|
PR EXTERNAL ECG REC>7D<15D RECORDING
|
Professional
|
Both
|
$53.06
|
|
|
Service Code
|
HCPCS 93246
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$31.09 |
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.37
|
| Rate for Payer: Healthfirst Commercial |
$13.82
|
| Rate for Payer: Healthfirst Essential Plan |
$31.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.13
|
| Rate for Payer: Healthfirst QHP |
$13.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.37
|
| Rate for Payer: SOMOS Essential |
$10.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.82
|
|
|
PR EXTERNAL ECG REC>7D<15D REVIEW & INTERPRETATION
|
Professional
|
Both
|
$101.68
|
|
|
Service Code
|
HCPCS 93248
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$61.13 |
| Rate for Payer: Amida Care Medicaid |
$13.77
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.38
|
| Rate for Payer: Healthfirst Commercial |
$27.17
|
| Rate for Payer: Healthfirst Essential Plan |
$61.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.81
|
| Rate for Payer: Healthfirst QHP |
$27.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.38
|
| Rate for Payer: SOMOS Essential |
$20.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.17
|
|
|
PR EXTERNAL ECG REC>7D<15D SCAN ALYS REPORT R&I
|
Professional
|
Both
|
$1,189.58
|
|
|
Service Code
|
HCPCS 93245
|
| Min. Negotiated Rate |
$226.11 |
| Max. Negotiated Rate |
$726.79 |
| Rate for Payer: Cash Price |
$318.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$323.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$290.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$290.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$306.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$323.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$306.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$323.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$323.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$242.26
|
| Rate for Payer: Healthfirst Commercial |
$323.02
|
| Rate for Payer: Healthfirst Essential Plan |
$726.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$306.87
|
| Rate for Payer: Healthfirst QHP |
$323.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$226.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$323.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$274.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$226.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$323.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$242.26
|
| Rate for Payer: SOMOS Essential |
$242.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$323.02
|
|
|
PR EXTERNAL ECG REC>7D<15D SCANNING ALYS W/REPORT
|
Professional
|
Both
|
$1,034.85
|
|
|
Service Code
|
HCPCS 93247
|
| Min. Negotiated Rate |
$197.42 |
| Max. Negotiated Rate |
$634.57 |
| Rate for Payer: Cash Price |
$276.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$282.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$253.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$253.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$267.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$282.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$267.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$282.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$211.52
|
| Rate for Payer: Healthfirst Commercial |
$282.03
|
| Rate for Payer: Healthfirst Essential Plan |
$634.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$267.93
|
| Rate for Payer: Healthfirst QHP |
$282.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$197.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$282.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$239.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$197.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$282.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$211.52
|
| Rate for Payer: SOMOS Essential |
$211.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$282.03
|
|
|
PR EXTERNAL ECG SCANNING ANALYSIS REPORT
|
Professional
|
Both
|
$156.56
|
|
|
Service Code
|
HCPCS 93226
|
| Min. Negotiated Rate |
$28.15 |
| Max. Negotiated Rate |
$90.47 |
| Rate for Payer: Cash Price |
$42.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.16
|
| Rate for Payer: Healthfirst Commercial |
$40.21
|
| Rate for Payer: Healthfirst Essential Plan |
$90.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.20
|
| Rate for Payer: Healthfirst QHP |
$40.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.16
|
| Rate for Payer: SOMOS Essential |
$30.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.21
|
|
|
PR EXTRAPLEURAL ENUCLEATION EMPYEMA EMPYEMECTOMY
|
Professional
|
Both
|
$7,656.25
|
|
|
Service Code
|
HCPCS 32540
|
| Min. Negotiated Rate |
$1,417.79 |
| Max. Negotiated Rate |
$4,557.17 |
| Rate for Payer: Cash Price |
$2,048.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,025.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,822.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,822.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,924.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,025.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,924.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,025.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,025.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,519.06
|
| Rate for Payer: Healthfirst Commercial |
$2,025.41
|
| Rate for Payer: Healthfirst Essential Plan |
$4,557.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,924.14
|
| Rate for Payer: Healthfirst QHP |
$2,025.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,417.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,025.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,721.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,417.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,025.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,519.06
|
| Rate for Payer: SOMOS Essential |
$1,519.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,025.41
|
|
|
PR EXTRNL COUNTERPULSE, PER TX
|
Professional
|
Both
|
$453.71
|
|
|
Service Code
|
HCPCS G0166
|
| Min. Negotiated Rate |
$82.16 |
| Max. Negotiated Rate |
$264.08 |
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$117.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$105.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$105.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$111.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$117.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$111.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$117.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$117.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.03
|
| Rate for Payer: Healthfirst Commercial |
$117.37
|
| Rate for Payer: Healthfirst Essential Plan |
$264.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$111.50
|
| Rate for Payer: Healthfirst QHP |
$117.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$117.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$99.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$117.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.03
|
| Rate for Payer: SOMOS Essential |
$88.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$117.37
|
|
|
PR EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5CM/>
|
Professional
|
Both
|
$1,837.68
|
|
|
Service Code
|
HCPCS 26111
|
| Min. Negotiated Rate |
$349.16 |
| Max. Negotiated Rate |
$1,122.30 |
| Rate for Payer: Cash Price |
$499.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$498.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$448.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$448.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$473.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$498.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$473.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$498.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$498.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$374.10
|
| Rate for Payer: Healthfirst Commercial |
$498.80
|
| Rate for Payer: Healthfirst Essential Plan |
$1,122.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$473.86
|
| Rate for Payer: Healthfirst QHP |
$498.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$349.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$498.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$423.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$349.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$498.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$374.10
|
| Rate for Payer: SOMOS Essential |
$374.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$498.80
|
|
|
PR EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/>
|
Professional
|
Both
|
$2,414.41
|
|
|
Service Code
|
HCPCS 26113
|
| Min. Negotiated Rate |
$459.24 |
| Max. Negotiated Rate |
$1,476.13 |
| Rate for Payer: Cash Price |
$656.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$656.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$590.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$590.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$623.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$656.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$623.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$656.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$656.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$492.05
|
| Rate for Payer: Healthfirst Commercial |
$656.06
|
| Rate for Payer: Healthfirst Essential Plan |
$1,476.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$623.26
|
| Rate for Payer: Healthfirst QHP |
$656.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$459.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$656.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$557.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$459.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$656.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$492.05
|
| Rate for Payer: SOMOS Essential |
$492.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$656.06
|
|
|
PR FACIAL NERVE FUNCTION STUDIES
|
Professional
|
Both
|
$94.99
|
|
|
Service Code
|
HCPCS 92516
|
| Min. Negotiated Rate |
$17.37 |
| Max. Negotiated Rate |
$55.84 |
| Rate for Payer: Cash Price |
$25.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.61
|
| Rate for Payer: Healthfirst Commercial |
$24.82
|
| Rate for Payer: Healthfirst Essential Plan |
$55.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.58
|
| Rate for Payer: Healthfirst QHP |
$24.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.61
|
| Rate for Payer: SOMOS Essential |
$18.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.82
|
|
|
PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS
|
Professional
|
Both
|
$368.62
|
|
|
Service Code
|
HCPCS 90846
|
| Min. Negotiated Rate |
$43.35 |
| Max. Negotiated Rate |
$242.78 |
| Rate for Payer: Amida Care Medicaid |
$43.35
|
| Rate for Payer: Cash Price |
$105.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$107.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$97.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$97.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.92
|
| Rate for Payer: Healthfirst Commercial |
$107.90
|
| Rate for Payer: Healthfirst Essential Plan |
$242.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$102.50
|
| Rate for Payer: Healthfirst QHP |
$107.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$107.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$91.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$80.92
|
| Rate for Payer: SOMOS Essential |
$80.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.90
|
|
|
PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS
|
Professional
|
Both
|
$384.02
|
|
|
Service Code
|
HCPCS 90847
|
| Min. Negotiated Rate |
$52.03 |
| Max. Negotiated Rate |
$253.03 |
| Rate for Payer: Amida Care Medicaid |
$52.03
|
| Rate for Payer: Cash Price |
$109.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$112.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$101.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$101.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$106.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$112.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$106.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$84.34
|
| Rate for Payer: Healthfirst Commercial |
$112.46
|
| Rate for Payer: Healthfirst Essential Plan |
$253.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$106.84
|
| Rate for Payer: Healthfirst QHP |
$112.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$112.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$95.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$112.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$84.34
|
| Rate for Payer: SOMOS Essential |
$84.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$112.46
|
|
|
PR FASCIA LATA GRAFT BY STRIPPER
|
Professional
|
Both
|
$1,729.95
|
|
|
Service Code
|
HCPCS 20920
|
| Min. Negotiated Rate |
$326.98 |
| Max. Negotiated Rate |
$1,051.00 |
| Rate for Payer: Cash Price |
$470.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$467.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$420.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$420.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$443.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$467.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$443.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$467.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$467.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$350.33
|
| Rate for Payer: Healthfirst Commercial |
$467.11
|
| Rate for Payer: Healthfirst Essential Plan |
$1,051.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$443.75
|
| Rate for Payer: Healthfirst QHP |
$467.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$326.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$467.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$397.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$326.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$467.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$350.33
|
| Rate for Payer: SOMOS Essential |
$350.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$467.11
|
|
|
PR FASCIA LATA GRAFT INCISION & AREA EXPOSURE
|
Professional
|
Both
|
$2,191.35
|
|
|
Service Code
|
HCPCS 20922
|
| Min. Negotiated Rate |
$417.63 |
| Max. Negotiated Rate |
$1,342.39 |
| Rate for Payer: Cash Price |
$599.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$596.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$536.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$536.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$566.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$596.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$566.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$596.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$596.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$447.46
|
| Rate for Payer: Healthfirst Commercial |
$596.62
|
| Rate for Payer: Healthfirst Essential Plan |
$1,342.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$566.79
|
| Rate for Payer: Healthfirst QHP |
$596.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$417.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$596.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$507.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$417.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$596.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$447.46
|
| Rate for Payer: SOMOS Essential |
$447.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$596.62
|
|
|
PR FASCIECTOMY PLANTAR FASCIA PARTIAL SPX
|
Professional
|
Both
|
$1,512.39
|
|
|
Service Code
|
HCPCS 28060
|
| Min. Negotiated Rate |
$291.60 |
| Max. Negotiated Rate |
$937.28 |
| Rate for Payer: Cash Price |
$418.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$416.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$374.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$374.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$395.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$416.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$395.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$416.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$416.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$312.43
|
| Rate for Payer: Healthfirst Commercial |
$416.57
|
| Rate for Payer: Healthfirst Essential Plan |
$937.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$395.74
|
| Rate for Payer: Healthfirst QHP |
$416.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$291.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$416.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$354.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$291.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$416.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$312.43
|
| Rate for Payer: SOMOS Essential |
$312.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$416.57
|
|
|
PR FASCIOTOMY FOOT&/TOE
|
Professional
|
Both
|
$1,230.43
|
|
|
Service Code
|
HCPCS 28008
|
| Min. Negotiated Rate |
$237.27 |
| Max. Negotiated Rate |
$762.66 |
| Rate for Payer: Cash Price |
$339.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$338.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$305.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$305.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$322.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$338.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$322.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$338.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$338.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$254.22
|
| Rate for Payer: Healthfirst Commercial |
$338.96
|
| Rate for Payer: Healthfirst Essential Plan |
$762.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$322.01
|
| Rate for Payer: Healthfirst QHP |
$338.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$237.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$338.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$288.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$237.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$338.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$254.22
|
| Rate for Payer: SOMOS Essential |
$254.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$338.96
|
|
|
PR FASCIOTOMY HIP/THIGH ANY TYPE
|
Professional
|
Both
|
$4,072.95
|
|
|
Service Code
|
HCPCS 27025
|
| Min. Negotiated Rate |
$780.25 |
| Max. Negotiated Rate |
$2,507.96 |
| Rate for Payer: Cash Price |
$1,109.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,114.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,003.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,003.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,058.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,114.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,058.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,114.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,114.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$835.99
|
| Rate for Payer: Healthfirst Commercial |
$1,114.65
|
| Rate for Payer: Healthfirst Essential Plan |
$2,507.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,058.92
|
| Rate for Payer: Healthfirst QHP |
$1,114.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$780.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,114.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$947.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$780.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,114.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$835.99
|
| Rate for Payer: SOMOS Essential |
$835.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,114.65
|
|
|
PR FASCIOTOMY ILIOTIBIAL OPEN
|
Professional
|
Both
|
$2,148.72
|
|
|
Service Code
|
HCPCS 27305
|
| Min. Negotiated Rate |
$406.90 |
| Max. Negotiated Rate |
$1,307.88 |
| Rate for Payer: Cash Price |
$582.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$581.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$523.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$523.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$552.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$581.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$552.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$581.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$581.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$435.96
|
| Rate for Payer: Healthfirst Commercial |
$581.28
|
| Rate for Payer: Healthfirst Essential Plan |
$1,307.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$552.22
|
| Rate for Payer: Healthfirst QHP |
$581.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$406.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$581.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$494.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$406.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$581.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$435.96
|
| Rate for Payer: SOMOS Essential |
$435.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$581.28
|
|
|
PR FASCIOTOMY PALMAR OPEN PARTIAL
|
Professional
|
Both
|
$2,100.95
|
|
|
Service Code
|
HCPCS 26045
|
| Min. Negotiated Rate |
$398.95 |
| Max. Negotiated Rate |
$1,282.34 |
| Rate for Payer: Cash Price |
$571.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$569.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$512.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$512.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$541.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$569.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$541.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$569.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$569.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$427.45
|
| Rate for Payer: Healthfirst Commercial |
$569.93
|
| Rate for Payer: Healthfirst Essential Plan |
$1,282.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$541.43
|
| Rate for Payer: Healthfirst QHP |
$569.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$398.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$569.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$484.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$398.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$569.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$427.45
|
| Rate for Payer: SOMOS Essential |
$427.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$569.93
|
|
|
PR FASCIOTOMY PALMAR PERCUTANEOUS
|
Professional
|
Both
|
$1,404.83
|
|
|
Service Code
|
HCPCS 26040
|
| Min. Negotiated Rate |
$267.74 |
| Max. Negotiated Rate |
$860.60 |
| Rate for Payer: Cash Price |
$383.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$382.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$344.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$344.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$363.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$382.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$363.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$382.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$382.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$286.87
|
| Rate for Payer: Healthfirst Commercial |
$382.49
|
| Rate for Payer: Healthfirst Essential Plan |
$860.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$363.37
|
| Rate for Payer: Healthfirst QHP |
$382.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$267.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$382.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$325.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$267.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$382.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$286.87
|
| Rate for Payer: SOMOS Essential |
$286.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$382.49
|
|
|
PR FASCIOTOMY PLANTAR FASCIA RADICAL SPX
|
Professional
|
Both
|
$1,683.47
|
|
|
Service Code
|
HCPCS 28062
|
| Min. Negotiated Rate |
$328.29 |
| Max. Negotiated Rate |
$1,055.23 |
| Rate for Payer: Cash Price |
$464.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$468.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$422.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$422.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$445.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$468.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$445.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$468.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$468.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$351.74
|
| Rate for Payer: Healthfirst Commercial |
$468.99
|
| Rate for Payer: Healthfirst Essential Plan |
$1,055.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$445.54
|
| Rate for Payer: Healthfirst QHP |
$468.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$328.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$468.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$398.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$328.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$468.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$351.74
|
| Rate for Payer: SOMOS Essential |
$351.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$468.99
|
|
|
PR FASCT PALM W/WO Z-PLASTY TISSUE REARGMT/SKN GRFT
|
Professional
|
Both
|
$2,655.80
|
|
|
Service Code
|
HCPCS 26121
|
| Min. Negotiated Rate |
$503.08 |
| Max. Negotiated Rate |
$1,617.05 |
| Rate for Payer: Cash Price |
$720.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$718.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$646.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$646.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$682.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$718.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$682.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$718.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$718.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$539.02
|
| Rate for Payer: Healthfirst Commercial |
$718.69
|
| Rate for Payer: Healthfirst Essential Plan |
$1,617.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$682.76
|
| Rate for Payer: Healthfirst QHP |
$718.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$503.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$718.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$610.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$503.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$718.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$539.02
|
| Rate for Payer: SOMOS Essential |
$539.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$718.69
|
|
|
PR FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W/WO RPR
|
Professional
|
Both
|
$3,695.16
|
|
|
Service Code
|
HCPCS 26123
|
| Min. Negotiated Rate |
$700.55 |
| Max. Negotiated Rate |
$2,251.76 |
| Rate for Payer: Cash Price |
$1,003.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,000.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$900.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$900.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$950.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,000.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$950.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,000.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,000.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$750.59
|
| Rate for Payer: Healthfirst Commercial |
$1,000.78
|
| Rate for Payer: Healthfirst Essential Plan |
$2,251.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$950.74
|
| Rate for Payer: Healthfirst QHP |
$1,000.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$700.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,000.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$850.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$700.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,000.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$750.59
|
| Rate for Payer: SOMOS Essential |
$750.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,000.78
|
|
|
PR FASCT PRTL PALMR ADDL DGT PROX IPHAL JT W/WO RPR
|
Professional
|
Both
|
$1,171.10
|
|
|
Service Code
|
HCPCS 26125
|
| Min. Negotiated Rate |
$218.62 |
| Max. Negotiated Rate |
$702.72 |
| Rate for Payer: Cash Price |
$314.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$312.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$281.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$281.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$296.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$312.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$296.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$312.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$312.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$234.24
|
| Rate for Payer: Healthfirst Commercial |
$312.32
|
| Rate for Payer: Healthfirst Essential Plan |
$702.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$296.70
|
| Rate for Payer: Healthfirst QHP |
$312.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$218.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$312.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$265.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$218.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$312.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$234.24
|
| Rate for Payer: SOMOS Essential |
$234.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$312.32
|
|
|
PR FECAL MICROBIOTA PREP INSTIL
|
Professional
|
Both
|
$300.58
|
|
|
Service Code
|
HCPCS G0455
|
| Min. Negotiated Rate |
$55.54 |
| Max. Negotiated Rate |
$178.51 |
| Rate for Payer: Cash Price |
$79.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$79.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.51
|
| Rate for Payer: Healthfirst Commercial |
$79.34
|
| Rate for Payer: Healthfirst Essential Plan |
$178.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$75.37
|
| Rate for Payer: Healthfirst QHP |
$79.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$79.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$67.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$59.51
|
| Rate for Payer: SOMOS Essential |
$59.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.34
|
|
