|
PR TRANSECTION/AVULSION PHRENIC NERVE
|
Professional
|
Both
|
$1,932.60
|
|
|
Service Code
|
HCPCS 64746
|
| Min. Negotiated Rate |
$359.74 |
| Max. Negotiated Rate |
$1,156.32 |
| Rate for Payer: Cash Price |
$518.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$513.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$462.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$462.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$488.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$513.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$488.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$513.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$513.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$385.44
|
| Rate for Payer: Healthfirst Commercial |
$513.92
|
| Rate for Payer: Healthfirst Essential Plan |
$1,156.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$488.22
|
| Rate for Payer: Healthfirst QHP |
$513.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$359.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$513.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$436.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$359.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$513.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$385.44
|
| Rate for Payer: SOMOS Essential |
$385.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$513.92
|
|
|
PR TRANSECTION/AVULSION SUPRAORBITAL NERVE
|
Professional
|
Both
|
$2,147.67
|
|
|
Service Code
|
HCPCS 64732
|
| Min. Negotiated Rate |
$401.23 |
| Max. Negotiated Rate |
$1,289.65 |
| Rate for Payer: Cash Price |
$575.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$573.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$515.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$515.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$544.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$573.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$544.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$573.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$573.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$429.88
|
| Rate for Payer: Healthfirst Commercial |
$573.18
|
| Rate for Payer: Healthfirst Essential Plan |
$1,289.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$544.52
|
| Rate for Payer: Healthfirst QHP |
$573.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$401.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$573.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$487.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$401.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$573.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$429.88
|
| Rate for Payer: SOMOS Essential |
$429.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$573.18
|
|
|
PR TRANSECTION/AVULSION VAGUS NERVE ABDOMINAL
|
Professional
|
Both
|
$2,360.05
|
|
|
Service Code
|
HCPCS 64760
|
| Min. Negotiated Rate |
$439.35 |
| Max. Negotiated Rate |
$1,412.19 |
| Rate for Payer: Cash Price |
$631.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$627.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$564.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$564.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$596.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$627.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$596.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$627.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$627.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$470.73
|
| Rate for Payer: Healthfirst Commercial |
$627.64
|
| Rate for Payer: Healthfirst Essential Plan |
$1,412.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$596.26
|
| Rate for Payer: Healthfirst QHP |
$627.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$439.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$627.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$533.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$439.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$627.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$470.73
|
| Rate for Payer: SOMOS Essential |
$470.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$627.64
|
|
|
PR TRANSECTION/AVULSION VAGUS NERVES
|
Professional
|
Both
|
$4,174.21
|
|
|
Service Code
|
HCPCS 64755
|
| Min. Negotiated Rate |
$772.64 |
| Max. Negotiated Rate |
$2,483.48 |
| Rate for Payer: Cash Price |
$1,112.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,103.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$993.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$993.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,048.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,103.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,048.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,103.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,103.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$827.83
|
| Rate for Payer: Healthfirst Commercial |
$1,103.77
|
| Rate for Payer: Healthfirst Essential Plan |
$2,483.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,048.58
|
| Rate for Payer: Healthfirst QHP |
$1,103.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$772.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,103.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$938.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$772.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,103.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$827.83
|
| Rate for Payer: SOMOS Essential |
$827.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,103.77
|
|
|
PR TRANSECTION PULMONARY ARTERY W/CARD BYPASS
|
Professional
|
Both
|
$6,187.09
|
|
|
Service Code
|
HCPCS 33922
|
| Min. Negotiated Rate |
$1,142.89 |
| Max. Negotiated Rate |
$3,673.57 |
| Rate for Payer: Cash Price |
$1,649.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,632.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,469.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,469.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,551.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,632.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,551.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,632.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,632.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,224.53
|
| Rate for Payer: Healthfirst Commercial |
$1,632.70
|
| Rate for Payer: Healthfirst Essential Plan |
$3,673.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,551.07
|
| Rate for Payer: Healthfirst QHP |
$1,632.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,142.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,632.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,387.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,142.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,632.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,224.53
|
| Rate for Payer: SOMOS Essential |
$1,224.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,632.70
|
|
|
PR TRANSESOPH DOPPL CARDIAC MON
|
Professional
|
Both
|
$382.31
|
|
|
Service Code
|
HCPCS G9157
|
| Min. Negotiated Rate |
$71.55 |
| Max. Negotiated Rate |
$229.97 |
| Rate for Payer: Cash Price |
$103.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$102.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$91.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$91.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$97.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$102.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$97.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$76.66
|
| Rate for Payer: Healthfirst Commercial |
$102.21
|
| Rate for Payer: Healthfirst Essential Plan |
$229.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$97.10
|
| Rate for Payer: Healthfirst QHP |
$102.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$71.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$102.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$86.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$71.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$76.66
|
| Rate for Payer: SOMOS Essential |
$76.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.21
|
|
|
PR TRANSFER ADDUCTOR ISCHIUM
|
Professional
|
Both
|
$3,090.47
|
|
|
Service Code
|
HCPCS 27098
|
| Min. Negotiated Rate |
$583.45 |
| Max. Negotiated Rate |
$1,875.38 |
| Rate for Payer: Cash Price |
$835.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$833.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$750.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$750.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$791.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$833.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$791.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$833.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$833.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$625.12
|
| Rate for Payer: Healthfirst Commercial |
$833.50
|
| Rate for Payer: Healthfirst Essential Plan |
$1,875.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$791.83
|
| Rate for Payer: Healthfirst QHP |
$833.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$583.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$833.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$708.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$583.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$833.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$625.12
|
| Rate for Payer: SOMOS Essential |
$625.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$833.50
|
|
|
PR TRANSFER ANY PEDICLE FLAP ANY LOCATION
|
Professional
|
Both
|
$1,757.18
|
|
|
Service Code
|
HCPCS 15650
|
| Min. Negotiated Rate |
$334.17 |
| Max. Negotiated Rate |
$1,074.13 |
| Rate for Payer: Cash Price |
$479.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$477.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$429.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$429.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$453.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$477.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$453.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$477.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$477.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$358.04
|
| Rate for Payer: Healthfirst Commercial |
$477.39
|
| Rate for Payer: Healthfirst Essential Plan |
$1,074.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$453.52
|
| Rate for Payer: Healthfirst QHP |
$477.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$334.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$477.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$405.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$334.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$477.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$358.04
|
| Rate for Payer: SOMOS Essential |
$358.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$477.39
|
|
|
PR TRANSFER FREE TOE JOINT W/MVASC ANASTOMOSIS
|
Professional
|
Both
|
$15,022.00
|
|
|
Service Code
|
HCPCS 26556
|
| Min. Negotiated Rate |
$2,796.03 |
| Max. Negotiated Rate |
$8,987.24 |
| Rate for Payer: Cash Price |
$4,033.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,994.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,594.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,594.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,794.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,994.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,794.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,994.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,994.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,995.75
|
| Rate for Payer: Healthfirst Commercial |
$3,994.33
|
| Rate for Payer: Healthfirst Essential Plan |
$8,987.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,794.61
|
| Rate for Payer: Healthfirst QHP |
$3,994.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,796.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,994.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,395.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,796.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,994.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,995.75
|
| Rate for Payer: SOMOS Essential |
$2,995.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,994.33
|
|
|
PR TRANSFER ILIOPSOAS FEMORAL NECK
|
Professional
|
Both
|
$3,999.70
|
|
|
Service Code
|
HCPCS 27111
|
| Min. Negotiated Rate |
$753.05 |
| Max. Negotiated Rate |
$2,420.53 |
| Rate for Payer: Cash Price |
$1,081.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,075.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$968.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$968.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,022.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,075.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,022.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,075.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,075.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$806.84
|
| Rate for Payer: Healthfirst Commercial |
$1,075.79
|
| Rate for Payer: Healthfirst Essential Plan |
$2,420.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,022.00
|
| Rate for Payer: Healthfirst QHP |
$1,075.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$753.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,075.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$914.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$753.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,075.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$806.84
|
| Rate for Payer: SOMOS Essential |
$806.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,075.79
|
|
|
PR TRANSFER ILIOPSOAS GREATER TROCHANTER FEMUR
|
Professional
|
Both
|
$4,298.14
|
|
|
Service Code
|
HCPCS 27110
|
| Min. Negotiated Rate |
$807.79 |
| Max. Negotiated Rate |
$2,596.48 |
| Rate for Payer: Cash Price |
$1,159.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,153.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,038.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,038.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,096.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,153.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,096.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,153.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,153.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$865.49
|
| Rate for Payer: Healthfirst Commercial |
$1,153.99
|
| Rate for Payer: Healthfirst Essential Plan |
$2,596.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,096.29
|
| Rate for Payer: Healthfirst QHP |
$1,153.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$807.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,153.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$980.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$807.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,153.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$865.49
|
| Rate for Payer: SOMOS Essential |
$865.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,153.99
|
|
|
PR TRANSFER TENDON/MUSCLE HAMSTRINGS FEMUR
|
Professional
|
Both
|
$3,091.73
|
|
|
Service Code
|
HCPCS 27400
|
| Min. Negotiated Rate |
$583.69 |
| Max. Negotiated Rate |
$1,876.14 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$833.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$750.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$750.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$792.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$833.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$792.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$833.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$833.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$625.38
|
| Rate for Payer: Healthfirst Commercial |
$833.84
|
| Rate for Payer: Healthfirst Essential Plan |
$1,876.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$792.15
|
| Rate for Payer: Healthfirst QHP |
$833.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$583.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$833.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$708.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$583.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$833.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$625.38
|
| Rate for Payer: SOMOS Essential |
$625.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$833.84
|
|
|
PR TRANSFER/TRANSPLANT TENDON PALMAR W/GRAFT EACH
|
Professional
|
Both
|
$4,289.32
|
|
|
Service Code
|
HCPCS 26489
|
| Min. Negotiated Rate |
$793.60 |
| Max. Negotiated Rate |
$2,550.87 |
| Rate for Payer: Cash Price |
$1,153.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,133.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,020.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,020.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,077.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,133.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,077.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,133.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,133.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$850.29
|
| Rate for Payer: Healthfirst Commercial |
$1,133.72
|
| Rate for Payer: Healthfirst Essential Plan |
$2,550.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,077.03
|
| Rate for Payer: Healthfirst QHP |
$1,133.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$793.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,133.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$963.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$793.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,133.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$850.29
|
| Rate for Payer: SOMOS Essential |
$850.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,133.72
|
|
|
PR TRANSFER/TRANSPLANT TENDON PALMAR W/O GRAFT EACH
|
Professional
|
Both
|
$3,697.89
|
|
|
Service Code
|
HCPCS 26485
|
| Min. Negotiated Rate |
$686.97 |
| Max. Negotiated Rate |
$2,208.13 |
| Rate for Payer: Cash Price |
$998.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$981.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$883.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$883.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$981.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$981.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$981.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$736.04
|
| Rate for Payer: Healthfirst Commercial |
$981.39
|
| Rate for Payer: Healthfirst Essential Plan |
$2,208.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$932.32
|
| Rate for Payer: Healthfirst QHP |
$981.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$686.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$981.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$834.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$686.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$981.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$736.04
|
| Rate for Payer: SOMOS Essential |
$736.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$981.39
|
|
|
PR TRANSFUSION BLOOD/BLOOD COMPONENTS
|
Professional
|
Both
|
$170.80
|
|
|
Service Code
|
HCPCS 36430
|
| Min. Negotiated Rate |
$35.53 |
| Max. Negotiated Rate |
$114.21 |
| Rate for Payer: Cash Price |
$50.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$50.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$45.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$48.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$50.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$48.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.07
|
| Rate for Payer: Healthfirst Commercial |
$50.76
|
| Rate for Payer: Healthfirst Essential Plan |
$114.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$48.22
|
| Rate for Payer: Healthfirst QHP |
$50.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$50.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.07
|
| Rate for Payer: SOMOS Essential |
$38.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.76
|
|
|
PR TRANSFUSION INTRAUTERINE FETAL
|
Professional
|
Both
|
$1,491.67
|
|
|
Service Code
|
HCPCS 36460
|
| Min. Negotiated Rate |
$275.72 |
| Max. Negotiated Rate |
$886.23 |
| Rate for Payer: Cash Price |
$399.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$393.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$354.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$354.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$374.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$393.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$374.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$393.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$393.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$295.41
|
| Rate for Payer: Healthfirst Commercial |
$393.88
|
| Rate for Payer: Healthfirst Essential Plan |
$886.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$374.19
|
| Rate for Payer: Healthfirst QHP |
$393.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$275.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$393.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$334.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$275.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$393.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$295.41
|
| Rate for Payer: SOMOS Essential |
$295.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$393.88
|
|
|
PR TRANSJ CARE MGMT HIGH MDM F2F 7 CAL D DISCHARGE
|
Professional
|
Both
|
$771.65
|
|
|
Service Code
|
HCPCS 99496
|
| Min. Negotiated Rate |
$145.52 |
| Max. Negotiated Rate |
$467.75 |
| Rate for Payer: Cash Price |
$210.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$207.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$187.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$187.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$197.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$207.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$197.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$207.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$207.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$155.92
|
| Rate for Payer: Healthfirst Commercial |
$207.89
|
| Rate for Payer: Healthfirst Essential Plan |
$467.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$197.50
|
| Rate for Payer: Healthfirst QHP |
$207.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$145.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$207.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$176.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$145.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$207.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$155.92
|
| Rate for Payer: SOMOS Essential |
$155.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$207.89
|
|
|
PR TRANSJ CARE MGMT MOD MDM F2F 14 CAL D DISCHARGE
|
Professional
|
Both
|
$565.64
|
|
|
Service Code
|
HCPCS 99495
|
| Min. Negotiated Rate |
$107.00 |
| Max. Negotiated Rate |
$343.94 |
| Rate for Payer: Cash Price |
$155.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$152.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$137.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$137.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$145.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$152.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$145.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$152.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$152.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.64
|
| Rate for Payer: Healthfirst Commercial |
$152.86
|
| Rate for Payer: Healthfirst Essential Plan |
$343.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$145.22
|
| Rate for Payer: Healthfirst QHP |
$152.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$107.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$152.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$129.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$107.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$152.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$114.64
|
| Rate for Payer: SOMOS Essential |
$114.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$152.86
|
|
|
PR TRANSMASTOID ANTROTOMY
|
Professional
|
Both
|
$3,087.46
|
|
|
Service Code
|
HCPCS 69501
|
| Min. Negotiated Rate |
$573.52 |
| Max. Negotiated Rate |
$1,843.47 |
| Rate for Payer: Cash Price |
$833.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$819.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$737.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$737.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$778.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$819.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$778.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$819.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$819.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$614.49
|
| Rate for Payer: Healthfirst Commercial |
$819.32
|
| Rate for Payer: Healthfirst Essential Plan |
$1,843.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$778.35
|
| Rate for Payer: Healthfirst QHP |
$819.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$573.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$819.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$696.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$573.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$819.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$614.49
|
| Rate for Payer: SOMOS Essential |
$614.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$819.32
|
|
|
PR TRANSMETACARPAL AMPUTATION
|
Professional
|
Both
|
$3,838.45
|
|
|
Service Code
|
HCPCS 25927
|
| Min. Negotiated Rate |
$712.73 |
| Max. Negotiated Rate |
$2,290.93 |
| Rate for Payer: Cash Price |
$1,032.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$916.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$916.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$967.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$967.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$763.64
|
| Rate for Payer: Healthfirst Commercial |
$1,018.19
|
| Rate for Payer: Healthfirst Essential Plan |
$2,290.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$967.28
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$712.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,018.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$865.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$712.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$763.64
|
| Rate for Payer: SOMOS Essential |
$763.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
|
|
PR TRANSMETACARPAL AMPUTATION RE-AMPUTATION
|
Professional
|
Both
|
$3,547.71
|
|
|
Service Code
|
HCPCS 25931
|
| Min. Negotiated Rate |
$658.01 |
| Max. Negotiated Rate |
$2,115.02 |
| Rate for Payer: Cash Price |
$955.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$940.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$846.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$846.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$893.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$940.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$893.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$940.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$940.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$705.01
|
| Rate for Payer: Healthfirst Commercial |
$940.01
|
| Rate for Payer: Healthfirst Essential Plan |
$2,115.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$893.01
|
| Rate for Payer: Healthfirst QHP |
$940.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$658.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$940.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$799.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$658.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$940.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$705.01
|
| Rate for Payer: SOMOS Essential |
$705.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$940.01
|
|
|
PR TRANSMETACARPAL AMPUTATION SEC CLOSURE/SCAR REVJ
|
Professional
|
Both
|
$2,663.96
|
|
|
Service Code
|
HCPCS 25929
|
| Min. Negotiated Rate |
$503.98 |
| Max. Negotiated Rate |
$1,619.93 |
| Rate for Payer: Cash Price |
$722.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$719.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$647.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$647.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$683.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$719.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$683.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$719.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$719.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$539.98
|
| Rate for Payer: Healthfirst Commercial |
$719.97
|
| Rate for Payer: Healthfirst Essential Plan |
$1,619.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$683.97
|
| Rate for Payer: Healthfirst QHP |
$719.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$503.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$719.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$611.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$503.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$719.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$539.98
|
| Rate for Payer: SOMOS Essential |
$539.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$719.97
|
|
|
PR TRANSMYOCARDIAL LASER REVASCULAR THORACOTOMY SPX
|
Professional
|
Both
|
$6,860.35
|
|
|
Service Code
|
HCPCS 33140
|
| Min. Negotiated Rate |
$1,264.19 |
| Max. Negotiated Rate |
$4,063.48 |
| Rate for Payer: Cash Price |
$1,820.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,805.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,625.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,625.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,715.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,805.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,715.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,805.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,805.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,354.49
|
| Rate for Payer: Healthfirst Commercial |
$1,805.99
|
| Rate for Payer: Healthfirst Essential Plan |
$4,063.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,715.69
|
| Rate for Payer: Healthfirst QHP |
$1,805.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,264.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,805.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,535.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,264.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,805.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,354.49
|
| Rate for Payer: SOMOS Essential |
$1,354.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,805.99
|
|
|
PR TRANSMYOCRD LASER REVSC PFRMD TM OTH OPN CAR PX
|
Professional
|
Both
|
$584.36
|
|
|
Service Code
|
HCPCS 33141
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$346.50 |
| Rate for Payer: Cash Price |
$154.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$154.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$138.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$138.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$146.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$154.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$146.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$115.50
|
| Rate for Payer: Healthfirst Commercial |
$154.00
|
| Rate for Payer: Healthfirst Essential Plan |
$346.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$146.30
|
| Rate for Payer: Healthfirst QHP |
$154.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$107.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$154.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$130.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$107.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$154.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$115.50
|
| Rate for Payer: SOMOS Essential |
$115.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$154.00
|
|
|
PR TRANSORAL LOWER ESOPHAGEAL MYOTOMY
|
Professional
|
Both
|
$3,389.65
|
|
|
Service Code
|
HCPCS 43497
|
| Min. Negotiated Rate |
$630.22 |
| Max. Negotiated Rate |
$2,025.72 |
| Rate for Payer: Cash Price |
$908.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$900.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$810.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$810.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$855.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$900.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$855.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$900.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$900.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$675.24
|
| Rate for Payer: Healthfirst Commercial |
$900.32
|
| Rate for Payer: Healthfirst Essential Plan |
$2,025.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$855.30
|
| Rate for Payer: Healthfirst QHP |
$900.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$630.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$900.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$765.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$630.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$900.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$675.24
|
| Rate for Payer: SOMOS Essential |
$675.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$900.32
|
|
