|
PR MEDICAL NUTRITION RE-ASSMT&IVNTJ INDIV EA 15 M
|
Professional
|
Both
|
$109.41
|
|
|
Service Code
|
HCPCS 97803
|
| Min. Negotiated Rate |
$21.06 |
| Max. Negotiated Rate |
$67.70 |
| Rate for Payer: Cash Price |
$30.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.57
|
| Rate for Payer: Healthfirst Commercial |
$30.09
|
| Rate for Payer: Healthfirst Essential Plan |
$67.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.59
|
| Rate for Payer: Healthfirst QHP |
$30.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$30.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.57
|
| Rate for Payer: SOMOS Essential |
$22.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.09
|
|
|
PR MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI
|
Professional
|
Both
|
$62.79
|
|
|
Service Code
|
HCPCS 97804
|
| Min. Negotiated Rate |
$11.89 |
| Max. Negotiated Rate |
$38.23 |
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.74
|
| Rate for Payer: Healthfirst Commercial |
$16.99
|
| Rate for Payer: Healthfirst Essential Plan |
$38.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.14
|
| Rate for Payer: Healthfirst QHP |
$16.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.74
|
| Rate for Payer: SOMOS Essential |
$12.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.99
|
|
|
PR MEDICATION ADMIN & HEMODYNAMIC MEASURMENT
|
Professional
|
Both
|
$397.64
|
|
|
Service Code
|
HCPCS 93463
|
| Min. Negotiated Rate |
$41.80 |
| Max. Negotiated Rate |
$239.29 |
| Rate for Payer: Amida Care Medicaid |
$41.80
|
| Rate for Payer: Cash Price |
$107.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$106.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$95.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$95.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$101.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$106.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$101.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.76
|
| Rate for Payer: Healthfirst Commercial |
$106.35
|
| Rate for Payer: Healthfirst Essential Plan |
$239.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$101.03
|
| Rate for Payer: Healthfirst QHP |
$106.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$106.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$90.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$74.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$106.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$79.76
|
| Rate for Payer: SOMOS Essential |
$79.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$106.35
|
|
|
PR MENISCECTOMY PRTL/COMPL TEMPOROMANDIBULAR JT SPX
|
Professional
|
Both
|
$3,311.56
|
|
|
Service Code
|
HCPCS 21060
|
| Min. Negotiated Rate |
$626.46 |
| Max. Negotiated Rate |
$2,013.62 |
| Rate for Payer: Cash Price |
$898.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$894.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$805.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$805.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$850.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$894.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$850.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$894.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$894.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$671.21
|
| Rate for Payer: Healthfirst Commercial |
$894.94
|
| Rate for Payer: Healthfirst Essential Plan |
$2,013.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$850.19
|
| Rate for Payer: Healthfirst QHP |
$894.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$626.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$894.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$760.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$626.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$894.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$671.21
|
| Rate for Payer: SOMOS Essential |
$671.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$894.94
|
|
|
PR METATARSECTOMY
|
Professional
|
Both
|
$1,816.01
|
|
|
Service Code
|
HCPCS 28140
|
| Min. Negotiated Rate |
$342.31 |
| Max. Negotiated Rate |
$1,100.27 |
| Rate for Payer: Cash Price |
$494.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$489.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$440.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$440.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$464.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$489.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$464.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$489.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$489.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$366.76
|
| Rate for Payer: Healthfirst Commercial |
$489.01
|
| Rate for Payer: Healthfirst Essential Plan |
$1,100.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$464.56
|
| Rate for Payer: Healthfirst QHP |
$489.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$342.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$489.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$415.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$342.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$489.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$366.76
|
| Rate for Payer: SOMOS Essential |
$366.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$489.01
|
|
|
PR MGMT LVR HEMRRG CPLX SUTR WND/INJ
|
Professional
|
Both
|
$8,475.92
|
|
|
Service Code
|
HCPCS 47360
|
| Min. Negotiated Rate |
$1,564.17 |
| Max. Negotiated Rate |
$5,027.69 |
| Rate for Payer: Cash Price |
$2,253.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,234.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,011.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,011.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,122.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,234.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,122.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,234.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,234.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,675.90
|
| Rate for Payer: Healthfirst Commercial |
$2,234.53
|
| Rate for Payer: Healthfirst Essential Plan |
$5,027.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,122.80
|
| Rate for Payer: Healthfirst QHP |
$2,234.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,564.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,234.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,899.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,564.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,234.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,675.90
|
| Rate for Payer: SOMOS Essential |
$1,675.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,234.53
|
|
|
PR MGMT LVR HEMRRG EXPL WND DBRDMT COAGJ/SUTR
|
Professional
|
Both
|
$13,566.39
|
|
|
Service Code
|
HCPCS 47361
|
| Min. Negotiated Rate |
$2,493.39 |
| Max. Negotiated Rate |
$8,014.45 |
| Rate for Payer: Cash Price |
$3,587.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,561.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,205.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,205.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,383.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,561.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,383.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,561.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,561.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,671.49
|
| Rate for Payer: Healthfirst Commercial |
$3,561.98
|
| Rate for Payer: Healthfirst Essential Plan |
$8,014.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,383.88
|
| Rate for Payer: Healthfirst QHP |
$3,561.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,493.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,561.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,027.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,493.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,561.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,671.49
|
| Rate for Payer: SOMOS Essential |
$2,671.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,561.98
|
|
|
PR MGMT LVR HEMRRG RE-EXPL WND RMVL PACKING
|
Professional
|
Both
|
$6,438.88
|
|
|
Service Code
|
HCPCS 47362
|
| Min. Negotiated Rate |
$1,176.27 |
| Max. Negotiated Rate |
$3,780.86 |
| Rate for Payer: Cash Price |
$1,746.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,680.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,512.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,512.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,596.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,680.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,596.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,680.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,680.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,260.29
|
| Rate for Payer: Healthfirst Commercial |
$1,680.38
|
| Rate for Payer: Healthfirst Essential Plan |
$3,780.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,596.36
|
| Rate for Payer: Healthfirst QHP |
$1,680.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,176.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,680.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,428.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,176.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,680.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,260.29
|
| Rate for Payer: SOMOS Essential |
$1,260.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,680.38
|
|
|
PR MGMT LVR HEMRRG SMPL SUTR LVR WND/INJ
|
Professional
|
Both
|
$6,141.35
|
|
|
Service Code
|
HCPCS 47350
|
| Min. Negotiated Rate |
$1,130.06 |
| Max. Negotiated Rate |
$3,632.33 |
| Rate for Payer: Cash Price |
$1,630.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,614.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,452.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,452.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,533.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,614.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,533.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,614.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,614.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,210.78
|
| Rate for Payer: Healthfirst Commercial |
$1,614.37
|
| Rate for Payer: Healthfirst Essential Plan |
$3,632.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,533.65
|
| Rate for Payer: Healthfirst QHP |
$1,614.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,130.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,614.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,372.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,130.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,614.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,210.78
|
| Rate for Payer: SOMOS Essential |
$1,210.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,614.37
|
|
|
PR MICRODISSECTION, LASER
|
Professional
|
Both
|
$307.34
|
|
|
Service Code
|
HCPCS 88380 TC
|
| Min. Negotiated Rate |
$61.35 |
| Max. Negotiated Rate |
$197.19 |
| Rate for Payer: Cash Price |
$87.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$87.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$78.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$78.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$83.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$87.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$83.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.73
|
| Rate for Payer: Healthfirst Commercial |
$87.64
|
| Rate for Payer: Healthfirst Essential Plan |
$197.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$83.26
|
| Rate for Payer: Healthfirst QHP |
$87.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$61.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$87.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$74.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$61.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$87.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$65.73
|
| Rate for Payer: SOMOS Essential |
$65.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.64
|
|
|
PR MICRODISSECTION, LASER
|
Professional
|
Both
|
$201.57
|
|
|
Service Code
|
HCPCS 88380 26
|
| Min. Negotiated Rate |
$38.68 |
| Max. Negotiated Rate |
$124.33 |
| Rate for Payer: Cash Price |
$54.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$55.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$52.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.45
|
| Rate for Payer: Healthfirst Commercial |
$55.26
|
| Rate for Payer: Healthfirst Essential Plan |
$124.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.50
|
| Rate for Payer: Healthfirst QHP |
$55.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$55.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$46.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.45
|
| Rate for Payer: SOMOS Essential |
$41.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.26
|
|
|
PR MICRODISSECTION, LASER
|
Professional
|
Both
|
$508.94
|
|
|
Service Code
|
HCPCS 88380
|
| Min. Negotiated Rate |
$100.03 |
| Max. Negotiated Rate |
$321.52 |
| Rate for Payer: Cash Price |
$142.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$142.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$128.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$128.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$135.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$142.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$135.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$107.17
|
| Rate for Payer: Healthfirst Commercial |
$142.90
|
| Rate for Payer: Healthfirst Essential Plan |
$321.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$135.75
|
| Rate for Payer: Healthfirst QHP |
$142.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$100.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$142.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$121.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$100.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$142.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$107.17
|
| Rate for Payer: SOMOS Essential |
$107.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$142.90
|
|
|
PR MICRODISSECTION, MANUAL
|
Professional
|
Both
|
$771.37
|
|
|
Service Code
|
HCPCS 88381 TC
|
| Min. Negotiated Rate |
$140.57 |
| Max. Negotiated Rate |
$451.85 |
| Rate for Payer: Cash Price |
$211.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$200.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$180.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$180.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$190.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$200.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$190.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$150.62
|
| Rate for Payer: Healthfirst Commercial |
$200.82
|
| Rate for Payer: Healthfirst Essential Plan |
$451.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$190.78
|
| Rate for Payer: Healthfirst QHP |
$200.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$140.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$200.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$170.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$140.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$200.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$150.62
|
| Rate for Payer: SOMOS Essential |
$150.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$200.82
|
|
|
PR MICRODISSECTION, MANUAL
|
Professional
|
Both
|
$862.05
|
|
|
Service Code
|
HCPCS 88381
|
| Min. Negotiated Rate |
$157.59 |
| Max. Negotiated Rate |
$506.54 |
| Rate for Payer: Cash Price |
$236.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$225.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$202.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$202.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$213.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$225.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$213.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$168.85
|
| Rate for Payer: Healthfirst Commercial |
$225.13
|
| Rate for Payer: Healthfirst Essential Plan |
$506.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$213.87
|
| Rate for Payer: Healthfirst QHP |
$225.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$157.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$225.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$191.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$157.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$225.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$168.85
|
| Rate for Payer: SOMOS Essential |
$168.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$225.13
|
|
|
PR MICRODISSECTION, MANUAL
|
Professional
|
Both
|
$90.69
|
|
|
Service Code
|
HCPCS 88381 26
|
| Min. Negotiated Rate |
$17.02 |
| Max. Negotiated Rate |
$54.70 |
| Rate for Payer: Cash Price |
$24.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.23
|
| Rate for Payer: Healthfirst Commercial |
$24.31
|
| Rate for Payer: Healthfirst Essential Plan |
$54.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.09
|
| Rate for Payer: Healthfirst QHP |
$24.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.23
|
| Rate for Payer: SOMOS Essential |
$18.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.31
|
|
|
PR MICROSURG TQS REQ USE OPERATING MICROSCOPE
|
Professional
|
Both
|
$1,045.56
|
|
|
Service Code
|
HCPCS 69990
|
| Min. Negotiated Rate |
$189.77 |
| Max. Negotiated Rate |
$609.98 |
| Rate for Payer: Cash Price |
$273.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$271.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$243.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$243.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$257.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$271.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$257.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$271.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$271.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$203.32
|
| Rate for Payer: Healthfirst Commercial |
$271.10
|
| Rate for Payer: Healthfirst Essential Plan |
$609.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$257.55
|
| Rate for Payer: Healthfirst QHP |
$271.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$189.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$271.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$230.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$189.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$271.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$203.32
|
| Rate for Payer: SOMOS Essential |
$203.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$271.10
|
|
|
PR MICROVOLT T-WAVE ASSESS VENTRICULAR ARRHYTHMIAS
|
Professional
|
Both
|
$511.70
|
|
|
Service Code
|
HCPCS 93025
|
| Min. Negotiated Rate |
$102.42 |
| Max. Negotiated Rate |
$329.20 |
| Rate for Payer: Amida Care Medicaid |
$202.57
|
| Rate for Payer: Cash Price |
$144.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$146.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$131.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$131.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$138.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$146.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$138.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$146.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$146.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$109.73
|
| Rate for Payer: Healthfirst Commercial |
$146.31
|
| Rate for Payer: Healthfirst Essential Plan |
$329.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$138.99
|
| Rate for Payer: Healthfirst QHP |
$146.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$102.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$146.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$124.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$102.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$146.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$109.73
|
| Rate for Payer: SOMOS Essential |
$109.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$146.31
|
|
|
PR MICROVOLT T-WAVE ASSESS VENTRICULAR ARRHYTHMIAS
|
Professional
|
Both
|
$143.96
|
|
|
Service Code
|
HCPCS 93025 26
|
| Min. Negotiated Rate |
$27.64 |
| Max. Negotiated Rate |
$202.57 |
| Rate for Payer: Amida Care Medicaid |
$202.57
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.62
|
| Rate for Payer: Healthfirst Commercial |
$39.49
|
| Rate for Payer: Healthfirst Essential Plan |
$88.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.52
|
| Rate for Payer: Healthfirst QHP |
$39.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.62
|
| Rate for Payer: SOMOS Essential |
$29.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.49
|
|
|
PR MICROVOLT T-WAVE ASSESS VENTRICULAR ARRHYTHMIAS
|
Professional
|
Both
|
$367.71
|
|
|
Service Code
|
HCPCS 93025 TC
|
| Min. Negotiated Rate |
$74.77 |
| Max. Negotiated Rate |
$240.34 |
| Rate for Payer: Amida Care Medicaid |
$202.57
|
| Rate for Payer: Cash Price |
$104.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$106.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$101.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$106.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$101.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.11
|
| Rate for Payer: Healthfirst Commercial |
$106.82
|
| Rate for Payer: Healthfirst Essential Plan |
$240.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$101.48
|
| Rate for Payer: Healthfirst QHP |
$106.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$106.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$90.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$74.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$106.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$80.11
|
| Rate for Payer: SOMOS Essential |
$80.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$106.82
|
|
|
PR MIDDLE EAR EXPL THRU POSTAUR/EAR CANAL INC
|
Professional
|
Both
|
$3,014.48
|
|
|
Service Code
|
HCPCS 69440
|
| Min. Negotiated Rate |
$557.18 |
| Max. Negotiated Rate |
$1,790.93 |
| Rate for Payer: Cash Price |
$815.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$795.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$716.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$716.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$756.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$795.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$756.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$795.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$795.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$596.98
|
| Rate for Payer: Healthfirst Commercial |
$795.97
|
| Rate for Payer: Healthfirst Essential Plan |
$1,790.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$756.17
|
| Rate for Payer: Healthfirst QHP |
$795.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$557.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$795.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$676.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$557.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$795.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$596.98
|
| Rate for Payer: SOMOS Essential |
$596.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$795.97
|
|
|
PR MIDFACE FLAP W/PRESERVATION OF VASCULAR PEDICLES
|
Professional
|
Both
|
$3,856.30
|
|
|
Service Code
|
HCPCS 15730
|
| Min. Negotiated Rate |
$729.21 |
| Max. Negotiated Rate |
$2,343.89 |
| Rate for Payer: Cash Price |
$1,052.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,041.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$937.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$937.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$989.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,041.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$989.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,041.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,041.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$781.30
|
| Rate for Payer: Healthfirst Commercial |
$1,041.73
|
| Rate for Payer: Healthfirst Essential Plan |
$2,343.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$989.64
|
| Rate for Payer: Healthfirst QHP |
$1,041.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$729.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,041.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$885.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$729.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,041.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$781.30
|
| Rate for Payer: SOMOS Essential |
$781.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,041.73
|
|
|
PR MLT OSTEOTOMIES W/RELIGNMT IMED ROD RADIUS&ULNA
|
Professional
|
Both
|
$4,226.57
|
|
|
Service Code
|
HCPCS 25375
|
| Min. Negotiated Rate |
$795.10 |
| Max. Negotiated Rate |
$2,555.68 |
| Rate for Payer: Cash Price |
$1,140.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,135.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,022.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,022.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,079.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,135.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,079.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,135.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,135.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$851.89
|
| Rate for Payer: Healthfirst Commercial |
$1,135.86
|
| Rate for Payer: Healthfirst Essential Plan |
$2,555.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,079.07
|
| Rate for Payer: Healthfirst QHP |
$1,135.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$795.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,135.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$965.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$795.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,135.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$851.89
|
| Rate for Payer: SOMOS Essential |
$851.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,135.86
|
|
|
PR MLT OSTEOTOMIES W/RELIGNMT IMED ROD RADIUS/ULNA
|
Professional
|
Both
|
$4,485.11
|
|
|
Service Code
|
HCPCS 25370
|
| Min. Negotiated Rate |
$844.10 |
| Max. Negotiated Rate |
$2,713.16 |
| Rate for Payer: Cash Price |
$1,210.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,205.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,085.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,085.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,145.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,205.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,145.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,205.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,205.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$904.39
|
| Rate for Payer: Healthfirst Commercial |
$1,205.85
|
| Rate for Payer: Healthfirst Essential Plan |
$2,713.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,145.56
|
| Rate for Payer: Healthfirst QHP |
$1,205.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$844.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,205.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,024.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$844.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,205.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$904.39
|
| Rate for Payer: SOMOS Essential |
$904.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,205.85
|
|
|
PR MLT OSTEOT W/RELIGNMT IMED ROD HUMERAL SHAFT
|
Professional
|
Both
|
$4,680.73
|
|
|
Service Code
|
HCPCS 24410
|
| Min. Negotiated Rate |
$880.37 |
| Max. Negotiated Rate |
$2,829.76 |
| Rate for Payer: Cash Price |
$1,263.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,257.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,131.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,131.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,194.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,257.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,194.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,257.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,257.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$943.25
|
| Rate for Payer: Healthfirst Commercial |
$1,257.67
|
| Rate for Payer: Healthfirst Essential Plan |
$2,829.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,194.79
|
| Rate for Payer: Healthfirst QHP |
$1,257.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$880.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,257.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,069.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$880.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,257.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$943.25
|
| Rate for Payer: SOMOS Essential |
$943.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,257.67
|
|
|
PR MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG
|
Professional
|
Both
|
$1,569.65
|
|
|
Service Code
|
HCPCS 95805 TC
|
| Min. Negotiated Rate |
$314.02 |
| Max. Negotiated Rate |
$1,009.35 |
| Rate for Payer: Amida Care Medicaid |
$437.98
|
| Rate for Payer: Cash Price |
$446.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$448.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$403.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$403.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$426.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$448.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$426.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$448.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$448.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$336.45
|
| Rate for Payer: Healthfirst Commercial |
$448.60
|
| Rate for Payer: Healthfirst Essential Plan |
$1,009.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$426.17
|
| Rate for Payer: Healthfirst QHP |
$448.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$314.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$448.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$381.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$314.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$448.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$336.45
|
| Rate for Payer: SOMOS Essential |
$336.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$448.60
|
|
