|
PR LYSIS LABIAL ADHESIONS
|
Professional
|
Both
|
$670.01
|
|
|
Service Code
|
HCPCS 56441
|
| Min. Negotiated Rate |
$125.82 |
| Max. Negotiated Rate |
$404.42 |
| Rate for Payer: Cash Price |
$183.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$179.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$161.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$161.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$170.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$179.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$170.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$134.81
|
| Rate for Payer: Healthfirst Commercial |
$179.74
|
| Rate for Payer: Healthfirst Essential Plan |
$404.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$170.75
|
| Rate for Payer: Healthfirst QHP |
$179.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$125.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$179.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$152.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$125.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$179.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$134.81
|
| Rate for Payer: SOMOS Essential |
$134.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$179.74
|
|
|
PR LYSIS OF ADHESIONS SALPINX/OVARY
|
Professional
|
Both
|
$3,963.82
|
|
|
Service Code
|
HCPCS 58740
|
| Min. Negotiated Rate |
$740.98 |
| Max. Negotiated Rate |
$2,381.72 |
| Rate for Payer: Cash Price |
$1,066.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,058.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$952.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$952.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,005.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,058.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,005.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,058.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,058.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$793.90
|
| Rate for Payer: Healthfirst Commercial |
$1,058.54
|
| Rate for Payer: Healthfirst Essential Plan |
$2,381.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,005.61
|
| Rate for Payer: Healthfirst QHP |
$1,058.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$740.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,058.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$899.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$740.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,058.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$793.90
|
| Rate for Payer: SOMOS Essential |
$793.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,058.54
|
|
|
PR MACRO EXAM/DISSECT/PREP, FOR NON-MICRO, IMPRINT/INTRAOP/FROZEN, EA
|
Professional
|
Both
|
$90.72
|
|
|
Service Code
|
HCPCS 88388 26
|
| Rate for Payer: Cash Price |
$24.96
|
|
|
PR MACRO EXAM/DISSECT/PREP, FOR NON-MICRO, IMPRINT/INTRAOP/FROZEN, EA
|
Professional
|
Both
|
$60.24
|
|
|
Service Code
|
HCPCS 88388 TC
|
| Rate for Payer: Cash Price |
$15.95
|
|
|
PR MACRO EXAM/DISSECT/PREP, FOR NON-MICRO, IMPRINT/INTRAOP/FROZEN, EA
|
Professional
|
Both
|
$150.96
|
|
|
Service Code
|
HCPCS 88388
|
| Rate for Payer: Cash Price |
$40.91
|
|
|
PR MACRO EXAM/DISSECT/PREP FOR NON-MICRO STUDY, EA
|
Professional
|
Both
|
$101.96
|
|
|
Service Code
|
HCPCS 88387 26
|
| Min. Negotiated Rate |
$19.46 |
| Max. Negotiated Rate |
$62.55 |
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.85
|
| Rate for Payer: Healthfirst Commercial |
$27.80
|
| Rate for Payer: Healthfirst Essential Plan |
$62.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.41
|
| Rate for Payer: Healthfirst QHP |
$27.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.85
|
| Rate for Payer: SOMOS Essential |
$20.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.80
|
|
|
PR MACRO EXAM/DISSECT/PREP FOR NON-MICRO STUDY, EA
|
Professional
|
Both
|
$136.33
|
|
|
Service Code
|
HCPCS 88387
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Cash Price |
$36.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.43
|
| Rate for Payer: Healthfirst Commercial |
$36.57
|
| Rate for Payer: Healthfirst Essential Plan |
$82.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.74
|
| Rate for Payer: Healthfirst QHP |
$36.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.43
|
| Rate for Payer: SOMOS Essential |
$27.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.57
|
|
|
PR MACRO EXAM/DISSECT/PREP FOR NON-MICRO STUDY, EA
|
Professional
|
Both
|
$34.37
|
|
|
Service Code
|
HCPCS 88387 TC
|
| Min. Negotiated Rate |
$6.14 |
| Max. Negotiated Rate |
$19.73 |
| Rate for Payer: Cash Price |
$8.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.58
|
| Rate for Payer: Healthfirst Commercial |
$8.77
|
| Rate for Payer: Healthfirst Essential Plan |
$19.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.33
|
| Rate for Payer: Healthfirst QHP |
$8.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.58
|
| Rate for Payer: SOMOS Essential |
$6.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.77
|
|
|
PR MAGNETOENCEPHALOGRAPHY SPON BRAIN ACTIVITY
|
Professional
|
Both
|
$1,632.68
|
|
|
Service Code
|
HCPCS 95965 26
|
| Min. Negotiated Rate |
$309.44 |
| Max. Negotiated Rate |
$994.61 |
| Rate for Payer: Cash Price |
$447.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$442.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$397.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$397.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$419.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$442.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$419.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$442.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$442.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$331.54
|
| Rate for Payer: Healthfirst Commercial |
$442.05
|
| Rate for Payer: Healthfirst Essential Plan |
$994.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$419.95
|
| Rate for Payer: Healthfirst QHP |
$442.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$309.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$442.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$375.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$309.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$442.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$331.54
|
| Rate for Payer: SOMOS Essential |
$331.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$442.05
|
|
|
PR MAGNETOENCEPHALOGRAPY EVOKED FIELDS 1 MODALITY
|
Professional
|
Both
|
$835.07
|
|
|
Service Code
|
HCPCS 95966 26
|
| Min. Negotiated Rate |
$152.62 |
| Max. Negotiated Rate |
$490.57 |
| Rate for Payer: Cash Price |
$217.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$218.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$196.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$207.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$218.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$207.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$218.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$218.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$163.52
|
| Rate for Payer: Healthfirst Commercial |
$218.03
|
| Rate for Payer: Healthfirst Essential Plan |
$490.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$207.13
|
| Rate for Payer: Healthfirst QHP |
$218.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$152.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$218.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$185.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$152.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$218.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$163.52
|
| Rate for Payer: SOMOS Essential |
$163.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$218.03
|
|
|
PR MAGNETOENCEPHALOGRAPY EVOKED FIELDS EACH ADDL
|
Professional
|
Both
|
$733.74
|
|
|
Service Code
|
HCPCS 95967 26
|
| Min. Negotiated Rate |
$131.50 |
| Max. Negotiated Rate |
$422.66 |
| Rate for Payer: Cash Price |
$188.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$187.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$169.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$169.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$178.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$187.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$178.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$187.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$187.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$140.89
|
| Rate for Payer: Healthfirst Commercial |
$187.85
|
| Rate for Payer: Healthfirst Essential Plan |
$422.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$178.46
|
| Rate for Payer: Healthfirst QHP |
$187.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$131.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$187.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$159.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$131.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$187.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$140.89
|
| Rate for Payer: SOMOS Essential |
$140.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$187.85
|
|
|
PR MAJOR RECONSTRUCTION CHEST WALL POSTTRAUMATIC
|
Professional
|
Both
|
$5,935.20
|
|
|
Service Code
|
HCPCS 32820
|
| Min. Negotiated Rate |
$1,149.48 |
| Max. Negotiated Rate |
$3,694.75 |
| Rate for Payer: Cash Price |
$1,582.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,642.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,477.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,477.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,560.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,642.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,560.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,642.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,642.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,231.58
|
| Rate for Payer: Healthfirst Commercial |
$1,642.11
|
| Rate for Payer: Healthfirst Essential Plan |
$3,694.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,560.00
|
| Rate for Payer: Healthfirst QHP |
$1,642.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,149.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,642.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,395.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,149.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,642.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,231.58
|
| Rate for Payer: SOMOS Essential |
$1,231.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,642.11
|
|
|
PR MALAR AUGMENTATION PROSTHETIC MATERIAL
|
Professional
|
Both
|
$3,275.41
|
|
|
Service Code
|
HCPCS 21270
|
| Min. Negotiated Rate |
$616.50 |
| Max. Negotiated Rate |
$1,981.60 |
| Rate for Payer: Cash Price |
$882.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$880.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$792.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$792.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$836.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$880.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$836.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$880.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$880.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$660.53
|
| Rate for Payer: Healthfirst Commercial |
$880.71
|
| Rate for Payer: Healthfirst Essential Plan |
$1,981.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$836.67
|
| Rate for Payer: Healthfirst QHP |
$880.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$616.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$880.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$748.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$616.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$880.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$660.53
|
| Rate for Payer: SOMOS Essential |
$660.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$880.71
|
|
|
PR MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD
|
Professional
|
Both
|
$345.80
|
|
|
Service Code
|
HCPCS 26341
|
| Min. Negotiated Rate |
$64.74 |
| Max. Negotiated Rate |
$208.08 |
| Rate for Payer: Cash Price |
$93.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.36
|
| Rate for Payer: Healthfirst Commercial |
$92.48
|
| Rate for Payer: Healthfirst Essential Plan |
$208.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.86
|
| Rate for Payer: Healthfirst QHP |
$92.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.36
|
| Rate for Payer: SOMOS Essential |
$69.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.48
|
|
|
PR MANIPULATION ANKLE UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$708.61
|
|
|
Service Code
|
HCPCS 27860
|
| Min. Negotiated Rate |
$134.29 |
| Max. Negotiated Rate |
$431.66 |
| Rate for Payer: Cash Price |
$191.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$191.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$172.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$182.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$191.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$182.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$143.89
|
| Rate for Payer: Healthfirst Commercial |
$191.85
|
| Rate for Payer: Healthfirst Essential Plan |
$431.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$182.26
|
| Rate for Payer: Healthfirst QHP |
$191.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$134.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$191.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$163.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$134.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$191.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$143.89
|
| Rate for Payer: SOMOS Essential |
$143.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.85
|
|
|
PR MANIPULATION ELBOW UNDER ANESTHESIA
|
Professional
|
Both
|
$1,930.36
|
|
|
Service Code
|
HCPCS 24300
|
| Min. Negotiated Rate |
$373.44 |
| Max. Negotiated Rate |
$1,200.33 |
| Rate for Payer: Cash Price |
$533.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$533.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$480.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$480.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$506.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$533.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$506.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$533.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$533.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$400.11
|
| Rate for Payer: Healthfirst Commercial |
$533.48
|
| Rate for Payer: Healthfirst Essential Plan |
$1,200.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$506.81
|
| Rate for Payer: Healthfirst QHP |
$533.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$373.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$533.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$453.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$373.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$533.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$400.11
|
| Rate for Payer: SOMOS Essential |
$400.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$533.48
|
|
|
PR MANIPULATION FINGER JOINT UNDER ANES EACH JOINT
|
Professional
|
Both
|
$1,568.35
|
|
|
Service Code
|
HCPCS 26340
|
| Min. Negotiated Rate |
$304.94 |
| Max. Negotiated Rate |
$980.17 |
| Rate for Payer: Cash Price |
$433.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$435.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$392.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$392.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$413.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$435.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$413.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$435.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$435.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$326.72
|
| Rate for Payer: Healthfirst Commercial |
$435.63
|
| Rate for Payer: Healthfirst Essential Plan |
$980.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$413.85
|
| Rate for Payer: Healthfirst QHP |
$435.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$304.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$435.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$370.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$304.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$435.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$326.72
|
| Rate for Payer: SOMOS Essential |
$326.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$435.63
|
|
|
PR MANIPULATION HIP JOINT GENERAL ANESTHESIA
|
Professional
|
Both
|
$810.60
|
|
|
Service Code
|
HCPCS 27275
|
| Min. Negotiated Rate |
$154.81 |
| Max. Negotiated Rate |
$497.59 |
| Rate for Payer: Cash Price |
$220.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$221.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$199.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$199.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$210.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$221.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$210.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$221.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$221.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.86
|
| Rate for Payer: Healthfirst Commercial |
$221.15
|
| Rate for Payer: Healthfirst Essential Plan |
$497.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$210.09
|
| Rate for Payer: Healthfirst QHP |
$221.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$154.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$221.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$187.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$154.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$221.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$165.86
|
| Rate for Payer: SOMOS Essential |
$165.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$221.15
|
|
|
PR MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$679.21
|
|
|
Service Code
|
HCPCS 27570
|
| Min. Negotiated Rate |
$130.25 |
| Max. Negotiated Rate |
$418.66 |
| Rate for Payer: Cash Price |
$185.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$186.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$167.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$176.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$186.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$176.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$186.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$186.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.55
|
| Rate for Payer: Healthfirst Commercial |
$186.07
|
| Rate for Payer: Healthfirst Essential Plan |
$418.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$176.77
|
| Rate for Payer: Healthfirst QHP |
$186.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$130.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$186.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$158.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$130.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$186.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$139.55
|
| Rate for Payer: SOMOS Essential |
$139.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$186.07
|
|
|
PR MANIPULATION SPINE REQUIRING ANESTHESIA
|
Professional
|
Both
|
$572.64
|
|
|
Service Code
|
HCPCS 22505
|
| Min. Negotiated Rate |
$131.12 |
| Max. Negotiated Rate |
$421.47 |
| Rate for Payer: Cash Price |
$156.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$187.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$168.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$168.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$177.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$187.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$177.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$187.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$187.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$140.49
|
| Rate for Payer: Healthfirst Commercial |
$187.32
|
| Rate for Payer: Healthfirst Essential Plan |
$421.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$177.95
|
| Rate for Payer: Healthfirst QHP |
$187.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$131.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$187.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$159.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$131.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$187.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$140.49
|
| Rate for Payer: SOMOS Essential |
$140.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$187.32
|
|
|
PR MANIPULATION TMJ THERAPEUTIC REQUIRE ANESTHESIA
|
Professional
|
Both
|
$1,022.11
|
|
|
Service Code
|
HCPCS 21073
|
| Min. Negotiated Rate |
$198.49 |
| Max. Negotiated Rate |
$638.01 |
| Rate for Payer: Cash Price |
$277.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$255.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$255.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$269.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$269.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$283.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$212.67
|
| Rate for Payer: Healthfirst Commercial |
$283.56
|
| Rate for Payer: Healthfirst Essential Plan |
$638.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$269.38
|
| Rate for Payer: Healthfirst QHP |
$283.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$198.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$283.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$241.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$198.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$212.67
|
| Rate for Payer: SOMOS Essential |
$212.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.56
|
|
|
PR MANIPULATION WRIST UNDER ANESTHESIA
|
Professional
|
Both
|
$1,914.40
|
|
|
Service Code
|
HCPCS 25259
|
| Min. Negotiated Rate |
$353.84 |
| Max. Negotiated Rate |
$1,137.33 |
| Rate for Payer: Cash Price |
$524.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$505.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$454.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$454.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$480.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$505.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$480.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$505.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$505.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$379.11
|
| Rate for Payer: Healthfirst Commercial |
$505.48
|
| Rate for Payer: Healthfirst Essential Plan |
$1,137.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$480.21
|
| Rate for Payer: Healthfirst QHP |
$505.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$353.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$505.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$429.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$353.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$505.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$379.11
|
| Rate for Payer: SOMOS Essential |
$379.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$505.48
|
|
|
PR MANJ CHEST WALL FACILITATE LUNG FUNCTION SUBSQ
|
Professional
|
Both
|
$159.29
|
|
|
Service Code
|
HCPCS 94668
|
| Min. Negotiated Rate |
$31.84 |
| Max. Negotiated Rate |
$102.35 |
| Rate for Payer: Cash Price |
$47.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.12
|
| Rate for Payer: Healthfirst Commercial |
$45.49
|
| Rate for Payer: Healthfirst Essential Plan |
$102.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.22
|
| Rate for Payer: Healthfirst QHP |
$45.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.12
|
| Rate for Payer: SOMOS Essential |
$34.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.49
|
|
|
PR MANJ CH WALL FACILITATE LNG FUNCJ 1 DEMO&/EVAL
|
Professional
|
Both
|
$103.22
|
|
|
Service Code
|
HCPCS 94667
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$67.41 |
| Rate for Payer: Cash Price |
$29.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.47
|
| Rate for Payer: Healthfirst Commercial |
$29.96
|
| Rate for Payer: Healthfirst Essential Plan |
$67.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.46
|
| Rate for Payer: Healthfirst QHP |
$29.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.47
|
| Rate for Payer: SOMOS Essential |
$22.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.96
|
|
|
PR MANJ W/ANES SHOULDER JOINT W/FIXATION APPARATUS
|
Professional
|
Both
|
$866.95
|
|
|
Service Code
|
HCPCS 23700
|
| Min. Negotiated Rate |
$163.76 |
| Max. Negotiated Rate |
$526.39 |
| Rate for Payer: Cash Price |
$234.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$233.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$210.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$210.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$222.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$233.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$222.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$233.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$233.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$175.46
|
| Rate for Payer: Healthfirst Commercial |
$233.95
|
| Rate for Payer: Healthfirst Essential Plan |
$526.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$222.25
|
| Rate for Payer: Healthfirst QHP |
$233.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$163.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$233.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$198.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$163.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$233.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$175.46
|
| Rate for Payer: SOMOS Essential |
$175.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$233.95
|
|
