCS 44604
|
| Min. Negotiated Rate |
$871.97 |
| Max. Negotiated Rate |
$2,802.76 |
| Rate for Payer: Cash Price |
$1,256.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,245.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,121.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,121.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,183.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,245.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,183.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,245.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,245.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$934.25
|
| Rate for Payer: Healthfirst Commercial |
$1,245.67
|
| Rate for Payer: Healthfirst Essential Plan |
$2,802.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,183.39
|
| Rate for Payer: Healthfirst QHP |
$1,245.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$871.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,245.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,058.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$871.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,245.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$934.25
|
| Rate for Payer: SOMOS Essential |
$934.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,245.67
|
|
|
PR SUTR&/LIG THORACIC DUCT ABDOMINAL APPROACH
|
Professional
|
Both
|
$3,052.25
|
|
|
Service Code
|
HCPCS 38382
|
| Min. Negotiated Rate |
$567.01 |
| Max. Negotiated Rate |
$1,822.55 |
| Rate for Payer: Cash Price |
$817.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$810.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$729.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$729.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$769.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$810.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$769.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$810.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$810.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$607.51
|
| Rate for Payer: Healthfirst Commercial |
$810.02
|
| Rate for Payer: Healthfirst Essential Plan |
$1,822.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$769.52
|
| Rate for Payer: Healthfirst QHP |
$810.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$567.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$810.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$688.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$567.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$810.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$607.51
|
| Rate for Payer: SOMOS Essential |
$607.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$810.02
|
|
|
PR SUTR&/LIG THORACIC DUCT CERVICAL APPROACH
|
Professional
|
Both
|
$2,494.35
|
|
|
Service Code
|
HCPCS 38380
|
| Min. Negotiated Rate |
$475.37 |
| Max. Negotiated Rate |
$1,527.97 |
| Rate for Payer: Cash Price |
$682.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$679.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$611.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$611.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$645.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$679.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$645.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$679.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$679.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$509.32
|
| Rate for Payer: Healthfirst Commercial |
$679.10
|
| Rate for Payer: Healthfirst Essential Plan |
$1,527.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$645.14
|
| Rate for Payer: Healthfirst QHP |
$679.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$475.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$679.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$577.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$475.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$679.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$509.32
|
| Rate for Payer: SOMOS Essential |
$509.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$679.10
|
|
|
PR SUTR&/LIG THORACIC DUCT THORACIC APPROACH
|
Professional
|
Both
|
$3,585.37
|
|
|
Service Code
|
HCPCS 38381
|
| Min. Negotiated Rate |
$669.51 |
| Max. Negotiated Rate |
$2,152.01 |
| Rate for Payer: Cash Price |
$959.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$956.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$860.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$860.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$908.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$956.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$908.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$956.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$956.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$717.34
|
| Rate for Payer: Healthfirst Commercial |
$956.45
|
| Rate for Payer: Healthfirst Essential Plan |
$2,152.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$908.63
|
| Rate for Payer: Healthfirst QHP |
$956.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$669.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$956.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$812.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$669.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$956.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$717.34
|
| Rate for Payer: SOMOS Essential |
$717.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$956.45
|
|
|
PR SUTR NRV ITPRL W/WO GRF/DCMPRN LAT GENICULATE
|
Professional
|
Both
|
$5,028.63
|
|
|
Service Code
|
HCPCS 69740
|
| Min. Negotiated Rate |
$932.95 |
| Max. Negotiated Rate |
$2,998.76 |
| Rate for Payer: Cash Price |
$1,355.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,332.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,199.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,199.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,266.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,332.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,266.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,332.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,332.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$999.59
|
| Rate for Payer: Healthfirst Commercial |
$1,332.78
|
| Rate for Payer: Healthfirst Essential Plan |
$2,998.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,266.14
|
| Rate for Payer: Healthfirst QHP |
$1,332.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$932.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,332.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,132.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$932.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,332.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$999.59
|
| Rate for Payer: SOMOS Essential |
$999.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,332.78
|
|
|
PR SUTR NRV ITPRL W/WO GRF/DCMPRN MEDIAL GENICULATE
|
Professional
|
Both
|
$5,361.23
|
|
|
Service Code
|
HCPCS 69745
|
| Min. Negotiated Rate |
$993.94 |
| Max. Negotiated Rate |
$3,194.82 |
| Rate for Payer: Cash Price |
$1,445.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,419.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,277.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,277.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,348.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,419.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,348.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,419.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,419.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,064.94
|
| Rate for Payer: Healthfirst Commercial |
$1,419.92
|
| Rate for Payer: Healthfirst Essential Plan |
$3,194.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,348.92
|
| Rate for Payer: Healthfirst QHP |
$1,419.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$993.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,419.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,206.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$993.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,419.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,064.94
|
| Rate for Payer: SOMOS Essential |
$1,064.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,419.92
|
|
|
PR SUTR PRPH NRV ARM/LEG XCP SCIATIC W/O TRPOS
|
Professional
|
Both
|
$4,627.77
|
|
|
Service Code
|
HCPCS 64857
|
| Min. Negotiated Rate |
$865.42 |
| Max. Negotiated Rate |
$2,781.70 |
| Rate for Payer: Cash Price |
$1,248.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,236.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,112.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,112.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,174.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,236.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,174.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,236.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,236.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$927.23
|
| Rate for Payer: Healthfirst Commercial |
$1,236.31
|
| Rate for Payer: Healthfirst Essential Plan |
$2,781.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,174.49
|
| Rate for Payer: Healthfirst QHP |
$1,236.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$865.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,236.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,050.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$865.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,236.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$927.23
|
| Rate for Payer: SOMOS Essential |
$927.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,236.31
|
|
|
PR SUTR PRPH NRV ARM/LEG XCP SCIATIC W/TRPOS
|
Professional
|
Both
|
$4,487.04
|
|
|
Service Code
|
HCPCS 64856
|
| Min. Negotiated Rate |
$840.34 |
| Max. Negotiated Rate |
$2,701.08 |
| Rate for Payer: Cash Price |
$1,196.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,200.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,080.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,080.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,140.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,200.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,140.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,200.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,200.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$900.36
|
| Rate for Payer: Healthfirst Commercial |
$1,200.48
|
| Rate for Payer: Healthfirst Essential Plan |
$2,701.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,140.46
|
| Rate for Payer: Healthfirst QHP |
$1,200.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$840.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,200.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,020.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$840.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,200.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$900.36
|
| Rate for Payer: SOMOS Essential |
$900.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,200.48
|
|
|
PR SUTR QUADRICEPS/HAMSTRING MUSC RPT RCNSTJ
|
Professional
|
Both
|
$3,784.76
|
|
|
Service Code
|
HCPCS 27386
|
| Min. Negotiated Rate |
$712.08 |
| Max. Negotiated Rate |
$2,288.84 |
| Rate for Payer: Cash Price |
$1,024.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,017.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$915.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$915.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$966.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,017.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$966.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,017.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,017.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$762.95
|
| Rate for Payer: Healthfirst Commercial |
$1,017.26
|
| Rate for Payer: Healthfirst Essential Plan |
$2,288.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$966.40
|
| Rate for Payer: Healthfirst QHP |
$1,017.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$712.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,017.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$864.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$712.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,017.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$762.95
|
| Rate for Payer: SOMOS Essential |
$762.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,017.26
|
|
|
PR SUTR RPR AORTA/GREAT VESSEL W/SHUNT BYPASS
|
Professional
|
Both
|
$5,235.30
|
|
|
Service Code
|
HCPCS 33321
|
| Min. Negotiated Rate |
$968.19 |
| Max. Negotiated Rate |
$3,112.04 |
| Rate for Payer: Cash Price |
$1,393.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,383.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,244.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,244.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,313.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,383.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,313.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,383.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,383.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,037.35
|
| Rate for Payer: Healthfirst Commercial |
$1,383.13
|
| Rate for Payer: Healthfirst Essential Plan |
$3,112.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,313.97
|
| Rate for Payer: Healthfirst QHP |
$1,383.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$968.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,383.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,175.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$968.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,383.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,037.35
|
| Rate for Payer: SOMOS Essential |
$1,037.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,383.13
|
|
|
PR SUTR RPR AORTA/GRT VSL W/O SHUNT/CARD BYP
|
Professional
|
Both
|
$4,764.17
|
|
|
Service Code
|
HCPCS 33320
|
| Min. Negotiated Rate |
$878.77 |
| Max. Negotiated Rate |
$2,824.63 |
| Rate for Payer: Cash Price |
$1,267.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,255.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,129.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,129.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,192.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,255.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,192.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,255.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,255.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$941.54
|
| Rate for Payer: Healthfirst Commercial |
$1,255.39
|
| Rate for Payer: Healthfirst Essential Plan |
$2,824.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,192.62
|
| Rate for Payer: Healthfirst QHP |
$1,255.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$878.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,255.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,067.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$878.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,255.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$941.54
|
| Rate for Payer: SOMOS Essential |
$941.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,255.39
|
|
|
PR SUTR WND EYELID/MARGIN/TARSUS/CONJUNC FULL THICK
|
Professional
|
Both
|
$1,810.87
|
|
|
Service Code
|
HCPCS 67935
|
| Min. Negotiated Rate |
$343.83 |
| Max. Negotiated Rate |
$1,105.15 |
| Rate for Payer: Cash Price |
$496.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$491.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$442.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$442.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$466.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$491.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$466.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$491.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$491.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$368.38
|
| Rate for Payer: Healthfirst Commercial |
$491.18
|
| Rate for Payer: Healthfirst Essential Plan |
$1,105.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$466.62
|
| Rate for Payer: Healthfirst QHP |
$491.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$343.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$491.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$417.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$343.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$491.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$368.38
|
| Rate for Payer: SOMOS Essential |
$368.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$491.18
|
|
|
PR SUTR WND EYELID/MARGIN/TARSUS/CONJUNC PRTL THICK
|
Professional
|
Both
|
$967.61
|
|
|
Service Code
|
HCPCS 67930
|
| Min. Negotiated Rate |
$184.35 |
| Max. Negotiated Rate |
$592.56 |
| Rate for Payer: Cash Price |
$265.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$263.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$237.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$237.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$250.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$263.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$250.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$263.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$263.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$197.52
|
| Rate for Payer: Healthfirst Commercial |
$263.36
|
| Rate for Payer: Healthfirst Essential Plan |
$592.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$250.19
|
| Rate for Payer: Healthfirst QHP |
$263.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$184.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$263.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$223.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$184.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$263.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$197.52
|
| Rate for Payer: SOMOS Essential |
$197.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$263.36
|
|
|
PR SUTURE 1 NERVE HAND/FOOT COMMON SENSORY NERVE
|
Professional
|
Both
|
$3,221.61
|
|
|
Service Code
|
HCPCS 64834
|
| Min. Negotiated Rate |
$615.26 |
| Max. Negotiated Rate |
$1,977.64 |
| Rate for Payer: Cash Price |
$879.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$878.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$791.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$791.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$835.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$878.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$835.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$878.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$878.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$659.21
|
| Rate for Payer: Healthfirst Commercial |
$878.95
|
| Rate for Payer: Healthfirst Essential Plan |
$1,977.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$835.00
|
| Rate for Payer: Healthfirst QHP |
$878.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$615.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$878.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$747.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$615.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$878.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$659.21
|
| Rate for Payer: SOMOS Essential |
$659.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$878.95
|
|
|
PR SUTURE 1 NERVE MEDIAN MOTOR THENAR
|
Professional
|
Both
|
$3,611.34
|
|
|
Service Code
|
HCPCS 64835
|
| Min. Negotiated Rate |
$678.91 |
| Max. Negotiated Rate |
$2,182.21 |
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$969.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$872.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$872.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$921.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$969.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$921.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$969.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$969.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$727.40
|
| Rate for Payer: Healthfirst Commercial |
$969.87
|
| Rate for Payer: Healthfirst Essential Plan |
$2,182.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$921.38
|
| Rate for Payer: Healthfirst QHP |
$969.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$678.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$969.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$824.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$678.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$969.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$727.40
|
| Rate for Payer: SOMOS Essential |
$727.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$969.87
|
|
|
PR SUTURE 1 NERVE ULNAR MOTOR
|
Professional
|
Both
|
$3,611.34
|
|
|
Service Code
|
HCPCS 64836
|
| Min. Negotiated Rate |
$678.91 |
| Max. Negotiated Rate |
$2,182.21 |
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$969.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$872.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$872.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$921.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$969.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$921.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$969.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$969.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$727.40
|
| Rate for Payer: Healthfirst Commercial |
$969.87
|
| Rate for Payer: Healthfirst Essential Plan |
$2,182.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$921.38
|
| Rate for Payer: Healthfirst QHP |
$969.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$678.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$969.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$824.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$678.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$969.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$727.40
|
| Rate for Payer: SOMOS Essential |
$727.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$969.87
|
|
|
PR SUTURE BRACHIAL PLEXUS
|
Professional
|
Both
|
$7,334.60
|
|
|
Service Code
|
HCPCS 64861
|
| Min. Negotiated Rate |
$1,344.57 |
| Max. Negotiated Rate |
$4,321.82 |
| Rate for Payer: Cash Price |
$1,936.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,920.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,728.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,728.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,824.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,920.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,824.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,920.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,920.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,440.61
|
| Rate for Payer: Healthfirst Commercial |
$1,920.81
|
| Rate for Payer: Healthfirst Essential Plan |
$4,321.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,824.77
|
| Rate for Payer: Healthfirst QHP |
$1,920.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,344.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,920.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,632.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,344.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,920.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,440.61
|
| Rate for Payer: SOMOS Essential |
$1,440.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,920.81
|
|
