|
PR AMP THIGH THRU FEMUR SEC CLOSURE/SCAR REVISION
|
Professional
|
Both
|
$2,245.43
|
|
|
Service Code
|
HCPCS 27594
|
| Min. Negotiated Rate |
$420.81 |
| Max. Negotiated Rate |
$1,352.61 |
| Rate for Payer: Cash Price |
$605.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$601.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$541.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$541.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$571.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$601.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$571.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$601.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$601.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$450.87
|
| Rate for Payer: Healthfirst Commercial |
$601.16
|
| Rate for Payer: Healthfirst Essential Plan |
$1,352.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$571.10
|
| Rate for Payer: Healthfirst QHP |
$601.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$420.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$601.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$510.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$420.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$601.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$450.87
|
| Rate for Payer: SOMOS Essential |
$450.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$601.16
|
|
|
PR AMP THI THRU FEMUR LVL IMMT FITG TQ W/1ST CST
|
Professional
|
Both
|
$4,268.57
|
|
|
Service Code
|
HCPCS 27591
|
| Min. Negotiated Rate |
$802.38 |
| Max. Negotiated Rate |
$2,579.06 |
| Rate for Payer: Cash Price |
$1,149.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,146.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,031.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,031.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,088.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,146.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,088.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,146.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,146.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$859.69
|
| Rate for Payer: Healthfirst Commercial |
$1,146.25
|
| Rate for Payer: Healthfirst Essential Plan |
$2,579.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,088.94
|
| Rate for Payer: Healthfirst QHP |
$1,146.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$802.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,146.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$974.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$802.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,146.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$859.69
|
| Rate for Payer: SOMOS Essential |
$859.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,146.25
|
|
|
PR AMPUTATION ARM THRU HUMERUS OPEN CIRCULAR
|
Professional
|
Both
|
$3,255.81
|
|
|
Service Code
|
HCPCS 24920
|
| Min. Negotiated Rate |
$614.03 |
| Max. Negotiated Rate |
$1,973.68 |
| Rate for Payer: Cash Price |
$879.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$877.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$789.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$789.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$833.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$877.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$833.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$877.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$877.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$657.89
|
| Rate for Payer: Healthfirst Commercial |
$877.19
|
| Rate for Payer: Healthfirst Essential Plan |
$1,973.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$833.33
|
| Rate for Payer: Healthfirst QHP |
$877.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$614.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$877.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$745.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$614.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$877.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$657.89
|
| Rate for Payer: SOMOS Essential |
$657.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$877.19
|
|
|
PR AMPUTATION ARM THRU HUMERUS RE-AMPUTATION
|
Professional
|
Both
|
$3,428.08
|
|
|
Service Code
|
HCPCS 24930
|
| Min. Negotiated Rate |
$646.59 |
| Max. Negotiated Rate |
$2,078.32 |
| Rate for Payer: Cash Price |
$927.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$923.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$831.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$831.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$877.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$923.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$877.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$923.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$692.77
|
| Rate for Payer: Healthfirst Commercial |
$923.70
|
| Rate for Payer: Healthfirst Essential Plan |
$2,078.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$877.51
|
| Rate for Payer: Healthfirst QHP |
$923.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$646.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$923.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$785.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$646.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$923.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$692.77
|
| Rate for Payer: SOMOS Essential |
$692.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$923.70
|
|
|
PR AMPUTATION ARM THRU HUMERUS W/IMPLANT
|
Professional
|
Both
|
$4,122.51
|
|
|
Service Code
|
HCPCS 24931
|
| Min. Negotiated Rate |
$775.28 |
| Max. Negotiated Rate |
$2,491.97 |
| Rate for Payer: Cash Price |
$1,111.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,107.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$996.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$996.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,052.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,107.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,052.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,107.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,107.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$830.65
|
| Rate for Payer: Healthfirst Commercial |
$1,107.54
|
| Rate for Payer: Healthfirst Essential Plan |
$2,491.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,052.16
|
| Rate for Payer: Healthfirst QHP |
$1,107.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$775.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,107.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$941.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$775.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,107.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$830.65
|
| Rate for Payer: SOMOS Essential |
$830.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,107.54
|
|
|
PR AMPUTATION ARM THRU HUMERUS W/PRIMARY CLOSURE
|
Professional
|
Both
|
$3,269.14
|
|
|
Service Code
|
HCPCS 24900
|
| Min. Negotiated Rate |
$639.58 |
| Max. Negotiated Rate |
$2,055.80 |
| Rate for Payer: Cash Price |
$887.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$913.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$822.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$822.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$868.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$913.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$868.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$913.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$913.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$685.27
|
| Rate for Payer: Healthfirst Commercial |
$913.69
|
| Rate for Payer: Healthfirst Essential Plan |
$2,055.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$868.01
|
| Rate for Payer: Healthfirst QHP |
$913.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$639.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$913.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$776.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$639.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$913.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$685.27
|
| Rate for Payer: SOMOS Essential |
$685.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$913.69
|
|
|
PR AMPUTATION FOOT MIDTARSAL
|
Professional
|
Both
|
$2,221.52
|
|
|
Service Code
|
HCPCS 28800
|
| Min. Negotiated Rate |
$423.37 |
| Max. Negotiated Rate |
$1,360.85 |
| Rate for Payer: Cash Price |
$608.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$604.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$544.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$544.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$574.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$604.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$574.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$604.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$604.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$453.62
|
| Rate for Payer: Healthfirst Commercial |
$604.82
|
| Rate for Payer: Healthfirst Essential Plan |
$1,360.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$574.58
|
| Rate for Payer: Healthfirst QHP |
$604.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$423.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$604.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$514.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$423.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$604.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$453.62
|
| Rate for Payer: SOMOS Essential |
$453.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$604.82
|
|
|
PR AMPUTATION FOOT TRANSMETARSAL
|
Professional
|
Both
|
$2,994.25
|
|
|
Service Code
|
HCPCS 28805
|
| Min. Negotiated Rate |
$563.98 |
| Max. Negotiated Rate |
$1,812.80 |
| Rate for Payer: Cash Price |
$812.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$805.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$725.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$725.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$765.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$805.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$765.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$805.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$805.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$604.27
|
| Rate for Payer: Healthfirst Commercial |
$805.69
|
| Rate for Payer: Healthfirst Essential Plan |
$1,812.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$765.41
|
| Rate for Payer: Healthfirst QHP |
$805.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$563.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$805.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$684.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$563.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$805.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$604.27
|
| Rate for Payer: SOMOS Essential |
$604.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$805.69
|
|
|
PR AMPUTATION FOREARM THROUGH RADIUS & ULNA
|
Professional
|
Both
|
$3,171.49
|
|
|
Service Code
|
HCPCS 25900
|
| Min. Negotiated Rate |
$602.35 |
| Max. Negotiated Rate |
$1,936.12 |
| Rate for Payer: Cash Price |
$859.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$860.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$774.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$774.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$817.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$860.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$817.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$860.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$860.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$645.38
|
| Rate for Payer: Healthfirst Commercial |
$860.50
|
| Rate for Payer: Healthfirst Essential Plan |
$1,936.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$817.48
|
| Rate for Payer: Healthfirst QHP |
$860.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$602.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$860.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$731.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$602.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$860.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$645.38
|
| Rate for Payer: SOMOS Essential |
$645.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$860.50
|
|
|
PR AMPUTATION LEG THROUGH TIBIA&FIBULA
|
Professional
|
Both
|
$4,024.58
|
|
|
Service Code
|
HCPCS 27880
|
| Min. Negotiated Rate |
$742.20 |
| Max. Negotiated Rate |
$2,385.63 |
| Rate for Payer: Cash Price |
$1,071.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,060.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$954.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$954.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,007.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,060.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,007.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,060.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,060.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$795.21
|
| Rate for Payer: Healthfirst Commercial |
$1,060.28
|
| Rate for Payer: Healthfirst Essential Plan |
$2,385.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,007.27
|
| Rate for Payer: Healthfirst QHP |
$1,060.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$742.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,060.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$901.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$742.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,060.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$795.21
|
| Rate for Payer: SOMOS Essential |
$795.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,060.28
|
|
|
PR AMPUTATION LEG THRU TIBIA&FIBULA OPEN CIRCULAR
|
Professional
|
Both
|
$2,648.73
|
|
|
Service Code
|
HCPCS 27882
|
| Min. Negotiated Rate |
$490.04 |
| Max. Negotiated Rate |
$1,575.11 |
| Rate for Payer: Cash Price |
$706.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$700.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$630.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$630.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$665.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$700.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$665.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$700.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$700.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$525.04
|
| Rate for Payer: Healthfirst Commercial |
$700.05
|
| Rate for Payer: Healthfirst Essential Plan |
$1,575.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$665.05
|
| Rate for Payer: Healthfirst QHP |
$700.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$490.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$700.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$595.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$490.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$700.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$525.04
|
| Rate for Payer: SOMOS Essential |
$525.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$700.05
|
|
|
PR AMPUTATION METATARSAL W/TOE SINGLE
|
Professional
|
Both
|
$1,814.23
|
|
|
Service Code
|
HCPCS 28810
|
| Min. Negotiated Rate |
$342.08 |
| Max. Negotiated Rate |
$1,099.55 |
| Rate for Payer: Cash Price |
$494.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$488.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$439.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$439.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$464.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$488.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$464.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$488.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$488.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$366.52
|
| Rate for Payer: Healthfirst Commercial |
$488.69
|
| Rate for Payer: Healthfirst Essential Plan |
$1,099.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$464.26
|
| Rate for Payer: Healthfirst QHP |
$488.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$342.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$488.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$415.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$342.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$488.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$366.52
|
| Rate for Payer: SOMOS Essential |
$366.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$488.69
|
|
|
PR AMPUTATION PENIS COMPLETE
|
Professional
|
Both
|
$3,471.30
|
|
|
Service Code
|
HCPCS 54125
|
| Min. Negotiated Rate |
$662.64 |
| Max. Negotiated Rate |
$2,129.92 |
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$946.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$851.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$851.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$899.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$946.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$899.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$946.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$946.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$709.97
|
| Rate for Payer: Healthfirst Commercial |
$946.63
|
| Rate for Payer: Healthfirst Essential Plan |
$2,129.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$899.30
|
| Rate for Payer: Healthfirst QHP |
$946.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$662.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$946.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$804.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$662.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$946.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$709.97
|
| Rate for Payer: SOMOS Essential |
$709.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$946.63
|
|
|
PR AMPUTATION PENIS PARTIAL
|
Professional
|
Both
|
$2,651.67
|
|
|
Service Code
|
HCPCS 54120
|
| Min. Negotiated Rate |
$506.77 |
| Max. Negotiated Rate |
$1,628.91 |
| Rate for Payer: Cash Price |
$727.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$723.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$651.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$651.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$687.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$723.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$687.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$723.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$723.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$542.97
|
| Rate for Payer: Healthfirst Commercial |
$723.96
|
| Rate for Payer: Healthfirst Essential Plan |
$1,628.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$687.76
|
| Rate for Payer: Healthfirst QHP |
$723.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$506.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$723.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$615.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$506.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$723.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$542.97
|
| Rate for Payer: SOMOS Essential |
$542.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$723.96
|
|
|
PR AMPUTATION PENIS RADICAL W/LYMPH NODES
|
Professional
|
Both
|
$6,290.59
|
|
|
Service Code
|
HCPCS 54135
|
| Min. Negotiated Rate |
$1,194.75 |
| Max. Negotiated Rate |
$3,840.26 |
| Rate for Payer: Cash Price |
$1,717.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,706.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,536.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,536.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,621.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,706.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,621.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,706.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,706.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,280.09
|
| Rate for Payer: Healthfirst Commercial |
$1,706.78
|
| Rate for Payer: Healthfirst Essential Plan |
$3,840.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,621.44
|
| Rate for Payer: Healthfirst QHP |
$1,706.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,194.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,706.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,450.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,194.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,706.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,280.09
|
| Rate for Payer: SOMOS Essential |
$1,280.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,706.78
|
|
|
PR AMPUTATION PENIS RADW/BI INGUINOFEMORAL LMPHADE
|
Professional
|
Both
|
$4,981.94
|
|
|
Service Code
|
HCPCS 54130
|
| Min. Negotiated Rate |
$946.83 |
| Max. Negotiated Rate |
$3,043.39 |
| Rate for Payer: Cash Price |
$1,361.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,352.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,217.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,217.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,284.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,352.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,284.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,352.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,352.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,014.47
|
| Rate for Payer: Healthfirst Commercial |
$1,352.62
|
| Rate for Payer: Healthfirst Essential Plan |
$3,043.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,284.99
|
| Rate for Payer: Healthfirst QHP |
$1,352.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$946.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,352.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,149.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$946.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,352.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,014.47
|
| Rate for Payer: SOMOS Essential |
$1,014.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,352.62
|
|
|
PR AMPUTATION THIGH THROUGH FEMUR ANY LEVEL
|
Professional
|
Both
|
$3,516.00
|
|
|
Service Code
|
HCPCS 27590
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$2,081.95 |
| Rate for Payer: Cash Price |
$937.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$925.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$832.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$832.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$879.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$925.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$879.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$925.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$925.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$693.98
|
| Rate for Payer: Healthfirst Commercial |
$925.31
|
| Rate for Payer: Healthfirst Essential Plan |
$2,081.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$879.04
|
| Rate for Payer: Healthfirst QHP |
$925.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$647.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$925.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$786.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$647.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$925.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$693.98
|
| Rate for Payer: SOMOS Essential |
$693.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$925.31
|
|
|
PR AMPUTATION THIGH THROUGH FEMUR RE-AMPUTATION
|
Professional
|
Both
|
$3,185.32
|
|
|
Service Code
|
HCPCS 27596
|
| Min. Negotiated Rate |
$589.56 |
| Max. Negotiated Rate |
$1,895.02 |
| Rate for Payer: Cash Price |
$849.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$842.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$758.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$758.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$800.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$842.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$800.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$842.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$842.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$631.67
|
| Rate for Payer: Healthfirst Commercial |
$842.23
|
| Rate for Payer: Healthfirst Essential Plan |
$1,895.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$800.12
|
| Rate for Payer: Healthfirst QHP |
$842.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$589.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$842.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$715.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$589.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$842.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$631.67
|
| Rate for Payer: SOMOS Essential |
$631.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$842.23
|
|
|
PR AMPUTATION THIGH THRU FEMUR OPEN CIRCULAR
|
Professional
|
Both
|
$2,999.99
|
|
|
Service Code
|
HCPCS 27592
|
| Min. Negotiated Rate |
$559.98 |
| Max. Negotiated Rate |
$1,799.93 |
| Rate for Payer: Cash Price |
$801.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$799.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$719.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$719.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$759.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$799.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$759.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$799.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$799.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$599.98
|
| Rate for Payer: Healthfirst Commercial |
$799.97
|
| Rate for Payer: Healthfirst Essential Plan |
$1,799.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$759.97
|
| Rate for Payer: Healthfirst QHP |
$799.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$559.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$799.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$679.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$559.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$799.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$599.98
|
| Rate for Payer: SOMOS Essential |
$599.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$799.97
|
|
|
PR AMPUTATION TOE INTERPHALANGEAL JOINT
|
Professional
|
Both
|
$720.83
|
|
|
Service Code
|
HCPCS 28825
|
| Min. Negotiated Rate |
$137.14 |
| Max. Negotiated Rate |
$440.82 |
| Rate for Payer: Cash Price |
$197.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$195.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$176.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$176.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$186.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$195.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$186.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$146.94
|
| Rate for Payer: Healthfirst Commercial |
$195.92
|
| Rate for Payer: Healthfirst Essential Plan |
$440.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$186.12
|
| Rate for Payer: Healthfirst QHP |
$195.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$137.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$195.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$166.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$137.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$195.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$146.94
|
| Rate for Payer: SOMOS Essential |
$146.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$195.92
|
|
|
PR AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$748.62
|
|
|
Service Code
|
HCPCS 28820
|
| Min. Negotiated Rate |
$140.53 |
| Max. Negotiated Rate |
$451.71 |
| Rate for Payer: Cash Price |
$202.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$200.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$180.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$180.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$190.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$200.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$190.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$150.57
|
| Rate for Payer: Healthfirst Commercial |
$200.76
|
| Rate for Payer: Healthfirst Essential Plan |
$451.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$190.72
|
| Rate for Payer: Healthfirst QHP |
$200.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$140.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$200.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$170.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$140.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$200.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$150.57
|
| Rate for Payer: SOMOS Essential |
$150.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$200.76
|
|
|
PR ANALYSIS COCHLEAR IMPLT 7 YR/> PRGRMG
|
Professional
|
Both
|
$473.59
|
|
|
Service Code
|
HCPCS 92603
|
| Min. Negotiated Rate |
$69.77 |
| Max. Negotiated Rate |
$289.64 |
| Rate for Payer: Amida Care Medicaid |
$69.77
|
| Rate for Payer: Cash Price |
$129.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$128.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$115.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$115.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$122.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$128.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$122.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$128.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.55
|
| Rate for Payer: Healthfirst Commercial |
$128.73
|
| Rate for Payer: Healthfirst Essential Plan |
$289.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$122.29
|
| Rate for Payer: Healthfirst QHP |
$128.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$90.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$128.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$109.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$90.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$128.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$96.55
|
| Rate for Payer: SOMOS Essential |
$96.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$128.73
|
|
|
PR ANALYSIS COCHLEAR IMPLT 7 YR/> SBSQ REPRGRMG
|
Professional
|
Both
|
$265.27
|
|
|
Service Code
|
HCPCS 92604
|
| Min. Negotiated Rate |
$41.01 |
| Max. Negotiated Rate |
$161.32 |
| Rate for Payer: Amida Care Medicaid |
$41.01
|
| Rate for Payer: Cash Price |
$71.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$71.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$64.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$68.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$71.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$68.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.77
|
| Rate for Payer: Healthfirst Commercial |
$71.70
|
| Rate for Payer: Healthfirst Essential Plan |
$161.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.11
|
| Rate for Payer: Healthfirst QHP |
$71.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$50.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$71.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$60.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$71.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$53.77
|
| Rate for Payer: SOMOS Essential |
$53.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.70
|
|
|
PR ANALYSIS COCHLEAR IMPLT PT <7 YR PRGRMG
|
Professional
|
Both
|
$487.06
|
|
|
Service Code
|
HCPCS 92601
|
| Min. Negotiated Rate |
$83.80 |
| Max. Negotiated Rate |
$297.90 |
| Rate for Payer: Amida Care Medicaid |
$83.80
|
| Rate for Payer: Cash Price |
$133.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$132.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$119.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$119.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$125.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$132.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$125.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$132.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$132.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$99.30
|
| Rate for Payer: Healthfirst Commercial |
$132.40
|
| Rate for Payer: Healthfirst Essential Plan |
$297.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.78
|
| Rate for Payer: Healthfirst QHP |
$132.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$132.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$112.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$92.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$132.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$99.30
|
| Rate for Payer: SOMOS Essential |
$99.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$132.40
|
|
|
PR ANALYSIS COCHLEAR IMPLT PT <7 YR SBSQ REPRGRMG
|
Professional
|
Both
|
$277.27
|
|
|
Service Code
|
HCPCS 92602
|
| Min. Negotiated Rate |
$52.36 |
| Max. Negotiated Rate |
$168.68 |
| Rate for Payer: Amida Care Medicaid |
$52.36
|
| Rate for Payer: Cash Price |
$75.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$74.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$74.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$71.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.23
|
| Rate for Payer: Healthfirst Commercial |
$74.97
|
| Rate for Payer: Healthfirst Essential Plan |
$168.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$71.22
|
| Rate for Payer: Healthfirst QHP |
$74.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$74.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56.23
|
| Rate for Payer: SOMOS Essential |
$56.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.97
|
|
