|
PR VENTRICULOCISTERNOSTOMY
|
Professional
|
Both
|
$7,720.97
|
|
|
Service Code
|
HCPCS 62180
|
| Min. Negotiated Rate |
$1,413.55 |
| Max. Negotiated Rate |
$4,543.56 |
| Rate for Payer: Cash Price |
$2,037.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,019.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,817.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,817.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,918.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,019.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,918.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,019.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,019.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,514.52
|
| Rate for Payer: Healthfirst Commercial |
$2,019.36
|
| Rate for Payer: Healthfirst Essential Plan |
$4,543.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,918.39
|
| Rate for Payer: Healthfirst QHP |
$2,019.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,413.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,019.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,716.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,413.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,019.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,514.52
|
| Rate for Payer: SOMOS Essential |
$1,514.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,019.36
|
|
|
PR VENTRICULOCISTERNOSTOMY 3RD VENTRICLE
|
Professional
|
Both
|
$6,646.01
|
|
|
Service Code
|
HCPCS 62200
|
| Min. Negotiated Rate |
$1,216.95 |
| Max. Negotiated Rate |
$3,911.62 |
| Rate for Payer: Cash Price |
$1,753.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,738.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,564.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,564.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,651.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,738.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,651.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,738.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,738.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,303.88
|
| Rate for Payer: Healthfirst Commercial |
$1,738.50
|
| Rate for Payer: Healthfirst Essential Plan |
$3,911.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,651.58
|
| Rate for Payer: Healthfirst QHP |
$1,738.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,216.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,738.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,477.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,216.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,738.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,303.88
|
| Rate for Payer: SOMOS Essential |
$1,303.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,738.50
|
|
|
PR VENTRICULOCISTERNOSTOMY 3RD VNTRC NEURONDSC
|
Professional
|
Both
|
$5,849.03
|
|
|
Service Code
|
HCPCS 62201
|
| Min. Negotiated Rate |
$1,072.34 |
| Max. Negotiated Rate |
$3,446.82 |
| Rate for Payer: Cash Price |
$1,545.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,531.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,378.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,378.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,455.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,531.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,455.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,531.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,531.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,148.94
|
| Rate for Payer: Healthfirst Commercial |
$1,531.92
|
| Rate for Payer: Healthfirst Essential Plan |
$3,446.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,455.32
|
| Rate for Payer: Healthfirst QHP |
$1,531.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,072.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,531.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,302.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,072.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,531.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,148.94
|
| Rate for Payer: SOMOS Essential |
$1,148.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,531.92
|
|
|
PR VENTRICULOMYOTOMY-MYECTOMY
|
Professional
|
Both
|
$8,961.47
|
|
|
Service Code
|
HCPCS 33416
|
| Min. Negotiated Rate |
$1,651.40 |
| Max. Negotiated Rate |
$5,308.09 |
| Rate for Payer: Cash Price |
$2,382.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,359.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,123.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,123.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,241.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,359.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,241.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,359.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,359.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,769.36
|
| Rate for Payer: Healthfirst Commercial |
$2,359.15
|
| Rate for Payer: Healthfirst Essential Plan |
$5,308.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,241.19
|
| Rate for Payer: Healthfirst QHP |
$2,359.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,651.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,359.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,005.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,651.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,359.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,769.36
|
| Rate for Payer: SOMOS Essential |
$1,769.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,359.15
|
|
|
PR VERMILIONECTOMY LIP SHV W/MUCOSAL ADVMNT
|
Professional
|
Both
|
$1,588.23
|
|
|
Service Code
|
HCPCS 40500
|
| Min. Negotiated Rate |
$302.21 |
| Max. Negotiated Rate |
$971.39 |
| Rate for Payer: Cash Price |
$435.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$431.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$388.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$388.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$431.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$431.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$431.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$323.80
|
| Rate for Payer: Healthfirst Commercial |
$431.73
|
| Rate for Payer: Healthfirst Essential Plan |
$971.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$410.14
|
| Rate for Payer: Healthfirst QHP |
$431.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$302.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$431.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$366.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$302.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$431.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$323.80
|
| Rate for Payer: SOMOS Essential |
$323.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$431.73
|
|
|
PR VERTEB CORPECT LAT XTRCAVITARY DCMPRN LMBR 1 SEG
|
Professional
|
Both
|
$10,671.22
|
|
|
Service Code
|
HCPCS 63102
|
| Min. Negotiated Rate |
$1,974.94 |
| Max. Negotiated Rate |
$6,348.04 |
| Rate for Payer: Cash Price |
$2,827.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,821.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,539.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,539.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,680.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,821.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,680.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,821.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,821.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,116.01
|
| Rate for Payer: Healthfirst Commercial |
$2,821.35
|
| Rate for Payer: Healthfirst Essential Plan |
$6,348.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,680.28
|
| Rate for Payer: Healthfirst QHP |
$2,821.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,974.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,821.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,398.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,974.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,821.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,116.01
|
| Rate for Payer: SOMOS Essential |
$2,116.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,821.35
|
|
|
PR VERTEB CORPECT LAT XTRCAVITARY DCMPRN THRC 1 SEG
|
Professional
|
Both
|
$10,974.88
|
|
|
Service Code
|
HCPCS 63101
|
| Min. Negotiated Rate |
$2,006.27 |
| Max. Negotiated Rate |
$6,448.73 |
| Rate for Payer: Cash Price |
$2,903.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,866.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,579.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,579.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,722.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,866.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,722.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,866.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,866.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,149.57
|
| Rate for Payer: Healthfirst Commercial |
$2,866.10
|
| Rate for Payer: Healthfirst Essential Plan |
$6,448.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,722.80
|
| Rate for Payer: Healthfirst QHP |
$2,866.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,006.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,866.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,436.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,006.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,866.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,149.57
|
| Rate for Payer: SOMOS Essential |
$2,149.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,866.10
|
|
|
PR VERTEBRAL CORPECTOMY ANT DCMPRN CERVICAL 1 SEG
|
Professional
|
Both
|
$8,199.98
|
|
|
Service Code
|
HCPCS 63081
|
| Min. Negotiated Rate |
$1,517.10 |
| Max. Negotiated Rate |
$4,876.40 |
| Rate for Payer: Cash Price |
$2,186.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,167.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,950.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,950.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,058.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,167.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,058.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,167.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,167.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,625.47
|
| Rate for Payer: Healthfirst Commercial |
$2,167.29
|
| Rate for Payer: Healthfirst Essential Plan |
$4,876.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,058.93
|
| Rate for Payer: Healthfirst QHP |
$2,167.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,517.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,167.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,842.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,517.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,167.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,625.47
|
| Rate for Payer: SOMOS Essential |
$1,625.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,167.29
|
|
|
PR VERTEBRAL CORPECTOMY DCMPRN CERVICAL EA SEG
|
Professional
|
Both
|
$1,230.15
|
|
|
Service Code
|
HCPCS 63082
|
| Min. Negotiated Rate |
$226.79 |
| Max. Negotiated Rate |
$728.98 |
| Rate for Payer: Cash Price |
$327.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$323.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$291.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$291.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$307.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$323.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$307.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$323.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$323.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$242.99
|
| Rate for Payer: Healthfirst Commercial |
$323.99
|
| Rate for Payer: Healthfirst Essential Plan |
$728.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$307.79
|
| Rate for Payer: Healthfirst QHP |
$323.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$226.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$323.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$275.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$226.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$323.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$242.99
|
| Rate for Payer: SOMOS Essential |
$242.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$323.99
|
|
|
PR VERTEBRAL CORPECTOMY DCMPRN CORD THORACIC 1 SEG
|
Professional
|
Both
|
$8,967.53
|
|
|
Service Code
|
HCPCS 63085
|
| Min. Negotiated Rate |
$1,654.07 |
| Max. Negotiated Rate |
$5,316.64 |
| Rate for Payer: Cash Price |
$2,410.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,362.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,126.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,126.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,244.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,362.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,244.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,362.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,362.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,772.21
|
| Rate for Payer: Healthfirst Commercial |
$2,362.95
|
| Rate for Payer: Healthfirst Essential Plan |
$5,316.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,244.80
|
| Rate for Payer: Healthfirst QHP |
$2,362.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,654.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,362.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,008.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,654.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,362.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,772.21
|
| Rate for Payer: SOMOS Essential |
$1,772.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,362.95
|
|
|
PR VERTEBRAL CORPECTOMY DCMPRN CORD THORACIC EA SEG
|
Professional
|
Both
|
$869.79
|
|
|
Service Code
|
HCPCS 63086
|
| Min. Negotiated Rate |
$162.04 |
| Max. Negotiated Rate |
$520.83 |
| Rate for Payer: Cash Price |
$235.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$208.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$208.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$231.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$173.61
|
| Rate for Payer: Healthfirst Commercial |
$231.48
|
| Rate for Payer: Healthfirst Essential Plan |
$520.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$219.91
|
| Rate for Payer: Healthfirst QHP |
$231.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$162.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$196.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$162.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$173.61
|
| Rate for Payer: SOMOS Essential |
$173.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.48
|
|
|
PR VERTEBRAL CORPECTOMY EXC INDRL LES EACH SEG
|
Professional
|
Both
|
$1,502.87
|
|
|
Service Code
|
HCPCS 63308
|
| Min. Negotiated Rate |
$273.81 |
| Max. Negotiated Rate |
$880.09 |
| Rate for Payer: Cash Price |
$397.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$391.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$352.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$352.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$371.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$391.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$371.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$391.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$391.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$293.36
|
| Rate for Payer: Healthfirst Commercial |
$391.15
|
| Rate for Payer: Healthfirst Essential Plan |
$880.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$371.59
|
| Rate for Payer: Healthfirst QHP |
$391.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$273.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$391.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$332.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$273.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$391.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$293.36
|
| Rate for Payer: SOMOS Essential |
$293.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$391.15
|
|
|
PR VERTEBRAL CORPECTOMY EXC LES 1 SEG IDRL CERVICAL
|
Professional
|
Both
|
$11,347.67
|
|
|
Service Code
|
HCPCS 63304
|
| Min. Negotiated Rate |
$2,072.43 |
| Max. Negotiated Rate |
$6,661.40 |
| Rate for Payer: Cash Price |
$2,988.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,960.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,664.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,664.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,812.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,960.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,812.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,960.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,960.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,220.47
|
| Rate for Payer: Healthfirst Commercial |
$2,960.62
|
| Rate for Payer: Healthfirst Essential Plan |
$6,661.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,812.59
|
| Rate for Payer: Healthfirst QHP |
$2,960.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,072.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,960.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,516.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,072.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,960.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,220.47
|
| Rate for Payer: SOMOS Essential |
$2,220.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,960.62
|
|
|
PR VERTEBRAL CORPECTOMY LES 1 SEG IDRL THRC TTHRC
|
Professional
|
Both
|
$12,077.73
|
|
|
Service Code
|
HCPCS 63305
|
| Min. Negotiated Rate |
$2,204.26 |
| Max. Negotiated Rate |
$7,085.11 |
| Rate for Payer: Cash Price |
$3,180.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,148.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,834.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,834.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,991.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,148.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,991.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,148.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,148.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,361.70
|
| Rate for Payer: Healthfirst Commercial |
$3,148.94
|
| Rate for Payer: Healthfirst Essential Plan |
$7,085.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,991.49
|
| Rate for Payer: Healthfirst QHP |
$3,148.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,204.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,148.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,676.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,204.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,148.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,361.70
|
| Rate for Payer: SOMOS Essential |
$2,361.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,148.94
|
|
|
PR VERTEBRL CORPECT LES 1 SEG IDRL THRC THORACOLMBR
|
Professional
|
Both
|
$11,870.01
|
|
|
Service Code
|
HCPCS 63306
|
| Min. Negotiated Rate |
$2,167.14 |
| Max. Negotiated Rate |
$6,965.80 |
| Rate for Payer: Cash Price |
$3,124.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,095.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,786.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,786.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,941.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,095.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,941.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,095.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,095.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,321.93
|
| Rate for Payer: Healthfirst Commercial |
$3,095.91
|
| Rate for Payer: Healthfirst Essential Plan |
$6,965.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,941.11
|
| Rate for Payer: Healthfirst QHP |
$3,095.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,167.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,095.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,631.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,167.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,095.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,321.93
|
| Rate for Payer: SOMOS Essential |
$2,321.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,095.91
|
|
|
PR VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL
|
Professional
|
Both
|
$891.31
|
|
|
Service Code
|
HCPCS 22512
|
| Min. Negotiated Rate |
$166.58 |
| Max. Negotiated Rate |
$535.43 |
| Rate for Payer: Cash Price |
$239.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$237.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$214.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$214.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$226.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$237.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$226.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$237.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$237.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$178.48
|
| Rate for Payer: Healthfirst Commercial |
$237.97
|
| Rate for Payer: Healthfirst Essential Plan |
$535.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$226.07
|
| Rate for Payer: Healthfirst QHP |
$237.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$166.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$237.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$202.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$166.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$237.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$178.48
|
| Rate for Payer: SOMOS Essential |
$178.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$237.97
|
|
|
PR VESICULECTOMY ANY APPROACH
|
Professional
|
Both
|
$3,013.71
|
|
|
Service Code
|
HCPCS 55650
|
| Min. Negotiated Rate |
$573.57 |
| Max. Negotiated Rate |
$1,843.61 |
| Rate for Payer: Cash Price |
$824.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$819.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$737.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$737.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$778.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$819.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$778.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$819.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$819.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$614.53
|
| Rate for Payer: Healthfirst Commercial |
$819.38
|
| Rate for Payer: Healthfirst Essential Plan |
$1,843.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$778.41
|
| Rate for Payer: Healthfirst QHP |
$819.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$573.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$819.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$696.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$573.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$819.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$614.53
|
| Rate for Payer: SOMOS Essential |
$614.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$819.38
|
|
|
PR VESICULOTOMY
|
Professional
|
Both
|
$1,776.39
|
|
|
Service Code
|
HCPCS 55600
|
| Min. Negotiated Rate |
$339.34 |
| Max. Negotiated Rate |
$1,090.73 |
| Rate for Payer: Cash Price |
$488.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$484.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$436.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$436.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$460.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$484.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$460.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$484.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$484.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$363.58
|
| Rate for Payer: Healthfirst Commercial |
$484.77
|
| Rate for Payer: Healthfirst Essential Plan |
$1,090.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$460.53
|
| Rate for Payer: Healthfirst QHP |
$484.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$339.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$484.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$412.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$339.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$484.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$363.58
|
| Rate for Payer: SOMOS Essential |
$363.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$484.77
|
|
|
PR VESICULOTOMY COMPLICATED
|
Professional
|
Both
|
$2,208.01
|
|
|
Service Code
|
HCPCS 55605
|
| Min. Negotiated Rate |
$420.52 |
| Max. Negotiated Rate |
$1,351.66 |
| Rate for Payer: Cash Price |
$605.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$600.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$540.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$540.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$570.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$600.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$570.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$600.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$600.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$450.56
|
| Rate for Payer: Healthfirst Commercial |
$600.74
|
| Rate for Payer: Healthfirst Essential Plan |
$1,351.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$570.70
|
| Rate for Payer: Healthfirst QHP |
$600.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$420.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$600.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$510.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$420.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$600.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$450.56
|
| Rate for Payer: SOMOS Essential |
$450.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$600.74
|
|
|
PR VESTIBULAR NRV SECTION TRANSCRANIAL APPROACH
|
Professional
|
Both
|
$7,528.64
|
|
|
Service Code
|
HCPCS 69950
|
| Min. Negotiated Rate |
$1,402.72 |
| Max. Negotiated Rate |
$4,508.75 |
| Rate for Payer: Cash Price |
$2,030.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,003.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,803.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,803.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,903.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,003.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,903.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,003.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,003.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,502.92
|
| Rate for Payer: Healthfirst Commercial |
$2,003.89
|
| Rate for Payer: Healthfirst Essential Plan |
$4,508.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,903.70
|
| Rate for Payer: Healthfirst QHP |
$2,003.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,402.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,003.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,703.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,402.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,003.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,502.92
|
| Rate for Payer: SOMOS Essential |
$1,502.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,003.89
|
|
|
PR VESTIBULAR NRV SECTION TRANSLABYRINTHINE APPR
|
Professional
|
Both
|
$6,494.08
|
|
|
Service Code
|
HCPCS 69915
|
| Min. Negotiated Rate |
$1,206.88 |
| Max. Negotiated Rate |
$3,879.25 |
| Rate for Payer: Cash Price |
$1,751.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,724.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,551.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,551.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,637.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,724.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,637.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,724.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,724.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,293.08
|
| Rate for Payer: Healthfirst Commercial |
$1,724.11
|
| Rate for Payer: Healthfirst Essential Plan |
$3,879.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,637.90
|
| Rate for Payer: Healthfirst QHP |
$1,724.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,206.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,724.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,465.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,206.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,724.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,293.08
|
| Rate for Payer: SOMOS Essential |
$1,293.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,724.11
|
|
|
PR VESTIBULOPLASTY ANTERIOR
|
Professional
|
Both
|
$2,743.90
|
|
|
Service Code
|
HCPCS 40840
|
| Min. Negotiated Rate |
$512.40 |
| Max. Negotiated Rate |
$1,647.00 |
| Rate for Payer: Cash Price |
$741.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$732.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$658.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$658.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$695.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$732.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$695.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$732.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$732.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$549.00
|
| Rate for Payer: Healthfirst Commercial |
$732.00
|
| Rate for Payer: Healthfirst Essential Plan |
$1,647.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$695.40
|
| Rate for Payer: Healthfirst QHP |
$732.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$512.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$732.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$622.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$512.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$732.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$549.00
|
| Rate for Payer: SOMOS Essential |
$549.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$732.00
|
|
|
PR VESTIBULOPLASTY CPLX W/RIDGE XTN MUSC RPSG
|
Professional
|
Both
|
$5,187.42
|
|
|
Service Code
|
HCPCS 40845
|
| Min. Negotiated Rate |
$975.48 |
| Max. Negotiated Rate |
$3,135.47 |
| Rate for Payer: Cash Price |
$1,401.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,393.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,254.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,254.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,323.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,393.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,323.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,393.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,393.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,045.15
|
| Rate for Payer: Healthfirst Commercial |
$1,393.54
|
| Rate for Payer: Healthfirst Essential Plan |
$3,135.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,323.86
|
| Rate for Payer: Healthfirst QHP |
$1,393.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$975.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,393.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,184.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$975.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,393.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,045.15
|
| Rate for Payer: SOMOS Essential |
$1,045.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,393.54
|
|
|
PR VESTIBULOPLASTY ENTIRE ARCH
|
Professional
|
Both
|
$5,149.83
|
|
|
Service Code
|
HCPCS 40844
|
| Min. Negotiated Rate |
$969.60 |
| Max. Negotiated Rate |
$3,116.57 |
| Rate for Payer: Cash Price |
$1,389.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,385.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,246.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,246.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,315.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,385.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,315.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,385.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,385.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,038.86
|
| Rate for Payer: Healthfirst Commercial |
$1,385.14
|
| Rate for Payer: Healthfirst Essential Plan |
$3,116.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,315.88
|
| Rate for Payer: Healthfirst QHP |
$1,385.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$969.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,385.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,177.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$969.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,385.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,038.86
|
| Rate for Payer: SOMOS Essential |
$1,038.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,385.14
|
|
|
PR VESTIBULOPLASTY POSTERIOR BILATERAL
|
Professional
|
Both
|
$3,808.18
|
|
|
Service Code
|
HCPCS 40843
|
| Min. Negotiated Rate |
$715.73 |
| Max. Negotiated Rate |
$2,300.56 |
| Rate for Payer: Cash Price |
$1,026.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,022.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$920.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$920.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$971.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,022.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$971.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,022.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,022.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$766.85
|
| Rate for Payer: Healthfirst Commercial |
$1,022.47
|
| Rate for Payer: Healthfirst Essential Plan |
$2,300.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$971.35
|
| Rate for Payer: Healthfirst QHP |
$1,022.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$715.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,022.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$869.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$715.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,022.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$766.85
|
| Rate for Payer: SOMOS Essential |
$766.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,022.47
|
|
