|
PR CORRECTION TRICHIASIS EPILATION OTH/THAN FORCEPS
|
Professional
|
Both
|
$503.90
|
|
|
Service Code
|
HCPCS 67825
|
| Min. Negotiated Rate |
$97.01 |
| Max. Negotiated Rate |
$311.81 |
| Rate for Payer: Cash Price |
$139.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$138.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$124.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$124.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$138.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$138.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$138.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.94
|
| Rate for Payer: Healthfirst Commercial |
$138.58
|
| Rate for Payer: Healthfirst Essential Plan |
$311.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$131.65
|
| Rate for Payer: Healthfirst QHP |
$138.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$97.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$138.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$117.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$97.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$138.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$103.94
|
| Rate for Payer: SOMOS Essential |
$103.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$138.58
|
|
|
PR CORRECTION TRICHIASIS INCCISION LID MARGIN
|
Professional
|
Both
|
$567.98
|
|
|
Service Code
|
HCPCS 67830
|
| Min. Negotiated Rate |
$108.74 |
| Max. Negotiated Rate |
$349.51 |
| Rate for Payer: Cash Price |
$156.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$155.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$139.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$139.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$147.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$155.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$147.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$155.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$155.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$116.50
|
| Rate for Payer: Healthfirst Commercial |
$155.34
|
| Rate for Payer: Healthfirst Essential Plan |
$349.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$147.57
|
| Rate for Payer: Healthfirst QHP |
$155.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$108.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$155.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$132.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$108.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$155.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$116.50
|
| Rate for Payer: SOMOS Essential |
$116.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$155.34
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC DSTL METAR OSTEOT
|
Professional
|
Both
|
$2,136.93
|
|
|
Service Code
|
HCPCS 28296
|
| Min. Negotiated Rate |
$414.36 |
| Max. Negotiated Rate |
$1,331.87 |
| Rate for Payer: Cash Price |
$591.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$591.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$532.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$532.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$562.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$591.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$562.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$591.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$591.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$443.95
|
| Rate for Payer: Healthfirst Commercial |
$591.94
|
| Rate for Payer: Healthfirst Essential Plan |
$1,331.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$562.34
|
| Rate for Payer: Healthfirst QHP |
$591.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$414.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$591.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$503.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$414.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$591.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$443.95
|
| Rate for Payer: SOMOS Essential |
$443.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$591.94
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC JOINT ARTHRODESIS
|
Professional
|
Both
|
$2,556.89
|
|
|
Service Code
|
HCPCS 28297
|
| Min. Negotiated Rate |
$484.32 |
| Max. Negotiated Rate |
$1,556.73 |
| Rate for Payer: Cash Price |
$699.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$691.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$622.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$622.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$657.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$691.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$657.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$691.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$691.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$518.91
|
| Rate for Payer: Healthfirst Commercial |
$691.88
|
| Rate for Payer: Healthfirst Essential Plan |
$1,556.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$657.29
|
| Rate for Payer: Healthfirst QHP |
$691.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$484.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$691.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$588.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$484.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$691.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$518.91
|
| Rate for Payer: SOMOS Essential |
$518.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$691.88
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC PROX METAR OSTEOT
|
Professional
|
Both
|
$2,620.56
|
|
|
Service Code
|
HCPCS 28295
|
| Min. Negotiated Rate |
$488.67 |
| Max. Negotiated Rate |
$1,570.72 |
| Rate for Payer: Cash Price |
$707.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$698.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$628.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$628.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$663.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$698.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$663.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$698.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$698.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$523.58
|
| Rate for Payer: Healthfirst Commercial |
$698.10
|
| Rate for Payer: Healthfirst Essential Plan |
$1,570.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$663.20
|
| Rate for Payer: Healthfirst QHP |
$698.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$488.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$698.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$593.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$488.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$698.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$523.58
|
| Rate for Payer: SOMOS Essential |
$523.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$698.10
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC PROX PHLX OSTEOT
|
Professional
|
Both
|
$2,138.36
|
|
|
Service Code
|
HCPCS 28298
|
| Min. Negotiated Rate |
$410.59 |
| Max. Negotiated Rate |
$1,319.76 |
| Rate for Payer: Cash Price |
$591.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$586.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$527.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$527.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$557.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$586.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$557.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$586.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$586.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$439.92
|
| Rate for Payer: Healthfirst Commercial |
$586.56
|
| Rate for Payer: Healthfirst Essential Plan |
$1,319.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$557.23
|
| Rate for Payer: Healthfirst QHP |
$586.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$410.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$586.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$498.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$410.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$586.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$439.92
|
| Rate for Payer: SOMOS Essential |
$439.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$586.56
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC RESCJ PROX PHLX BASE
|
Professional
|
Both
|
$2,024.40
|
|
|
Service Code
|
HCPCS 28292
|
| Min. Negotiated Rate |
$392.77 |
| Max. Negotiated Rate |
$1,262.47 |
| Rate for Payer: Cash Price |
$562.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$561.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$504.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$504.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$533.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$561.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$533.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$561.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$561.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$420.82
|
| Rate for Payer: Healthfirst Commercial |
$561.10
|
| Rate for Payer: Healthfirst Essential Plan |
$1,262.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$533.04
|
| Rate for Payer: Healthfirst QHP |
$561.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$392.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$561.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$476.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$392.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$561.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$420.82
|
| Rate for Payer: SOMOS Essential |
$420.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$561.10
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC W/DOUBLE OSTEOTOMY
|
Professional
|
Both
|
$2,494.87
|
|
|
Service Code
|
HCPCS 28299
|
| Min. Negotiated Rate |
$482.20 |
| Max. Negotiated Rate |
$1,549.93 |
| Rate for Payer: Cash Price |
$691.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$688.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$619.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$619.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$654.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$688.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$654.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$688.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$688.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$516.64
|
| Rate for Payer: Healthfirst Commercial |
$688.86
|
| Rate for Payer: Healthfirst Essential Plan |
$1,549.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$654.42
|
| Rate for Payer: Healthfirst QHP |
$688.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$482.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$688.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$585.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$482.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$688.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$516.64
|
| Rate for Payer: SOMOS Essential |
$516.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$688.86
|
|
|
PR CORRJ LAGOPHTHALMOS IMPLTJ UPR EYELID LID LOAD
|
Professional
|
Both
|
$2,030.84
|
|
|
Service Code
|
HCPCS 67912
|
| Min. Negotiated Rate |
$383.96 |
| Max. Negotiated Rate |
$1,234.17 |
| Rate for Payer: Cash Price |
$556.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$548.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$493.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$493.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$521.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$548.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$521.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$548.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$548.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$411.39
|
| Rate for Payer: Healthfirst Commercial |
$548.52
|
| Rate for Payer: Healthfirst Essential Plan |
$1,234.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$521.09
|
| Rate for Payer: Healthfirst QHP |
$548.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$383.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$548.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$466.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$383.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$548.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$411.39
|
| Rate for Payer: SOMOS Essential |
$411.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$548.52
|
|
|
PR CORRJ MALROTATION BANDS&/RDCTJ VOLVULUS
|
Professional
|
Both
|
$6,688.43
|
|
|
Service Code
|
HCPCS 44055
|
| Min. Negotiated Rate |
$1,244.42 |
| Max. Negotiated Rate |
$3,999.91 |
| Rate for Payer: Cash Price |
$1,785.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,777.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,599.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,599.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,688.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,777.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,688.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,777.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,777.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,333.31
|
| Rate for Payer: Healthfirst Commercial |
$1,777.74
|
| Rate for Payer: Healthfirst Essential Plan |
$3,999.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,688.85
|
| Rate for Payer: Healthfirst QHP |
$1,777.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,244.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,777.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,511.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,244.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,777.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,333.31
|
| Rate for Payer: SOMOS Essential |
$1,333.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,777.74
|
|
|
PR CORRJ TRICHIASIS INC LID MRGN W/FR MUC MEMB GRF
|
Professional
|
Both
|
$1,818.99
|
|
|
Service Code
|
HCPCS 67835
|
| Min. Negotiated Rate |
$348.26 |
| Max. Negotiated Rate |
$1,119.40 |
| Rate for Payer: Cash Price |
$500.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$497.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$447.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$447.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$472.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$497.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$472.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$497.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$497.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$373.13
|
| Rate for Payer: Healthfirst Commercial |
$497.51
|
| Rate for Payer: Healthfirst Essential Plan |
$1,119.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$472.63
|
| Rate for Payer: Healthfirst QHP |
$497.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$348.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$497.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$422.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$348.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$497.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$373.13
|
| Rate for Payer: SOMOS Essential |
$373.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$497.51
|
|
|
PR COSTOTRANSVERSECTOMY SEPARATE PROCEDURE
|
Professional
|
Both
|
$5,282.10
|
|
|
Service Code
|
HCPCS 21610
|
| Min. Negotiated Rate |
$1,064.43 |
| Max. Negotiated Rate |
$3,421.37 |
| Rate for Payer: Cash Price |
$1,532.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,520.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,368.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,368.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,444.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,520.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,444.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,520.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,520.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,140.46
|
| Rate for Payer: Healthfirst Commercial |
$1,520.61
|
| Rate for Payer: Healthfirst Essential Plan |
$3,421.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,444.58
|
| Rate for Payer: Healthfirst QHP |
$1,520.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,064.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,520.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,292.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,064.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,520.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,140.46
|
| Rate for Payer: SOMOS Essential |
$1,140.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,520.61
|
|
|
PR COSTOVERTEBRAL DCMPRN SPINAL CORD THORACIC 1 SEG
|
Professional
|
Both
|
$8,433.81
|
|
|
Service Code
|
HCPCS 63064
|
| Min. Negotiated Rate |
$1,522.66 |
| Max. Negotiated Rate |
$4,894.27 |
| Rate for Payer: Cash Price |
$2,220.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,175.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,957.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,957.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,066.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,175.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,066.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,175.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,175.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,631.42
|
| Rate for Payer: Healthfirst Commercial |
$2,175.23
|
| Rate for Payer: Healthfirst Essential Plan |
$4,894.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,066.47
|
| Rate for Payer: Healthfirst QHP |
$2,175.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,522.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,175.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,848.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,522.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,175.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,631.42
|
| Rate for Payer: SOMOS Essential |
$1,631.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,175.23
|
|
|
PR COSTOVERTEBRAL DCMPRN SPINE CORD THORACIC EA SEG
|
Professional
|
Both
|
$995.19
|
|
|
Service Code
|
HCPCS 63066
|
| Min. Negotiated Rate |
$180.23 |
| Max. Negotiated Rate |
$579.31 |
| Rate for Payer: Cash Price |
$259.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$257.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$231.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$231.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$244.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$257.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$244.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$257.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$257.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$193.10
|
| Rate for Payer: Healthfirst Commercial |
$257.47
|
| Rate for Payer: Healthfirst Essential Plan |
$579.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$244.60
|
| Rate for Payer: Healthfirst QHP |
$257.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$180.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$257.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$218.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$180.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$257.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$193.10
|
| Rate for Payer: SOMOS Essential |
$193.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$257.47
|
|
|
PR CPAP VENTILATION CPAP INITIATION&MGMT
|
Professional
|
Both
|
$150.43
|
|
|
Service Code
|
HCPCS 94660
|
| Min. Negotiated Rate |
$28.10 |
| Max. Negotiated Rate |
$90.31 |
| Rate for Payer: Cash Price |
$41.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.11
|
| Rate for Payer: Healthfirst Commercial |
$40.14
|
| Rate for Payer: Healthfirst Essential Plan |
$90.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.13
|
| Rate for Payer: Healthfirst QHP |
$40.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.11
|
| Rate for Payer: SOMOS Essential |
$30.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.14
|
|
|
PR CPLX CHRONIC CARE MGMT SVC EA ADDL 30 MIN CAL MO
|
Professional
|
Both
|
$203.35
|
|
|
Service Code
|
HCPCS 99489
|
| Min. Negotiated Rate |
$37.58 |
| Max. Negotiated Rate |
$120.78 |
| Rate for Payer: Cash Price |
$55.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.26
|
| Rate for Payer: Healthfirst Commercial |
$53.68
|
| Rate for Payer: Healthfirst Essential Plan |
$120.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.00
|
| Rate for Payer: Healthfirst QHP |
$53.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.26
|
| Rate for Payer: SOMOS Essential |
$40.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.68
|
|
|
PR CPLX INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ
|
Professional
|
Both
|
$22,350.69
|
|
|
Service Code
|
HCPCS 61698
|
| Min. Negotiated Rate |
$4,063.70 |
| Max. Negotiated Rate |
$13,061.90 |
| Rate for Payer: Cash Price |
$5,864.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,805.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5,224.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,224.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,515.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,805.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,515.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,805.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,805.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4,353.97
|
| Rate for Payer: Healthfirst Commercial |
$5,805.29
|
| Rate for Payer: Healthfirst Essential Plan |
$13,061.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,515.03
|
| Rate for Payer: Healthfirst QHP |
$5,805.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$4,063.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5,805.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4,934.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$4,063.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,805.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,353.97
|
| Rate for Payer: SOMOS Essential |
$4,353.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,805.29
|
|
|
PR CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS
|
Professional
|
Both
|
$638.09
|
|
|
Service Code
|
HCPCS 20985
|
| Min. Negotiated Rate |
$118.22 |
| Max. Negotiated Rate |
$379.98 |
| Rate for Payer: Cash Price |
$169.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$168.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$151.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$151.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$168.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$168.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$168.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$126.66
|
| Rate for Payer: Healthfirst Commercial |
$168.88
|
| Rate for Payer: Healthfirst Essential Plan |
$379.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$160.44
|
| Rate for Payer: Healthfirst QHP |
$168.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$118.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$168.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$143.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$118.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$168.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$126.66
|
| Rate for Payer: SOMOS Essential |
$126.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$168.88
|
|
|
PR CRANFCL ANT CRANIAL FOSSA UNI/BI CRANIOT/OSTEOT
|
Professional
|
Both
|
$14,887.18
|
|
|
Service Code
|
HCPCS 61582
|
| Min. Negotiated Rate |
$2,612.91 |
| Max. Negotiated Rate |
$8,398.64 |
| Rate for Payer: Cash Price |
$3,719.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,732.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,359.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,359.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,546.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,732.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,546.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,732.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,732.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,799.55
|
| Rate for Payer: Healthfirst Commercial |
$3,732.73
|
| Rate for Payer: Healthfirst Essential Plan |
$8,398.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,546.09
|
| Rate for Payer: Healthfirst QHP |
$3,732.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,612.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,732.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,172.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,612.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,732.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,799.55
|
| Rate for Payer: SOMOS Essential |
$2,799.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,732.73
|
|
|
PR CRANFCL ANT CRANIAL FOSSA UNI/BIFRNTL ELEV LOBE
|
Professional
|
Both
|
$13,922.93
|
|
|
Service Code
|
HCPCS 61583
|
| Min. Negotiated Rate |
$2,542.72 |
| Max. Negotiated Rate |
$8,173.01 |
| Rate for Payer: Cash Price |
$3,654.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,632.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,269.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,269.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,450.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,632.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,450.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,632.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,632.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,724.34
|
| Rate for Payer: Healthfirst Commercial |
$3,632.45
|
| Rate for Payer: Healthfirst Essential Plan |
$8,173.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,450.83
|
| Rate for Payer: Healthfirst QHP |
$3,632.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,542.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,632.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,087.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,542.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,632.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,724.34
|
| Rate for Payer: SOMOS Essential |
$2,724.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,632.45
|
|
|
PR CRANIEC CRANIOSYNOSTOSIS FRONT/PARIET BONE FLAP
|
Professional
|
Both
|
$8,245.34
|
|
|
Service Code
|
HCPCS 61556
|
| Min. Negotiated Rate |
$1,509.28 |
| Max. Negotiated Rate |
$4,851.27 |
| Rate for Payer: Cash Price |
$2,175.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,156.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,940.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,940.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,048.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,156.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,048.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,156.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,156.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,617.09
|
| Rate for Payer: Healthfirst Commercial |
$2,156.12
|
| Rate for Payer: Healthfirst Essential Plan |
$4,851.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,048.31
|
| Rate for Payer: Healthfirst QHP |
$2,156.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,509.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,156.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,832.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,509.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,156.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,617.09
|
| Rate for Payer: SOMOS Essential |
$1,617.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,156.12
|
|
|
PR CRANIECT CRANIOSYNOSTOSIS MULT CRANIAL SUTURES
|
Professional
|
Both
|
$7,169.65
|
|
|
Service Code
|
HCPCS 61552
|
| Min. Negotiated Rate |
$1,314.43 |
| Max. Negotiated Rate |
$4,224.96 |
| Rate for Payer: Cash Price |
$1,893.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,877.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,689.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,689.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,783.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,877.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,783.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,877.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,877.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,408.32
|
| Rate for Payer: Healthfirst Commercial |
$1,877.76
|
| Rate for Payer: Healthfirst Essential Plan |
$4,224.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,783.87
|
| Rate for Payer: Healthfirst QHP |
$1,877.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,314.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,877.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,596.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,314.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,877.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,408.32
|
| Rate for Payer: SOMOS Essential |
$1,408.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,877.76
|
|
|
PR CRANIECT/CRANIOT W/WO DURAPLASTY W/LOBECTOMY
|
Professional
|
Both
|
$11,550.60
|
|
|
Service Code
|
HCPCS 61323
|
| Min. Negotiated Rate |
$2,086.15 |
| Max. Negotiated Rate |
$6,705.47 |
| Rate for Payer: Cash Price |
$3,040.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,980.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,682.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,682.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,831.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,980.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,831.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,980.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,980.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,235.16
|
| Rate for Payer: Healthfirst Commercial |
$2,980.21
|
| Rate for Payer: Healthfirst Essential Plan |
$6,705.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,831.20
|
| Rate for Payer: Healthfirst QHP |
$2,980.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,086.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,980.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,533.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,086.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,980.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,235.16
|
| Rate for Payer: SOMOS Essential |
$2,235.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,980.21
|
|
|
PR CRANIECT/CRANIOT W/WO DURAPLASTY W/O LOBECTOMY
|
Professional
|
Both
|
$11,483.89
|
|
|
Service Code
|
HCPCS 61322
|
| Min. Negotiated Rate |
$2,097.08 |
| Max. Negotiated Rate |
$6,740.62 |
| Rate for Payer: Cash Price |
$3,029.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,995.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,696.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,696.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,846.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,995.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,846.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,995.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,995.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,246.87
|
| Rate for Payer: Healthfirst Commercial |
$2,995.83
|
| Rate for Payer: Healthfirst Essential Plan |
$6,740.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,846.04
|
| Rate for Payer: Healthfirst QHP |
$2,995.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,097.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,995.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,546.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,097.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,995.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,246.87
|
| Rate for Payer: SOMOS Essential |
$2,246.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,995.83
|
|
|
PR CRANIECTOMY CRANIOSYNOSTOSIS 1 CRANIAL SUTURE
|
Professional
|
Both
|
$5,751.90
|
|
|
Service Code
|
HCPCS 61550
|
| Min. Negotiated Rate |
$1,059.67 |
| Max. Negotiated Rate |
$3,406.09 |
| Rate for Payer: Cash Price |
$1,525.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,513.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,362.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,362.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,438.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,513.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,438.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,513.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,513.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,135.37
|
| Rate for Payer: Healthfirst Commercial |
$1,513.82
|
| Rate for Payer: Healthfirst Essential Plan |
$3,406.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,438.13
|
| Rate for Payer: Healthfirst QHP |
$1,513.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,059.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,513.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,286.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,059.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,513.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,135.37
|
| Rate for Payer: SOMOS Essential |
$1,135.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,513.82
|
|
