|
PR INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG
|
Professional
|
Both
|
$207.24
|
|
|
Service Code
|
HCPCS 23350
|
| Min. Negotiated Rate |
$38.77 |
| Max. Negotiated Rate |
$124.61 |
| Rate for Payer: Cash Price |
$55.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$55.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$52.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.53
|
| Rate for Payer: Healthfirst Commercial |
$55.38
|
| Rate for Payer: Healthfirst Essential Plan |
$124.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.61
|
| Rate for Payer: Healthfirst QHP |
$55.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$55.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.53
|
| Rate for Payer: SOMOS Essential |
$41.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.38
|
|
|
PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES
|
Professional
|
Both
|
$156.31
|
|
|
Service Code
|
HCPCS 20552
|
| Min. Negotiated Rate |
$28.73 |
| Max. Negotiated Rate |
$92.34 |
| Rate for Payer: Cash Price |
$42.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.78
|
| Rate for Payer: Healthfirst Commercial |
$41.04
|
| Rate for Payer: Healthfirst Essential Plan |
$92.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.99
|
| Rate for Payer: Healthfirst QHP |
$41.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.78
|
| Rate for Payer: SOMOS Essential |
$30.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.04
|
|
|
PR INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES
|
Professional
|
Both
|
$180.25
|
|
|
Service Code
|
HCPCS 20553
|
| Min. Negotiated Rate |
$32.69 |
| Max. Negotiated Rate |
$105.08 |
| Rate for Payer: Cash Price |
$47.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.02
|
| Rate for Payer: Healthfirst Commercial |
$46.70
|
| Rate for Payer: Healthfirst Essential Plan |
$105.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.37
|
| Rate for Payer: Healthfirst QHP |
$46.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.02
|
| Rate for Payer: SOMOS Essential |
$35.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.70
|
|
|
PR INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Professional
|
Both
|
$165.87
|
|
|
Service Code
|
HCPCS 20551
|
| Min. Negotiated Rate |
$30.24 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Cash Price |
$43.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.40
|
| Rate for Payer: Healthfirst Commercial |
$43.20
|
| Rate for Payer: Healthfirst Essential Plan |
$97.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.04
|
| Rate for Payer: Healthfirst QHP |
$43.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.40
|
| Rate for Payer: SOMOS Essential |
$32.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.20
|
|
|
PR INJECTION SINUS TRACT DIAGNOSTIC
|
Professional
|
Both
|
$150.29
|
|
|
Service Code
|
HCPCS 20501
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$89.08 |
| Rate for Payer: Cash Price |
$40.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.69
|
| Rate for Payer: Healthfirst Commercial |
$39.59
|
| Rate for Payer: Healthfirst Essential Plan |
$89.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.61
|
| Rate for Payer: Healthfirst QHP |
$39.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.69
|
| Rate for Payer: SOMOS Essential |
$29.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.59
|
|
|
PR INJECTION SINUS TRACT THERAPEUTIC SEPARATE PROC
|
Professional
|
Both
|
$380.77
|
|
|
Service Code
|
HCPCS 20500
|
| Min. Negotiated Rate |
$73.11 |
| Max. Negotiated Rate |
$235.01 |
| Rate for Payer: Cash Price |
$103.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$104.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$94.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$94.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$99.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$104.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$99.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$78.34
|
| Rate for Payer: Healthfirst Commercial |
$104.45
|
| Rate for Payer: Healthfirst Essential Plan |
$235.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$99.23
|
| Rate for Payer: Healthfirst QHP |
$104.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$73.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$104.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$88.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$73.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$104.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$78.34
|
| Rate for Payer: SOMOS Essential |
$78.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$104.45
|
|
|
PR INJECTION TEMPOROMANDIBULAR JOINT ARTHROGRAPHY
|
Professional
|
Both
|
$186.59
|
|
|
Service Code
|
HCPCS 21116
|
| Min. Negotiated Rate |
$34.52 |
| Max. Negotiated Rate |
$110.95 |
| Rate for Payer: Cash Price |
$50.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.98
|
| Rate for Payer: Healthfirst Commercial |
$49.31
|
| Rate for Payer: Healthfirst Essential Plan |
$110.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.84
|
| Rate for Payer: Healthfirst QHP |
$49.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.98
|
| Rate for Payer: SOMOS Essential |
$36.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.31
|
|
|
PR INJECTION THERAPEUTIC CARPAL TUNNEL
|
Professional
|
Both
|
$250.36
|
|
|
Service Code
|
HCPCS 20526
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$148.39 |
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$65.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.46
|
| Rate for Payer: Healthfirst Commercial |
$65.95
|
| Rate for Payer: Healthfirst Essential Plan |
$148.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.65
|
| Rate for Payer: Healthfirst QHP |
$65.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$56.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$49.46
|
| Rate for Payer: SOMOS Essential |
$49.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.95
|
|
|
PR INJECTION TURBINATE THERAPEUTIC
|
Professional
|
Both
|
$255.75
|
|
|
Service Code
|
HCPCS 30200
|
| Min. Negotiated Rate |
$49.27 |
| Max. Negotiated Rate |
$158.38 |
| Rate for Payer: Cash Price |
$69.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$63.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$63.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$66.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$66.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.79
|
| Rate for Payer: Healthfirst Commercial |
$70.39
|
| Rate for Payer: Healthfirst Essential Plan |
$158.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$66.87
|
| Rate for Payer: Healthfirst QHP |
$70.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$49.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$70.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$59.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$49.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$52.79
|
| Rate for Payer: SOMOS Essential |
$52.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.39
|
|
|
PR INJECTION WRIST ARTHROGRAPHY
|
Professional
|
Both
|
$300.41
|
|
|
Service Code
|
HCPCS 25246
|
| Min. Negotiated Rate |
$56.67 |
| Max. Negotiated Rate |
$182.16 |
| Rate for Payer: Cash Price |
$81.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$80.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.72
|
| Rate for Payer: Healthfirst Commercial |
$80.96
|
| Rate for Payer: Healthfirst Essential Plan |
$182.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.91
|
| Rate for Payer: Healthfirst QHP |
$80.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.72
|
| Rate for Payer: SOMOS Essential |
$60.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.96
|
|
|
PR INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA
|
Professional
|
Both
|
$343.00
|
|
|
Service Code
|
HCPCS 27096
|
| Min. Negotiated Rate |
$65.82 |
| Max. Negotiated Rate |
$211.57 |
| Rate for Payer: Cash Price |
$93.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$94.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$84.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$84.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$89.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$94.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$89.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$94.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$94.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$70.52
|
| Rate for Payer: Healthfirst Commercial |
$94.03
|
| Rate for Payer: Healthfirst Essential Plan |
$211.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$89.33
|
| Rate for Payer: Healthfirst QHP |
$94.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$65.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$94.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$79.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$65.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$94.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$70.52
|
| Rate for Payer: SOMOS Essential |
$70.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$94.03
|
|
|
PR INJ PX URETEROGRAPHY/URETEROPYLOGRAPHY CATH
|
Professional
|
Both
|
$214.55
|
|
|
Service Code
|
HCPCS 50684
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$129.42 |
| Rate for Payer: Cash Price |
$58.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$57.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$51.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$54.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$57.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$54.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.14
|
| Rate for Payer: Healthfirst Commercial |
$57.52
|
| Rate for Payer: Healthfirst Essential Plan |
$129.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$54.64
|
| Rate for Payer: Healthfirst QHP |
$57.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$57.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$43.14
|
| Rate for Payer: SOMOS Essential |
$43.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57.52
|
|
|
PR INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE
|
Professional
|
Both
|
$136.36
|
|
|
Service Code
|
HCPCS 38792
|
| Min. Negotiated Rate |
$24.95 |
| Max. Negotiated Rate |
$80.21 |
| Rate for Payer: Cash Price |
$36.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.74
|
| Rate for Payer: Healthfirst Commercial |
$35.65
|
| Rate for Payer: Healthfirst Essential Plan |
$80.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.87
|
| Rate for Payer: Healthfirst QHP |
$35.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.74
|
| Rate for Payer: SOMOS Essential |
$26.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.65
|
|
|
PR INJ SUBSTITUTE PARS PLANA/LIMBL W/WO ASPIR SPX
|
Professional
|
Both
|
$2,602.50
|
|
|
Service Code
|
HCPCS 67025
|
| Min. Negotiated Rate |
$493.72 |
| Max. Negotiated Rate |
$1,586.97 |
| Rate for Payer: Cash Price |
$715.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$705.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$634.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$634.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$670.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$705.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$670.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$705.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$705.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$528.99
|
| Rate for Payer: Healthfirst Commercial |
$705.32
|
| Rate for Payer: Healthfirst Essential Plan |
$1,586.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$670.05
|
| Rate for Payer: Healthfirst QHP |
$705.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$493.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$705.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$599.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$493.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$705.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$528.99
|
| Rate for Payer: SOMOS Essential |
$528.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$705.32
|
|
|
PR INJX ANES CELIAC PLEXUS W/WO RADIOLOGIC MONITRNG
|
Professional
|
Both
|
$395.36
|
|
|
Service Code
|
HCPCS 64530
|
| Min. Negotiated Rate |
$74.91 |
| Max. Negotiated Rate |
$240.79 |
| Rate for Payer: Cash Price |
$107.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$107.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$101.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$101.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.27
|
| Rate for Payer: Healthfirst Commercial |
$107.02
|
| Rate for Payer: Healthfirst Essential Plan |
$240.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$101.67
|
| Rate for Payer: Healthfirst QHP |
$107.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$107.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$90.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$74.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$80.27
|
| Rate for Payer: SOMOS Essential |
$80.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.02
|
|
|
PR INJX ANTERIOR CHAMBER EYE AIR/LIQUID SPX
|
Professional
|
Both
|
$540.12
|
|
|
Service Code
|
HCPCS 66020
|
| Min. Negotiated Rate |
$103.59 |
| Max. Negotiated Rate |
$332.98 |
| Rate for Payer: Cash Price |
$149.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$133.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$110.99
|
| Rate for Payer: Healthfirst Commercial |
$147.99
|
| Rate for Payer: Healthfirst Essential Plan |
$332.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$140.59
|
| Rate for Payer: Healthfirst QHP |
$147.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$103.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$125.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$103.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$110.99
|
| Rate for Payer: SOMOS Essential |
$110.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.99
|
|
|
PR INJX ANTERIOR CHAMBER EYE MEDICATION SPX
|
Professional
|
Both
|
$460.43
|
|
|
Service Code
|
HCPCS 66030
|
| Min. Negotiated Rate |
$87.84 |
| Max. Negotiated Rate |
$282.35 |
| Rate for Payer: Cash Price |
$127.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$125.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$112.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$112.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$119.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$125.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$119.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.12
|
| Rate for Payer: Healthfirst Commercial |
$125.49
|
| Rate for Payer: Healthfirst Essential Plan |
$282.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$119.22
|
| Rate for Payer: Healthfirst QHP |
$125.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$87.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$125.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$106.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$87.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$125.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$94.12
|
| Rate for Payer: SOMOS Essential |
$94.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$125.49
|
|
|
PR INJX/INFUSION NEUROLYTIC SUBSTANCE SUBARACHNOID
|
Professional
|
Both
|
$662.03
|
|
|
Service Code
|
HCPCS 62280
|
| Min. Negotiated Rate |
$127.44 |
| Max. Negotiated Rate |
$409.61 |
| Rate for Payer: Cash Price |
$182.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$163.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$163.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$172.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$172.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$182.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$136.54
|
| Rate for Payer: Healthfirst Commercial |
$182.05
|
| Rate for Payer: Healthfirst Essential Plan |
$409.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$172.95
|
| Rate for Payer: Healthfirst QHP |
$182.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$127.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$182.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$154.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$127.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$136.54
|
| Rate for Payer: SOMOS Essential |
$136.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.05
|
|
|
PR INJX/INFUS NEUROLYT SBST EPIDURAL LUMBAR/SACRAL
|
Professional
|
Both
|
$585.17
|
|
|
Service Code
|
HCPCS 62282
|
| Min. Negotiated Rate |
$112.01 |
| Max. Negotiated Rate |
$360.02 |
| Rate for Payer: Cash Price |
$161.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$160.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$144.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$144.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$152.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$160.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$152.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$160.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$120.01
|
| Rate for Payer: Healthfirst Commercial |
$160.01
|
| Rate for Payer: Healthfirst Essential Plan |
$360.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$152.01
|
| Rate for Payer: Healthfirst QHP |
$160.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$112.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$160.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$136.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$112.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$160.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$120.01
|
| Rate for Payer: SOMOS Essential |
$120.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$160.01
|
|
|
PR INJX/INFUS NEUROLYT SUBST EPIDURAL CERV/THORACIC
|
Professional
|
Both
|
$660.31
|
|
|
Service Code
|
HCPCS 62281
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$397.28 |
| Rate for Payer: Cash Price |
$175.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$176.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$158.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$158.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$167.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$176.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$167.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$176.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$176.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$132.43
|
| Rate for Payer: Healthfirst Commercial |
$176.57
|
| Rate for Payer: Healthfirst Essential Plan |
$397.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$167.74
|
| Rate for Payer: Healthfirst QHP |
$176.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$123.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$176.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$150.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$123.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$176.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$132.43
|
| Rate for Payer: SOMOS Essential |
$132.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$176.57
|
|
|
PR INPT TELEHEALTH CON 70/>M
|
Professional
|
Both
|
$751.52
|
|
|
Service Code
|
HCPCS G0427
|
| Min. Negotiated Rate |
$142.97 |
| Max. Negotiated Rate |
$459.54 |
| Rate for Payer: Amida Care Medicaid |
$151.38
|
| Rate for Payer: Cash Price |
$205.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$204.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$183.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$183.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$194.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$204.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$194.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$204.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$204.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$153.18
|
| Rate for Payer: Healthfirst Commercial |
$204.24
|
| Rate for Payer: Healthfirst Essential Plan |
$459.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$194.03
|
| Rate for Payer: Healthfirst QHP |
$204.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$142.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$204.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$173.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$142.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$204.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$153.18
|
| Rate for Payer: SOMOS Essential |
$153.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$204.24
|
|
|
PR INPT TELEHEALTH CONSULT 30M
|
Professional
|
Both
|
$383.18
|
|
|
Service Code
|
HCPCS G0425
|
| Min. Negotiated Rate |
$71.59 |
| Max. Negotiated Rate |
$230.11 |
| Rate for Payer: Amida Care Medicaid |
$77.79
|
| Rate for Payer: Cash Price |
$103.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$102.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$92.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$97.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$102.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$97.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$76.70
|
| Rate for Payer: Healthfirst Commercial |
$102.27
|
| Rate for Payer: Healthfirst Essential Plan |
$230.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$97.16
|
| Rate for Payer: Healthfirst QHP |
$102.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$71.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$102.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$86.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$71.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$76.70
|
| Rate for Payer: SOMOS Essential |
$76.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.27
|
|
|
PR INPT TELEHEALTH CONSULT 50M
|
Professional
|
Both
|
$535.15
|
|
|
Service Code
|
HCPCS G0426
|
| Min. Negotiated Rate |
$101.26 |
| Max. Negotiated Rate |
$325.49 |
| Rate for Payer: Amida Care Medicaid |
$103.64
|
| Rate for Payer: Cash Price |
$146.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$144.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$130.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$130.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$137.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$144.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$137.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$108.50
|
| Rate for Payer: Healthfirst Commercial |
$144.66
|
| Rate for Payer: Healthfirst Essential Plan |
$325.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$137.43
|
| Rate for Payer: Healthfirst QHP |
$144.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$101.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$144.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$122.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$101.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$144.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$108.50
|
| Rate for Payer: SOMOS Essential |
$108.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$144.66
|
|
|
PR INSERT ANTER DRAINAGE DEV W/O EXTRAOC RESERVOIR
|
Professional
|
Both
|
$4,239.69
|
|
|
Service Code
|
HCPCS 66183
|
| Min. Negotiated Rate |
$804.95 |
| Max. Negotiated Rate |
$2,587.34 |
| Rate for Payer: Cash Price |
$1,169.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,149.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,034.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,034.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,092.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,149.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,092.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,149.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,149.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$862.45
|
| Rate for Payer: Healthfirst Commercial |
$1,149.93
|
| Rate for Payer: Healthfirst Essential Plan |
$2,587.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,092.43
|
| Rate for Payer: Healthfirst QHP |
$1,149.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$804.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,149.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$977.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$804.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,149.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$862.45
|
| Rate for Payer: SOMOS Essential |
$862.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,149.93
|
|
|
PR INSERT CECOSTOMY/OTHER COLONIC TUBE PERCUTANEOUS
|
Professional
|
Both
|
$840.56
|
|
|
Service Code
|
HCPCS 49442
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$516.11 |
| Rate for Payer: Cash Price |
$229.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$229.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$206.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$206.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$217.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$229.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$217.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$229.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$229.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$172.03
|
| Rate for Payer: Healthfirst Commercial |
$229.38
|
| Rate for Payer: Healthfirst Essential Plan |
$516.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$217.91
|
| Rate for Payer: Healthfirst QHP |
$229.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$160.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$229.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$194.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$160.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$229.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$172.03
|
| Rate for Payer: SOMOS Essential |
$172.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$229.38
|
|
