|
PR ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION
|
Professional
|
Both
|
$2,579.15
|
|
|
Service Code
|
HCPCS 93650
|
| Min. Negotiated Rate |
$306.03 |
| Max. Negotiated Rate |
$1,507.99 |
| Rate for Payer: Amida Care Medicaid |
$306.03
|
| Rate for Payer: Cash Price |
$676.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$670.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$603.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$603.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$636.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$670.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$636.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$670.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$670.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$502.67
|
| Rate for Payer: Healthfirst Commercial |
$670.22
|
| Rate for Payer: Healthfirst Essential Plan |
$1,507.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$636.71
|
| Rate for Payer: Healthfirst QHP |
$670.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$469.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$670.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$569.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$469.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$670.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$502.67
|
| Rate for Payer: SOMOS Essential |
$502.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$670.22
|
|
|
PR ICRA CRV APPL OCCLUDING CLAMP CRV CRTD ART
|
Professional
|
Both
|
$6,557.22
|
|
|
Service Code
|
HCPCS 61703
|
| Min. Negotiated Rate |
$1,202.89 |
| Max. Negotiated Rate |
$3,866.42 |
| Rate for Payer: Cash Price |
$1,732.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,718.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,546.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,546.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,632.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,718.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,632.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,718.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,718.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,288.81
|
| Rate for Payer: Healthfirst Commercial |
$1,718.41
|
| Rate for Payer: Healthfirst Essential Plan |
$3,866.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,632.49
|
| Rate for Payer: Healthfirst QHP |
$1,718.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,202.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,718.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,460.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,202.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,718.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,288.81
|
| Rate for Payer: SOMOS Essential |
$1,288.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,718.41
|
|
|
PR IC TSTS W/ALLGIC XTRCS DLYD TYP RXN W/READING
|
Professional
|
Both
|
$55.93
|
|
|
Service Code
|
HCPCS 95028
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Amida Care Medicaid |
$5.79
|
| Rate for Payer: Cash Price |
$15.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.94
|
| Rate for Payer: Healthfirst Commercial |
$14.59
|
| Rate for Payer: Healthfirst Essential Plan |
$32.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.86
|
| Rate for Payer: Healthfirst QHP |
$14.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.94
|
| Rate for Payer: SOMOS Essential |
$10.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.59
|
|
|
PR I&D ABSCESS PERITONSILLAR
|
Professional
|
Both
|
$589.51
|
|
|
Service Code
|
HCPCS 42700
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Cash Price |
$160.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$160.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$144.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$144.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$152.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$160.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$152.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$160.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$120.00
|
| Rate for Payer: Healthfirst Commercial |
$160.00
|
| Rate for Payer: Healthfirst Essential Plan |
$360.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$152.00
|
| Rate for Payer: Healthfirst QHP |
$160.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$112.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$160.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$136.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$112.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$160.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$120.00
|
| Rate for Payer: SOMOS Essential |
$120.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$160.00
|
|
|
PR I&D ABSC RTRPHRNGL/PARAPHARYNGEAL INTRAORAL
|
Professional
|
Both
|
$1,653.82
|
|
|
Service Code
|
HCPCS 42720
|
| Min. Negotiated Rate |
$311.75 |
| Max. Negotiated Rate |
$1,002.04 |
| Rate for Payer: Cash Price |
$449.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$445.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$400.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$400.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$423.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$445.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$423.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$445.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$445.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$334.01
|
| Rate for Payer: Healthfirst Commercial |
$445.35
|
| Rate for Payer: Healthfirst Essential Plan |
$1,002.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$423.08
|
| Rate for Payer: Healthfirst QHP |
$445.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$311.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$445.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$378.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$311.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$445.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$334.01
|
| Rate for Payer: SOMOS Essential |
$334.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$445.35
|
|
|
PR I&D ABSC RTRPHRNGL/PARAPHARYNGEAL XTRNL APPR
|
Professional
|
Both
|
$3,432.73
|
|
|
Service Code
|
HCPCS 42725
|
| Min. Negotiated Rate |
$650.36 |
| Max. Negotiated Rate |
$2,090.43 |
| Rate for Payer: Cash Price |
$935.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$929.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$836.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$836.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$882.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$929.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$882.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$929.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$929.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$696.81
|
| Rate for Payer: Healthfirst Commercial |
$929.08
|
| Rate for Payer: Healthfirst Essential Plan |
$2,090.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$882.63
|
| Rate for Payer: Healthfirst QHP |
$929.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$650.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$929.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$789.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$650.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$929.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$696.81
|
| Rate for Payer: SOMOS Essential |
$696.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$929.08
|
|
|
PR I&D BELOW FASCIA FOOT 1 BURSAL SPACE
|
Professional
|
Both
|
$577.40
|
|
|
Service Code
|
HCPCS 28002
|
| Min. Negotiated Rate |
$109.72 |
| Max. Negotiated Rate |
$352.69 |
| Rate for Payer: Cash Price |
$158.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$156.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$141.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$148.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$156.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$148.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$156.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$117.56
|
| Rate for Payer: Healthfirst Commercial |
$156.75
|
| Rate for Payer: Healthfirst Essential Plan |
$352.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$148.91
|
| Rate for Payer: Healthfirst QHP |
$156.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$109.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$156.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$133.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$109.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$156.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$117.56
|
| Rate for Payer: SOMOS Essential |
$117.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$156.75
|
|
|
PR I&D BELOW FASCIA FOOT MULTIPLE AREAS
|
Professional
|
Both
|
$1,089.97
|
|
|
Service Code
|
HCPCS 28003
|
| Min. Negotiated Rate |
$202.04 |
| Max. Negotiated Rate |
$649.42 |
| Rate for Payer: Cash Price |
$292.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$288.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$259.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$259.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$274.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$288.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$274.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$288.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$288.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$216.47
|
| Rate for Payer: Healthfirst Commercial |
$288.63
|
| Rate for Payer: Healthfirst Essential Plan |
$649.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$274.20
|
| Rate for Payer: Healthfirst QHP |
$288.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$202.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$288.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$245.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$202.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$288.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$216.47
|
| Rate for Payer: SOMOS Essential |
$216.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$288.63
|
|
|
PR I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION
|
Professional
|
Both
|
$2,254.46
|
|
|
Service Code
|
HCPCS 27301
|
| Min. Negotiated Rate |
$426.71 |
| Max. Negotiated Rate |
$1,371.56 |
| Rate for Payer: Cash Price |
$612.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$609.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$548.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$548.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$579.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$609.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$579.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$609.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$609.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$457.19
|
| Rate for Payer: Healthfirst Commercial |
$609.58
|
| Rate for Payer: Healthfirst Essential Plan |
$1,371.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$579.10
|
| Rate for Payer: Healthfirst QHP |
$609.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$426.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$609.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$518.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$426.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$609.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$457.19
|
| Rate for Payer: SOMOS Essential |
$457.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$609.58
|
|
|
PR I&D DEEP ABSCESS PST SPINE CRV THRC/CERVICOTHR
|
Professional
|
Both
|
$4,450.36
|
|
|
Service Code
|
HCPCS 22010
|
| Min. Negotiated Rate |
$836.16 |
| Max. Negotiated Rate |
$2,687.65 |
| Rate for Payer: Cash Price |
$1,197.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,194.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,075.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,075.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,134.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,194.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,134.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,194.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,194.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$895.88
|
| Rate for Payer: Healthfirst Commercial |
$1,194.51
|
| Rate for Payer: Healthfirst Essential Plan |
$2,687.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,134.78
|
| Rate for Payer: Healthfirst QHP |
$1,194.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$836.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,194.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,015.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$836.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,194.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$895.88
|
| Rate for Payer: SOMOS Essential |
$895.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,194.51
|
|
|
PR I&D DEEP ABSCESS PST SPINE LUMBAR SAC/LUMBOSAC
|
Professional
|
Both
|
$4,346.76
|
|
|
Service Code
|
HCPCS 22015
|
| Min. Negotiated Rate |
$808.49 |
| Max. Negotiated Rate |
$2,598.70 |
| Rate for Payer: Cash Price |
$1,160.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,154.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,039.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,039.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,097.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,154.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,097.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,154.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,154.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$866.24
|
| Rate for Payer: Healthfirst Commercial |
$1,154.98
|
| Rate for Payer: Healthfirst Essential Plan |
$2,598.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,097.23
|
| Rate for Payer: Healthfirst QHP |
$1,154.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$808.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,154.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$981.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$808.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,154.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$866.24
|
| Rate for Payer: SOMOS Essential |
$866.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,154.98
|
|
|
PR I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX
|
Professional
|
Both
|
$1,479.38
|
|
|
Service Code
|
HCPCS 21501
|
| Min. Negotiated Rate |
$282.53 |
| Max. Negotiated Rate |
$908.12 |
| Rate for Payer: Cash Price |
$404.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$403.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$363.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$363.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$383.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$403.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$383.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$403.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$403.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$302.71
|
| Rate for Payer: Healthfirst Commercial |
$403.61
|
| Rate for Payer: Healthfirst Essential Plan |
$908.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$383.43
|
| Rate for Payer: Healthfirst QHP |
$403.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$282.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$403.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$343.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$282.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$403.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$302.71
|
| Rate for Payer: SOMOS Essential |
$302.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$403.61
|
|
|
PR I&D DP ABSC/HMTMA SOFT TISS NCK/THORAX PRTL RI
|
Professional
|
Both
|
$2,280.36
|
|
|
Service Code
|
HCPCS 21502
|
| Min. Negotiated Rate |
$425.73 |
| Max. Negotiated Rate |
$1,368.43 |
| Rate for Payer: Cash Price |
$611.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$608.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$547.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$547.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$577.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$608.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$577.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$608.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$608.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$456.14
|
| Rate for Payer: Healthfirst Commercial |
$608.19
|
| Rate for Payer: Healthfirst Essential Plan |
$1,368.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$577.78
|
| Rate for Payer: Healthfirst QHP |
$608.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$425.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$608.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$516.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$425.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$608.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$456.14
|
| Rate for Payer: SOMOS Essential |
$456.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$608.19
|
|
|
PR I&D DP SUPRALEVATOR PELVIRCT/RETRORCT ABSC
|
Professional
|
Both
|
$2,535.30
|
|
|
Service Code
|
HCPCS 45020
|
| Min. Negotiated Rate |
$473.99 |
| Max. Negotiated Rate |
$1,523.54 |
| Rate for Payer: Cash Price |
$672.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$677.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$609.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$609.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$643.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$677.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$643.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$677.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$677.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$507.85
|
| Rate for Payer: Healthfirst Commercial |
$677.13
|
| Rate for Payer: Healthfirst Essential Plan |
$1,523.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$643.27
|
| Rate for Payer: Healthfirst QHP |
$677.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$473.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$677.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$575.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$473.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$677.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$507.85
|
| Rate for Payer: SOMOS Essential |
$507.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$677.13
|
|
|
PR I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE
|
Professional
|
Both
|
$898.56
|
|
|
Service Code
|
HCPCS 54700
|
| Min. Negotiated Rate |
$173.35 |
| Max. Negotiated Rate |
$557.19 |
| Rate for Payer: Cash Price |
$247.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$247.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$222.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$222.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$235.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$247.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$235.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$247.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$247.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$185.73
|
| Rate for Payer: Healthfirst Commercial |
$247.64
|
| Rate for Payer: Healthfirst Essential Plan |
$557.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$235.26
|
| Rate for Payer: Healthfirst QHP |
$247.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$173.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$247.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$210.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$173.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$247.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$185.73
|
| Rate for Payer: SOMOS Essential |
$185.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$247.64
|
|
|
PR I&D FOREARM&/WRIST DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$3,056.69
|
|
|
Service Code
|
HCPCS 25028
|
| Min. Negotiated Rate |
$565.36 |
| Max. Negotiated Rate |
$1,817.23 |
| Rate for Payer: Cash Price |
$826.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$807.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$726.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$726.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$767.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$807.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$767.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$807.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$807.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$605.75
|
| Rate for Payer: Healthfirst Commercial |
$807.66
|
| Rate for Payer: Healthfirst Essential Plan |
$1,817.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$767.28
|
| Rate for Payer: Healthfirst QHP |
$807.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$565.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$807.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$686.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$565.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$807.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$605.75
|
| Rate for Payer: SOMOS Essential |
$605.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$807.66
|
|
|
PR I&D HEMATOMA SEROMA/FLUID COLLECTION
|
Professional
|
Both
|
$501.31
|
|
|
Service Code
|
HCPCS 10140
|
| Min. Negotiated Rate |
$96.37 |
| Max. Negotiated Rate |
$309.76 |
| Rate for Payer: Cash Price |
$138.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$137.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$123.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$130.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$137.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$130.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.25
|
| Rate for Payer: Healthfirst Commercial |
$137.67
|
| Rate for Payer: Healthfirst Essential Plan |
$309.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.79
|
| Rate for Payer: Healthfirst QHP |
$137.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$96.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$137.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$117.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$96.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$137.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$103.25
|
| Rate for Payer: SOMOS Essential |
$103.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.67
|
|
|
PR I&D INTRAMURAL IM/ABSC TRANSANAL ANES
|
Professional
|
Both
|
$1,932.77
|
|
|
Service Code
|
HCPCS 46045
|
| Min. Negotiated Rate |
$364.83 |
| Max. Negotiated Rate |
$1,172.65 |
| Rate for Payer: Cash Price |
$524.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$521.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$469.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$469.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$495.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$521.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$495.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$521.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$521.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$390.88
|
| Rate for Payer: Healthfirst Commercial |
$521.18
|
| Rate for Payer: Healthfirst Essential Plan |
$1,172.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$495.12
|
| Rate for Payer: Healthfirst QHP |
$521.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$364.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$521.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$443.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$364.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$521.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$390.88
|
| Rate for Payer: SOMOS Essential |
$390.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$521.18
|
|
|
PR I&D ISCHIORCT/INTRAMURAL ABSC W/WO SETON
|
Professional
|
Both
|
$2,138.57
|
|
|
Service Code
|
HCPCS 46060
|
| Min. Negotiated Rate |
$403.07 |
| Max. Negotiated Rate |
$1,295.60 |
| Rate for Payer: Cash Price |
$577.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$575.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$518.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$518.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$547.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$575.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$547.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$575.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$575.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$431.87
|
| Rate for Payer: Healthfirst Commercial |
$575.82
|
| Rate for Payer: Healthfirst Essential Plan |
$1,295.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$547.03
|
| Rate for Payer: Healthfirst QHP |
$575.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$403.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$575.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$489.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$403.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$575.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$431.87
|
| Rate for Payer: SOMOS Essential |
$431.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$575.82
|
|
|
PR I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX
|
Professional
|
Both
|
$1,884.51
|
|
|
Service Code
|
HCPCS 46040
|
| Min. Negotiated Rate |
$356.95 |
| Max. Negotiated Rate |
$1,147.34 |
| Rate for Payer: Cash Price |
$510.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$509.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$458.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$458.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$484.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$509.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$484.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$509.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$509.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$382.45
|
| Rate for Payer: Healthfirst Commercial |
$509.93
|
| Rate for Payer: Healthfirst Essential Plan |
$1,147.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$484.43
|
| Rate for Payer: Healthfirst QHP |
$509.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$356.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$509.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$433.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$356.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$509.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$382.45
|
| Rate for Payer: SOMOS Essential |
$382.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$509.93
|
|
|
PR I&D OF BARTHOLINS GLAND ABSCESS
|
Professional
|
Both
|
$487.38
|
|
|
Service Code
|
HCPCS 56420
|
| Min. Negotiated Rate |
$89.67 |
| Max. Negotiated Rate |
$288.23 |
| Rate for Payer: Cash Price |
$130.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$128.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$115.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$115.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$121.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$128.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$121.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$128.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.08
|
| Rate for Payer: Healthfirst Commercial |
$128.10
|
| Rate for Payer: Healthfirst Essential Plan |
$288.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$121.69
|
| Rate for Payer: Healthfirst QHP |
$128.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$89.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$128.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$108.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$89.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$128.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$96.08
|
| Rate for Payer: SOMOS Essential |
$96.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$128.10
|
|
|
PR I&D PELVIS/HIP JOINT AREA INFECTED BURSA
|
Professional
|
Both
|
$2,347.63
|
|
|
Service Code
|
HCPCS 26991
|
| Min. Negotiated Rate |
$437.37 |
| Max. Negotiated Rate |
$1,405.85 |
| Rate for Payer: Cash Price |
$634.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$624.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$562.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$562.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$593.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$624.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$593.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$624.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$624.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$468.62
|
| Rate for Payer: Healthfirst Commercial |
$624.82
|
| Rate for Payer: Healthfirst Essential Plan |
$1,405.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$593.58
|
| Rate for Payer: Healthfirst QHP |
$624.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$437.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$624.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$531.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$437.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$624.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$468.62
|
| Rate for Payer: SOMOS Essential |
$468.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$624.82
|
|
|
PR I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$3,022.67
|
|
|
Service Code
|
HCPCS 26990
|
| Min. Negotiated Rate |
$565.30 |
| Max. Negotiated Rate |
$1,817.03 |
| Rate for Payer: Cash Price |
$816.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$807.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$726.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$726.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$767.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$807.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$767.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$807.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$807.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$605.68
|
| Rate for Payer: Healthfirst Commercial |
$807.57
|
| Rate for Payer: Healthfirst Essential Plan |
$1,817.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$767.19
|
| Rate for Payer: Healthfirst QHP |
$807.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$565.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$807.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$686.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$565.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$807.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$605.68
|
| Rate for Payer: SOMOS Essential |
$605.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$807.57
|
|
|
PR I&D PENIS DEEP
|
Professional
|
Both
|
$1,279.01
|
|
|
Service Code
|
HCPCS 54015
|
| Min. Negotiated Rate |
$242.81 |
| Max. Negotiated Rate |
$780.46 |
| Rate for Payer: Cash Price |
$350.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$346.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$312.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$312.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$329.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$346.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$329.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$346.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$346.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$260.15
|
| Rate for Payer: Healthfirst Commercial |
$346.87
|
| Rate for Payer: Healthfirst Essential Plan |
$780.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$329.53
|
| Rate for Payer: Healthfirst QHP |
$346.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$242.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$346.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$294.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$242.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$346.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$260.15
|
| Rate for Payer: SOMOS Essential |
$260.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$346.87
|
|
|
PR I&D PERIANAL ABSCESS SUPERFICIAL
|
Professional
|
Both
|
$446.53
|
|
|
Service Code
|
HCPCS 46050
|
| Min. Negotiated Rate |
$84.30 |
| Max. Negotiated Rate |
$270.97 |
| Rate for Payer: Cash Price |
$120.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$120.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$114.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$120.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$114.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$90.32
|
| Rate for Payer: Healthfirst Commercial |
$120.43
|
| Rate for Payer: Healthfirst Essential Plan |
$270.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$114.41
|
| Rate for Payer: Healthfirst QHP |
$120.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$84.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$120.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$102.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$84.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$120.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$90.32
|
| Rate for Payer: SOMOS Essential |
$90.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$120.43
|
|
