|
PR SUTURE DIGITAL NERVE HAND/FOOT 1 NERVE
|
Professional
|
Both
|
$3,047.45
|
|
|
Service Code
|
HCPCS 64831
|
| Min. Negotiated Rate |
$578.00 |
| Max. Negotiated Rate |
$1,857.87 |
| Rate for Payer: Cash Price |
$826.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$825.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$743.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$743.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$784.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$825.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$784.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$825.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$825.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$619.29
|
| Rate for Payer: Healthfirst Commercial |
$825.72
|
| Rate for Payer: Healthfirst Essential Plan |
$1,857.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$784.43
|
| Rate for Payer: Healthfirst QHP |
$825.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$578.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$825.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$701.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$578.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$825.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$619.29
|
| Rate for Payer: SOMOS Essential |
$619.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$825.72
|
|
|
PR SUTURE EACH ADDITIONAL NERVE HAND/FOOT
|
Professional
|
Both
|
$1,593.31
|
|
|
Service Code
|
HCPCS 64837
|
| Min. Negotiated Rate |
$296.04 |
| Max. Negotiated Rate |
$951.55 |
| Rate for Payer: Cash Price |
$425.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$422.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$380.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$380.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$401.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$422.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$401.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$422.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$422.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$317.18
|
| Rate for Payer: Healthfirst Commercial |
$422.91
|
| Rate for Payer: Healthfirst Essential Plan |
$951.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$401.76
|
| Rate for Payer: Healthfirst QHP |
$422.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$296.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$422.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$359.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$296.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$422.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$317.18
|
| Rate for Payer: SOMOS Essential |
$317.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$422.91
|
|
|
PR SUTURE EACH ADDITIONAL PERIPHERAL NERVE
|
Professional
|
Both
|
$1,082.55
|
|
|
Service Code
|
HCPCS 64859
|
| Min. Negotiated Rate |
$200.83 |
| Max. Negotiated Rate |
$645.52 |
| Rate for Payer: Cash Price |
$289.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$286.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$258.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$258.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$272.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$286.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$272.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$286.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$286.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$215.18
|
| Rate for Payer: Healthfirst Commercial |
$286.90
|
| Rate for Payer: Healthfirst Essential Plan |
$645.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$272.56
|
| Rate for Payer: Healthfirst QHP |
$286.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$200.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$286.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$243.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$200.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$286.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$215.18
|
| Rate for Payer: SOMOS Essential |
$215.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$286.90
|
|
|
PR SUTURE EXTRAHEPATIC BILE DUCT PRE-EXIST INJURY
|
Professional
|
Both
|
$6,245.65
|
|
|
Service Code
|
HCPCS 47900
|
| Min. Negotiated Rate |
$1,153.97 |
| Max. Negotiated Rate |
$3,709.19 |
| Rate for Payer: Cash Price |
$1,661.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,648.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,483.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,483.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,566.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,648.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,566.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,648.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,648.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,236.40
|
| Rate for Payer: Healthfirst Commercial |
$1,648.53
|
| Rate for Payer: Healthfirst Essential Plan |
$3,709.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,566.10
|
| Rate for Payer: Healthfirst QHP |
$1,648.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,153.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,648.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,401.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,153.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,648.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,236.40
|
| Rate for Payer: SOMOS Essential |
$1,236.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,648.53
|
|
|
PR SUTURE FACIAL NERVE EXTRACRANIAL
|
Professional
|
Both
|
$3,739.86
|
|
|
Service Code
|
HCPCS 64864
|
| Min. Negotiated Rate |
$701.09 |
| Max. Negotiated Rate |
$2,253.49 |
| Rate for Payer: Cash Price |
$1,005.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,001.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$901.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$901.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$951.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,001.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$951.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,001.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,001.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$751.16
|
| Rate for Payer: Healthfirst Commercial |
$1,001.55
|
| Rate for Payer: Healthfirst Essential Plan |
$2,253.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$951.47
|
| Rate for Payer: Healthfirst QHP |
$1,001.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$701.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,001.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$851.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$701.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,001.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$751.16
|
| Rate for Payer: SOMOS Essential |
$751.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,001.55
|
|
|
PR SUTURE FACIAL NERVE INFRATEMPORAL W/WO GRAFT
|
Professional
|
Both
|
$4,683.07
|
|
|
Service Code
|
HCPCS 64865
|
| Min. Negotiated Rate |
$871.07 |
| Max. Negotiated Rate |
$2,799.86 |
| Rate for Payer: Cash Price |
$1,263.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,244.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,119.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,119.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,182.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,244.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,182.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,244.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,244.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$933.28
|
| Rate for Payer: Healthfirst Commercial |
$1,244.38
|
| Rate for Payer: Healthfirst Essential Plan |
$2,799.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,182.16
|
| Rate for Payer: Healthfirst QHP |
$1,244.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$871.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,244.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,057.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$871.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,244.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$933.28
|
| Rate for Payer: SOMOS Essential |
$933.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,244.38
|
|
|
PR SUTURE INFRAPATELLAR TENDON PRIMARY
|
Professional
|
Both
|
$2,769.80
|
|
|
Service Code
|
HCPCS 27380
|
| Min. Negotiated Rate |
$518.50 |
| Max. Negotiated Rate |
$1,666.62 |
| Rate for Payer: Cash Price |
$748.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$740.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$666.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$666.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$703.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$740.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$703.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$740.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$740.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$555.54
|
| Rate for Payer: Healthfirst Commercial |
$740.72
|
| Rate for Payer: Healthfirst Essential Plan |
$1,666.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$703.68
|
| Rate for Payer: Healthfirst QHP |
$740.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$518.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$740.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$629.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$518.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$740.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$555.54
|
| Rate for Payer: SOMOS Essential |
$555.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$740.72
|
|
|
PR SUTURE IRIS CILIARY BODY SPX RETRIEVAL SUTURE
|
Professional
|
Both
|
$2,980.29
|
|
|
Service Code
|
HCPCS 66682
|
| Min. Negotiated Rate |
$519.07 |
| Max. Negotiated Rate |
$1,668.44 |
| Rate for Payer: Cash Price |
$815.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$741.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$667.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$667.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$704.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$741.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$704.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$741.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$741.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$556.15
|
| Rate for Payer: Healthfirst Commercial |
$741.53
|
| Rate for Payer: Healthfirst Essential Plan |
$1,668.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$704.45
|
| Rate for Payer: Healthfirst QHP |
$741.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$519.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$741.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$630.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$519.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$741.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$556.15
|
| Rate for Payer: SOMOS Essential |
$556.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$741.53
|
|
|
PR SUTURE LUMBAR PLEXUS
|
Professional
|
Both
|
$6,050.00
|
|
|
Service Code
|
HCPCS 64862
|
| Min. Negotiated Rate |
$1,134.04 |
| Max. Negotiated Rate |
$3,645.11 |
| Rate for Payer: Cash Price |
$1,627.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,620.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,458.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,458.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,539.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,620.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,539.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,620.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,620.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,215.04
|
| Rate for Payer: Healthfirst Commercial |
$1,620.05
|
| Rate for Payer: Healthfirst Essential Plan |
$3,645.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,539.05
|
| Rate for Payer: Healthfirst QHP |
$1,620.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,134.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,620.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,377.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,134.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,620.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,215.04
|
| Rate for Payer: SOMOS Essential |
$1,215.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,620.05
|
|
|
PR SUTURE MESENTERY SEPARATE PROCEDURE
|
Professional
|
Both
|
$3,350.66
|
|
|
Service Code
|
HCPCS 44850
|
| Min. Negotiated Rate |
$623.16 |
| Max. Negotiated Rate |
$2,003.02 |
| Rate for Payer: Cash Price |
$897.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$890.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$801.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$801.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$845.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$890.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$845.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$890.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$890.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$667.67
|
| Rate for Payer: Healthfirst Commercial |
$890.23
|
| Rate for Payer: Healthfirst Essential Plan |
$2,003.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$845.72
|
| Rate for Payer: Healthfirst QHP |
$890.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$623.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$890.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$756.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$623.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$890.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$667.67
|
| Rate for Payer: SOMOS Essential |
$667.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$890.23
|
|
|
PR SUTURE NERVE REQ SECONDARY/DELAYED SUTURE
|
Professional
|
Both
|
$506.77
|
|
|
Service Code
|
HCPCS 64872
|
| Min. Negotiated Rate |
$94.09 |
| Max. Negotiated Rate |
$302.44 |
| Rate for Payer: Cash Price |
$134.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$134.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$120.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$120.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$127.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$134.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$127.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$134.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$134.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$100.81
|
| Rate for Payer: Healthfirst Commercial |
$134.42
|
| Rate for Payer: Healthfirst Essential Plan |
$302.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.70
|
| Rate for Payer: Healthfirst QHP |
$134.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$94.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$134.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$114.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$94.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$134.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$100.81
|
| Rate for Payer: SOMOS Essential |
$100.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$134.42
|
|
|
PR SUTURE NERVE REQ SHORTENING BONE EXTREMITY
|
Professional
|
Both
|
$856.98
|
|
|
Service Code
|
HCPCS 64876
|
| Min. Negotiated Rate |
$159.49 |
| Max. Negotiated Rate |
$512.64 |
| Rate for Payer: Cash Price |
$229.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$227.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$205.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$205.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$216.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$227.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$216.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$227.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$227.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$170.88
|
| Rate for Payer: Healthfirst Commercial |
$227.84
|
| Rate for Payer: Healthfirst Essential Plan |
$512.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$216.45
|
| Rate for Payer: Healthfirst QHP |
$227.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$159.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$227.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$193.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$159.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$227.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$170.88
|
| Rate for Payer: SOMOS Essential |
$170.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.84
|
|
|
PR SUTURE NERVE REQ XTNSV MOBIL/TRPOS NERVE
|
Professional
|
Both
|
$756.04
|
|
|
Service Code
|
HCPCS 64874
|
| Min. Negotiated Rate |
$140.92 |
| Max. Negotiated Rate |
$452.95 |
| Rate for Payer: Cash Price |
$202.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$201.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$181.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$181.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$191.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$201.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$191.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$201.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$201.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$150.98
|
| Rate for Payer: Healthfirst Commercial |
$201.31
|
| Rate for Payer: Healthfirst Essential Plan |
$452.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$191.24
|
| Rate for Payer: Healthfirst QHP |
$201.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$140.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$201.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$171.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$140.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$201.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$150.98
|
| Rate for Payer: SOMOS Essential |
$150.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$201.31
|
|
|
PR SUTURE PHARYNX WOUND/INJURY
|
Professional
|
Both
|
$1,428.39
|
|
|
Service Code
|
HCPCS 42900
|
| Min. Negotiated Rate |
$268.75 |
| Max. Negotiated Rate |
$863.84 |
| Rate for Payer: Cash Price |
$387.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$383.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$345.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$345.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$364.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$383.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$364.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$383.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$287.95
|
| Rate for Payer: Healthfirst Commercial |
$383.93
|
| Rate for Payer: Healthfirst Essential Plan |
$863.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$364.73
|
| Rate for Payer: Healthfirst QHP |
$383.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$268.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$383.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$326.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$268.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$383.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$287.95
|
| Rate for Payer: SOMOS Essential |
$287.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$383.93
|
|
|
PR SUTURE POSTERIOR TIBIAL NERVE
|
Professional
|
Both
|
$4,253.87
|
|
|
Service Code
|
HCPCS 64840
|
| Min. Negotiated Rate |
$799.46 |
| Max. Negotiated Rate |
$2,569.70 |
| Rate for Payer: Cash Price |
$1,146.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,142.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,027.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,027.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,084.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,142.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,084.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,142.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,142.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$856.57
|
| Rate for Payer: Healthfirst Commercial |
$1,142.09
|
| Rate for Payer: Healthfirst Essential Plan |
$2,569.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,084.99
|
| Rate for Payer: Healthfirst QHP |
$1,142.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$799.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,142.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$970.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$799.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,142.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$856.57
|
| Rate for Payer: SOMOS Essential |
$856.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,142.09
|
|
|
PR SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY
|
Professional
|
Both
|
$2,689.37
|
|
|
Service Code
|
HCPCS 27385
|
| Min. Negotiated Rate |
$505.98 |
| Max. Negotiated Rate |
$1,626.37 |
| Rate for Payer: Cash Price |
$729.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$722.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$650.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$650.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$686.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$722.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$686.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$722.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$722.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$542.12
|
| Rate for Payer: Healthfirst Commercial |
$722.83
|
| Rate for Payer: Healthfirst Essential Plan |
$1,626.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$686.69
|
| Rate for Payer: Healthfirst QHP |
$722.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$505.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$722.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$614.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$505.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$722.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$542.12
|
| Rate for Payer: SOMOS Essential |
$542.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$722.83
|
|
|
PR SUTURE REPAIR AORTA/GREAT VESSEL W/BYPASS
|
Professional
|
Both
|
$6,123.88
|
|
|
Service Code
|
HCPCS 33322
|
| Min. Negotiated Rate |
$1,136.10 |
| Max. Negotiated Rate |
$3,651.75 |
| Rate for Payer: Cash Price |
$1,652.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,623.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,460.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,460.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,541.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,623.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,541.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,623.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,623.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,217.25
|
| Rate for Payer: Healthfirst Commercial |
$1,623.00
|
| Rate for Payer: Healthfirst Essential Plan |
$3,651.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,541.85
|
| Rate for Payer: Healthfirst QHP |
$1,623.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,136.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,623.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,379.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,136.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,623.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,217.25
|
| Rate for Payer: SOMOS Essential |
$1,217.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,623.00
|
|
|
PR SUTURE/REPAIR TESTICULAR INJURY
|
Professional
|
Both
|
$1,724.66
|
|
|
Service Code
|
HCPCS 54670
|
| Min. Negotiated Rate |
$329.64 |
| Max. Negotiated Rate |
$1,059.55 |
| Rate for Payer: Cash Price |
$473.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$470.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$423.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$423.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$447.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$470.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$447.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$470.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$470.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$353.18
|
| Rate for Payer: Healthfirst Commercial |
$470.91
|
| Rate for Payer: Healthfirst Essential Plan |
$1,059.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$447.36
|
| Rate for Payer: Healthfirst QHP |
$470.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$329.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$470.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$400.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$329.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$470.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$353.18
|
| Rate for Payer: SOMOS Essential |
$353.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$470.91
|
|
|
PR SUTURE SCIATIC NERVE
|
Professional
|
Both
|
$5,182.28
|
|
|
Service Code
|
HCPCS 64858
|
| Min. Negotiated Rate |
$971.58 |
| Max. Negotiated Rate |
$3,122.93 |
| Rate for Payer: Cash Price |
$1,395.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,387.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,249.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,249.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,318.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,387.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,318.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,387.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,387.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,040.98
|
| Rate for Payer: Healthfirst Commercial |
$1,387.97
|
| Rate for Payer: Healthfirst Essential Plan |
$3,122.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,318.57
|
| Rate for Payer: Healthfirst QHP |
$1,387.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$971.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,387.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,179.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$971.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,387.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,040.98
|
| Rate for Payer: SOMOS Essential |
$1,040.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,387.97
|
|
|
PR SUTURE TONGUE LIP MICROGNATHIA
|
Professional
|
Both
|
$1,973.69
|
|
|
Service Code
|
HCPCS 41510
|
| Min. Negotiated Rate |
$369.18 |
| Max. Negotiated Rate |
$1,186.65 |
| Rate for Payer: Cash Price |
$533.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$527.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$474.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$474.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$501.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$527.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$501.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$527.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$527.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$395.55
|
| Rate for Payer: Healthfirst Commercial |
$527.40
|
| Rate for Payer: Healthfirst Essential Plan |
$1,186.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$501.03
|
| Rate for Payer: Healthfirst QHP |
$527.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$369.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$527.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$448.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$369.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$527.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$395.55
|
| Rate for Payer: SOMOS Essential |
$395.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$527.40
|
|
|
PR SUTURE TRACHEAL WOUND/INJURY CERVICAL
|
Professional
|
Both
|
$3,075.42
|
|
|
Service Code
|
HCPCS 31800
|
| Min. Negotiated Rate |
$569.86 |
| Max. Negotiated Rate |
$1,831.68 |
| Rate for Payer: Cash Price |
$828.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$814.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$732.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$732.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$773.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$814.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$773.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$814.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$814.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$610.56
|
| Rate for Payer: Healthfirst Commercial |
$814.08
|
| Rate for Payer: Healthfirst Essential Plan |
$1,831.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$773.38
|
| Rate for Payer: Healthfirst QHP |
$814.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$569.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$814.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$691.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$569.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$814.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$610.56
|
| Rate for Payer: SOMOS Essential |
$610.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$814.08
|
|
|
PR SUTURE TRACHEAL WOUND/INJURY INTRATHORACIC
|
Professional
|
Both
|
$3,647.04
|
|
|
Service Code
|
HCPCS 31805
|
| Min. Negotiated Rate |
$676.12 |
| Max. Negotiated Rate |
$2,173.23 |
| Rate for Payer: Cash Price |
$974.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$965.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$869.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$869.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$917.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$965.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$917.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$965.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$965.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$724.41
|
| Rate for Payer: Healthfirst Commercial |
$965.88
|
| Rate for Payer: Healthfirst Essential Plan |
$2,173.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$917.59
|
| Rate for Payer: Healthfirst QHP |
$965.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$676.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$965.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$821.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$676.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$965.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$724.41
|
| Rate for Payer: SOMOS Essential |
$724.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$965.88
|
|
|
PR SYMPATHECTOMY CERVICAL
|
Professional
|
Both
|
$4,043.66
|
|
|
Service Code
|
HCPCS 64802
|
| Min. Negotiated Rate |
$747.84 |
| Max. Negotiated Rate |
$2,403.76 |
| Rate for Payer: Cash Price |
$1,075.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,068.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$961.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$961.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,014.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,068.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,014.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,068.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,068.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$801.25
|
| Rate for Payer: Healthfirst Commercial |
$1,068.34
|
| Rate for Payer: Healthfirst Essential Plan |
$2,403.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,014.92
|
| Rate for Payer: Healthfirst QHP |
$1,068.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$747.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,068.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$908.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$747.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,068.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$801.25
|
| Rate for Payer: SOMOS Essential |
$801.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,068.34
|
|
|
PR SYMPATHECTOMY CERVICOTHORACIC
|
Professional
|
Both
|
$5,738.43
|
|
|
Service Code
|
HCPCS 64804
|
| Min. Negotiated Rate |
$1,053.56 |
| Max. Negotiated Rate |
$3,386.45 |
| Rate for Payer: Cash Price |
$1,517.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,505.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,354.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,354.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,429.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,505.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,429.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,505.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,505.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,128.82
|
| Rate for Payer: Healthfirst Commercial |
$1,505.09
|
| Rate for Payer: Healthfirst Essential Plan |
$3,386.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,429.84
|
| Rate for Payer: Healthfirst QHP |
$1,505.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,053.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,505.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,279.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,053.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,505.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,128.82
|
| Rate for Payer: SOMOS Essential |
$1,128.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,505.09
|
|
|
PR SYMPATHECTOMY DIGITAL ARTERIES EACH DIGIT
|
Professional
|
Both
|
$3,347.37
|
|
|
Service Code
|
HCPCS 64820
|
| Min. Negotiated Rate |
$633.98 |
| Max. Negotiated Rate |
$2,037.80 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$905.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$815.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$815.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$860.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$905.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$860.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$905.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$905.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$679.27
|
| Rate for Payer: Healthfirst Commercial |
$905.69
|
| Rate for Payer: Healthfirst Essential Plan |
$2,037.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$860.41
|
| Rate for Payer: Healthfirst QHP |
$905.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$633.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$905.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$769.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$633.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$905.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$679.27
|
| Rate for Payer: SOMOS Essential |
$679.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$905.69
|
|
