|
PR GROUP BEHAVE COUNS 2-10
|
Professional
|
Both
|
$45.92
|
|
|
Service Code
|
HCPCS G0473
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.31
|
| Rate for Payer: Healthfirst Commercial |
$12.42
|
| Rate for Payer: Healthfirst Essential Plan |
$27.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.80
|
| Rate for Payer: Healthfirst QHP |
$12.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.31
|
| Rate for Payer: SOMOS Essential |
$9.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.42
|
|
|
PR GROUP MNT 2 OR MORE 30 MINS
|
Professional
|
Both
|
$62.79
|
|
|
Service Code
|
HCPCS G0271
|
| Min. Negotiated Rate |
$11.89 |
| Max. Negotiated Rate |
$38.23 |
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.74
|
| Rate for Payer: Healthfirst Commercial |
$16.99
|
| Rate for Payer: Healthfirst Essential Plan |
$38.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.14
|
| Rate for Payer: Healthfirst QHP |
$16.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.74
|
| Rate for Payer: SOMOS Essential |
$12.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.99
|
|
|
PR GROUP PSYCHOTHERAPY
|
Professional
|
Both
|
$90.86
|
|
|
Service Code
|
HCPCS 90853
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$60.14 |
| Rate for Payer: Amida Care Medicaid |
$14.69
|
| Rate for Payer: Cash Price |
$26.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.05
|
| Rate for Payer: Healthfirst Commercial |
$26.73
|
| Rate for Payer: Healthfirst Essential Plan |
$60.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.39
|
| Rate for Payer: Healthfirst QHP |
$26.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.05
|
| Rate for Payer: SOMOS Essential |
$20.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.73
|
|
|
PR GSTRCT PRTL DSTL W/FRMJ INTSTINAL POUCH
|
Professional
|
Both
|
$9,609.46
|
|
|
Service Code
|
HCPCS 43634
|
| Min. Negotiated Rate |
$1,773.35 |
| Max. Negotiated Rate |
$5,700.04 |
| Rate for Payer: Cash Price |
$2,556.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,533.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,280.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,280.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,406.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,533.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,406.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,533.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,533.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,900.01
|
| Rate for Payer: Healthfirst Commercial |
$2,533.35
|
| Rate for Payer: Healthfirst Essential Plan |
$5,700.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,406.68
|
| Rate for Payer: Healthfirst QHP |
$2,533.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,773.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,533.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,153.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,773.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,533.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,900.01
|
| Rate for Payer: SOMOS Essential |
$1,900.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,533.35
|
|
|
PR GSTRCT PRTL DSTL W/GASTRODUODENOSTOMY
|
Professional
|
Both
|
$6,515.81
|
|
|
Service Code
|
HCPCS 43631
|
| Min. Negotiated Rate |
$1,211.60 |
| Max. Negotiated Rate |
$3,894.41 |
| Rate for Payer: Cash Price |
$1,741.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,730.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,557.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,557.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,644.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,730.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,644.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,730.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,730.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,298.14
|
| Rate for Payer: Healthfirst Commercial |
$1,730.85
|
| Rate for Payer: Healthfirst Essential Plan |
$3,894.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,644.31
|
| Rate for Payer: Healthfirst QHP |
$1,730.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,211.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,730.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,471.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,211.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,730.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,298.14
|
| Rate for Payer: SOMOS Essential |
$1,298.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,730.85
|
|
|
PR GSTRCT PRTL DSTL W/GASTROJEJUNOSTOMY
|
Professional
|
Both
|
$9,183.69
|
|
|
Service Code
|
HCPCS 43632
|
| Min. Negotiated Rate |
$1,696.93 |
| Max. Negotiated Rate |
$5,454.40 |
| Rate for Payer: Cash Price |
$2,443.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,424.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,181.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,181.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,302.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,424.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,302.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,424.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,424.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,818.13
|
| Rate for Payer: Healthfirst Commercial |
$2,424.18
|
| Rate for Payer: Healthfirst Essential Plan |
$5,454.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,302.97
|
| Rate for Payer: Healthfirst QHP |
$2,424.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,696.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,424.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,060.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,696.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,424.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,818.13
|
| Rate for Payer: SOMOS Essential |
$1,818.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,424.18
|
|
|
PR GSTRCT PRTL DSTL W/ROUX-EN-Y RCNSTJ
|
Professional
|
Both
|
$8,666.28
|
|
|
Service Code
|
HCPCS 43633
|
| Min. Negotiated Rate |
$1,603.97 |
| Max. Negotiated Rate |
$5,155.63 |
| Rate for Payer: Cash Price |
$2,311.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,291.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,062.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,062.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,176.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,291.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,176.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,291.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,291.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,718.54
|
| Rate for Payer: Healthfirst Commercial |
$2,291.39
|
| Rate for Payer: Healthfirst Essential Plan |
$5,155.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,176.82
|
| Rate for Payer: Healthfirst QHP |
$2,291.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,603.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,291.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,947.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,603.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,291.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,718.54
|
| Rate for Payer: SOMOS Essential |
$1,718.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,291.39
|
|
|
PR GSTRCT TOT W/ESOPHAGOENTEROSTOMY
|
Professional
|
Both
|
$8,972.01
|
|
|
Service Code
|
HCPCS 43620
|
| Min. Negotiated Rate |
$1,655.46 |
| Max. Negotiated Rate |
$5,321.14 |
| Rate for Payer: Cash Price |
$2,385.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,364.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,128.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,128.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,246.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,364.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,246.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,364.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,364.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,773.71
|
| Rate for Payer: Healthfirst Commercial |
$2,364.95
|
| Rate for Payer: Healthfirst Essential Plan |
$5,321.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,246.70
|
| Rate for Payer: Healthfirst QHP |
$2,364.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,655.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,364.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,010.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,655.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,364.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,773.71
|
| Rate for Payer: SOMOS Essential |
$1,773.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,364.95
|
|
|
PR GSTRCT TOT W/FRMJ INTSTINAL POUCH ANY TYPE
|
Professional
|
Both
|
$10,451.81
|
|
|
Service Code
|
HCPCS 43622
|
| Min. Negotiated Rate |
$1,927.25 |
| Max. Negotiated Rate |
$6,194.72 |
| Rate for Payer: Cash Price |
$2,778.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,753.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,477.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,477.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,615.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,753.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,615.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,753.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,753.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,064.91
|
| Rate for Payer: Healthfirst Commercial |
$2,753.21
|
| Rate for Payer: Healthfirst Essential Plan |
$6,194.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,615.55
|
| Rate for Payer: Healthfirst QHP |
$2,753.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,927.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,753.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,340.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,927.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,753.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,064.91
|
| Rate for Payer: SOMOS Essential |
$2,064.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,753.21
|
|
|
PR GSTRCT TOT W/ROUX-EN-Y RCNSTJ
|
Professional
|
Both
|
$10,224.76
|
|
|
Service Code
|
HCPCS 43621
|
| Min. Negotiated Rate |
$1,892.53 |
| Max. Negotiated Rate |
$6,083.12 |
| Rate for Payer: Cash Price |
$2,727.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,703.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,433.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,433.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,568.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,703.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,568.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,703.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,703.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,027.71
|
| Rate for Payer: Healthfirst Commercial |
$2,703.61
|
| Rate for Payer: Healthfirst Essential Plan |
$6,083.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,568.43
|
| Rate for Payer: Healthfirst QHP |
$2,703.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,892.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,703.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,298.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,892.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,703.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,027.71
|
| Rate for Payer: SOMOS Essential |
$2,027.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,703.61
|
|
|
PR GSTR RSTCV OPN RMVL & RPLCMT SUBQ PORT
|
Professional
|
Both
|
$2,100.98
|
|
|
Service Code
|
HCPCS 43888
|
| Min. Negotiated Rate |
$392.55 |
| Max. Negotiated Rate |
$1,261.76 |
| Rate for Payer: Cash Price |
$563.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$560.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$504.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$504.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$532.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$560.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$532.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$560.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$560.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$420.58
|
| Rate for Payer: Healthfirst Commercial |
$560.78
|
| Rate for Payer: Healthfirst Essential Plan |
$1,261.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$532.74
|
| Rate for Payer: Healthfirst QHP |
$560.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$392.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$560.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$476.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$392.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$560.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$420.58
|
| Rate for Payer: SOMOS Essential |
$420.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$560.78
|
|
|
PR GSTR RSTCV PX OPN REVJ SUBQ PORT COMPONENT ONLY
|
Professional
|
Both
|
$1,658.86
|
|
|
Service Code
|
HCPCS 43886
|
| Min. Negotiated Rate |
$310.32 |
| Max. Negotiated Rate |
$997.47 |
| Rate for Payer: Cash Price |
$447.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$443.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$398.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$398.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$421.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$443.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$421.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$443.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$443.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$332.49
|
| Rate for Payer: Healthfirst Commercial |
$443.32
|
| Rate for Payer: Healthfirst Essential Plan |
$997.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$421.15
|
| Rate for Payer: Healthfirst QHP |
$443.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$310.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$443.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$376.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$310.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$443.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$332.49
|
| Rate for Payer: SOMOS Essential |
$332.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$443.32
|
|
|
PR GSTR RSTCV PX OPN RMVL SUBQ PORT COMPONENT ONLY
|
Professional
|
Both
|
$1,496.39
|
|
|
Service Code
|
HCPCS 43887
|
| Min. Negotiated Rate |
$281.54 |
| Max. Negotiated Rate |
$904.95 |
| Rate for Payer: Cash Price |
$404.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$402.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$361.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$361.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$382.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$402.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$382.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$402.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$402.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$301.65
|
| Rate for Payer: Healthfirst Commercial |
$402.20
|
| Rate for Payer: Healthfirst Essential Plan |
$904.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$382.09
|
| Rate for Payer: Healthfirst QHP |
$402.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$281.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$402.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$341.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$281.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$402.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$301.65
|
| Rate for Payer: SOMOS Essential |
$301.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$402.20
|
|
|
PR GSTR RSTCV W/O BYP OTH/THN VER-BANDED GSTP
|
Professional
|
Both
|
$5,814.31
|
|
|
Service Code
|
HCPCS 43843
|
| Min. Negotiated Rate |
$1,076.33 |
| Max. Negotiated Rate |
$3,459.64 |
| Rate for Payer: Cash Price |
$1,549.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,537.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,383.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,383.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,460.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,537.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,460.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,537.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,537.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,153.21
|
| Rate for Payer: Healthfirst Commercial |
$1,537.62
|
| Rate for Payer: Healthfirst Essential Plan |
$3,459.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,460.74
|
| Rate for Payer: Healthfirst QHP |
$1,537.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,076.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,537.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,306.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,076.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,537.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,153.21
|
| Rate for Payer: SOMOS Essential |
$1,153.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,537.62
|
|
|
PR GSTRT W/ESOPHGL DILAT&INSJ PRM INTRAL TUBE
|
Professional
|
Both
|
$4,299.02
|
|
|
Service Code
|
HCPCS 43510
|
| Min. Negotiated Rate |
$798.50 |
| Max. Negotiated Rate |
$2,566.60 |
| Rate for Payer: Cash Price |
$1,148.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,140.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,026.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,026.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,083.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,140.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,083.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,140.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,140.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$855.53
|
| Rate for Payer: Healthfirst Commercial |
$1,140.71
|
| Rate for Payer: Healthfirst Essential Plan |
$2,566.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,083.67
|
| Rate for Payer: Healthfirst QHP |
$1,140.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$798.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,140.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$969.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$798.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,140.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$855.53
|
| Rate for Payer: SOMOS Essential |
$855.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,140.71
|
|
|
PR HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/IMPLT
|
Professional
|
Both
|
$2,024.96
|
|
|
Service Code
|
HCPCS 28291
|
| Min. Negotiated Rate |
$381.20 |
| Max. Negotiated Rate |
$1,225.28 |
| Rate for Payer: Cash Price |
$552.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$544.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$490.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$490.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$517.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$544.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$517.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$544.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$544.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$408.43
|
| Rate for Payer: Healthfirst Commercial |
$544.57
|
| Rate for Payer: Healthfirst Essential Plan |
$1,225.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$517.34
|
| Rate for Payer: Healthfirst QHP |
$544.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$381.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$544.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$462.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$381.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$544.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$408.43
|
| Rate for Payer: SOMOS Essential |
$408.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$544.57
|
|
|
PR HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/O IMPLT
|
Professional
|
Both
|
$1,951.50
|
|
|
Service Code
|
HCPCS 28289
|
| Min. Negotiated Rate |
$375.61 |
| Max. Negotiated Rate |
$1,207.31 |
| Rate for Payer: Cash Price |
$537.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$536.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$482.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$482.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$509.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$536.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$509.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$536.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$536.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$402.44
|
| Rate for Payer: Healthfirst Commercial |
$536.58
|
| Rate for Payer: Healthfirst Essential Plan |
$1,207.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$509.75
|
| Rate for Payer: Healthfirst QHP |
$536.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$375.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$536.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$456.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$375.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$536.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$402.44
|
| Rate for Payer: SOMOS Essential |
$402.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$536.58
|
|
|
PR HARVEST FEMPOP VEIN 1 SGM VASC RCNSTJ PX
|
Professional
|
Both
|
$1,519.14
|
|
|
Service Code
|
HCPCS 35572
|
| Min. Negotiated Rate |
$278.27 |
| Max. Negotiated Rate |
$894.44 |
| Rate for Payer: Cash Price |
$402.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$397.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$357.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$357.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$377.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$397.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$377.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$397.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$397.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$298.15
|
| Rate for Payer: Healthfirst Commercial |
$397.53
|
| Rate for Payer: Healthfirst Essential Plan |
$894.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$377.65
|
| Rate for Payer: Healthfirst QHP |
$397.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$278.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$397.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$337.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$278.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$397.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$298.15
|
| Rate for Payer: SOMOS Essential |
$298.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$397.53
|
|
|
PR HARVESTING CONJUNCIVAL ALLOGRAPHY LIVING DONOR
|
Professional
|
Both
|
$1,696.00
|
|
|
Service Code
|
HCPCS 68371
|
| Min. Negotiated Rate |
$323.57 |
| Max. Negotiated Rate |
$1,040.04 |
| Rate for Payer: Cash Price |
$468.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$462.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$416.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$416.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$439.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$462.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$439.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$462.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$462.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$346.68
|
| Rate for Payer: Healthfirst Commercial |
$462.24
|
| Rate for Payer: Healthfirst Essential Plan |
$1,040.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$439.13
|
| Rate for Payer: Healthfirst QHP |
$462.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$323.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$462.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$392.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$323.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$462.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$346.68
|
| Rate for Payer: SOMOS Essential |
$346.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$462.24
|
|
|
PR HARVEST SKIN TISSUE CLTR SKIN AGRFT 100 CM/<
|
Professional
|
Both
|
$540.05
|
|
|
Service Code
|
HCPCS 15040
|
| Min. Negotiated Rate |
$103.26 |
| Max. Negotiated Rate |
$331.90 |
| Rate for Payer: Cash Price |
$147.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$132.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$132.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$110.63
|
| Rate for Payer: Healthfirst Commercial |
$147.51
|
| Rate for Payer: Healthfirst Essential Plan |
$331.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$140.13
|
| Rate for Payer: Healthfirst QHP |
$147.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$103.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$125.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$103.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$110.63
|
| Rate for Payer: SOMOS Essential |
$110.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.51
|
|
|
PR HARVEST UXTR VEIN 1 SGM LOWER EXTREMITY/CABG PX
|
Professional
|
Both
|
$1,410.40
|
|
|
Service Code
|
HCPCS 35500
|
| Min. Negotiated Rate |
$258.01 |
| Max. Negotiated Rate |
$829.30 |
| Rate for Payer: Cash Price |
$372.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$368.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$331.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$331.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$350.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$368.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$350.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$368.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$368.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$276.44
|
| Rate for Payer: Healthfirst Commercial |
$368.58
|
| Rate for Payer: Healthfirst Essential Plan |
$829.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$350.15
|
| Rate for Payer: Healthfirst QHP |
$368.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$258.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$368.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$313.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$258.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$368.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$276.44
|
| Rate for Payer: SOMOS Essential |
$276.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$368.58
|
|
|
PR HBOT, FULL BODY CHAMBER, 30M
|
Professional
|
Both
|
$732.83
|
|
|
Service Code
|
HCPCS G0277
|
| Min. Negotiated Rate |
$143.56 |
| Max. Negotiated Rate |
$461.45 |
| Rate for Payer: Cash Price |
$215.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$205.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$184.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$184.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$194.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$205.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$194.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$205.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$205.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$153.82
|
| Rate for Payer: Healthfirst Commercial |
$205.09
|
| Rate for Payer: Healthfirst Essential Plan |
$461.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$194.84
|
| Rate for Payer: Healthfirst QHP |
$205.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$143.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$205.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$174.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$143.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$205.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$153.82
|
| Rate for Payer: SOMOS Essential |
$153.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$205.09
|
|
|
PR HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT
|
Professional
|
Both
|
$326.87
|
|
|
Service Code
|
HCPCS 96156
|
| Min. Negotiated Rate |
$66.75 |
| Max. Negotiated Rate |
$214.56 |
| Rate for Payer: Cash Price |
$95.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$95.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$85.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$85.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$90.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$95.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$90.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$95.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$71.52
|
| Rate for Payer: Healthfirst Commercial |
$95.36
|
| Rate for Payer: Healthfirst Essential Plan |
$214.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$90.59
|
| Rate for Payer: Healthfirst QHP |
$95.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$66.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$95.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$81.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$66.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$95.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$71.52
|
| Rate for Payer: SOMOS Essential |
$71.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$95.36
|
|
|
PR HEALTH BEHAVIOR IVNTJ FAM W/PT F2F 1ST 30 MIN
|
Professional
|
Both
|
$233.84
|
|
|
Service Code
|
HCPCS 96167
|
| Min. Negotiated Rate |
$48.43 |
| Max. Negotiated Rate |
$155.68 |
| Rate for Payer: Cash Price |
$66.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$69.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$69.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$69.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$69.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.89
|
| Rate for Payer: Healthfirst Commercial |
$69.19
|
| Rate for Payer: Healthfirst Essential Plan |
$155.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.73
|
| Rate for Payer: Healthfirst QHP |
$69.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$69.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$69.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.89
|
| Rate for Payer: SOMOS Essential |
$51.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69.19
|
|
|
PR HEALTH BEHAVIOR IVNTJ FAM W/PT F2F EA ADD 15 MIN
|
Professional
|
Both
|
$81.69
|
|
|
Service Code
|
HCPCS 96168
|
| Min. Negotiated Rate |
$17.51 |
| Max. Negotiated Rate |
$56.27 |
| Rate for Payer: Cash Price |
$23.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.76
|
| Rate for Payer: Healthfirst Commercial |
$25.01
|
| Rate for Payer: Healthfirst Essential Plan |
$56.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.76
|
| Rate for Payer: Healthfirst QHP |
$25.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$25.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.76
|
| Rate for Payer: SOMOS Essential |
$18.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.01
|
|
