|
PR MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB
|
Professional
|
Both
|
$149.73
|
|
|
Service Code
|
HCPCS 95905
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$86.13 |
| Rate for Payer: Amida Care Medicaid |
$61.89
|
| Rate for Payer: Cash Price |
$39.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.71
|
| Rate for Payer: Healthfirst Commercial |
$38.28
|
| Rate for Payer: Healthfirst Essential Plan |
$86.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.37
|
| Rate for Payer: Healthfirst QHP |
$38.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.71
|
| Rate for Payer: SOMOS Essential |
$28.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.28
|
|
|
PR M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL
|
Professional
|
Both
|
$158.97
|
|
|
Service Code
|
HCPCS 88368 26
|
| Min. Negotiated Rate |
$30.89 |
| Max. Negotiated Rate |
$99.29 |
| Rate for Payer: Cash Price |
$44.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$44.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.10
|
| Rate for Payer: Healthfirst Commercial |
$44.13
|
| Rate for Payer: Healthfirst Essential Plan |
$99.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.92
|
| Rate for Payer: Healthfirst QHP |
$44.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.10
|
| Rate for Payer: SOMOS Essential |
$33.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.13
|
|
|
PR M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL
|
Professional
|
Both
|
$438.17
|
|
|
Service Code
|
HCPCS 88368 TC
|
| Min. Negotiated Rate |
$88.35 |
| Max. Negotiated Rate |
$284.00 |
| Rate for Payer: Cash Price |
$126.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$126.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$113.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$119.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$126.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$119.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.67
|
| Rate for Payer: Healthfirst Commercial |
$126.22
|
| Rate for Payer: Healthfirst Essential Plan |
$284.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$119.91
|
| Rate for Payer: Healthfirst QHP |
$126.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$88.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$126.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$107.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$88.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$126.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$94.67
|
| Rate for Payer: SOMOS Essential |
$94.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$126.22
|
|
|
PR M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL
|
Professional
|
Both
|
$597.10
|
|
|
Service Code
|
HCPCS 88368
|
| Min. Negotiated Rate |
$119.25 |
| Max. Negotiated Rate |
$383.29 |
| Rate for Payer: Cash Price |
$171.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$170.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$153.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$161.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$170.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$161.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$170.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$127.76
|
| Rate for Payer: Healthfirst Commercial |
$170.35
|
| Rate for Payer: Healthfirst Essential Plan |
$383.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$161.83
|
| Rate for Payer: Healthfirst QHP |
$170.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$119.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$170.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$144.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$119.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$170.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$127.76
|
| Rate for Payer: SOMOS Essential |
$127.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$170.35
|
|
|
PR M/PHMTRC ALYS ISH CPTR-ASST TECH 1ST PROBE STAIN
|
Professional
|
Both
|
$127.23
|
|
|
Service Code
|
HCPCS 88367 26
|
| Min. Negotiated Rate |
$24.02 |
| Max. Negotiated Rate |
$77.20 |
| Rate for Payer: Cash Price |
$34.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.73
|
| Rate for Payer: Healthfirst Commercial |
$34.31
|
| Rate for Payer: Healthfirst Essential Plan |
$77.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.59
|
| Rate for Payer: Healthfirst QHP |
$34.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.73
|
| Rate for Payer: SOMOS Essential |
$25.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.31
|
|
|
PR M/PHMTRC ALYS ISH CPTR-ASST TECH 1ST PROBE STAIN
|
Professional
|
Both
|
$349.16
|
|
|
Service Code
|
HCPCS 88367 TC
|
| Min. Negotiated Rate |
$63.08 |
| Max. Negotiated Rate |
$202.77 |
| Rate for Payer: Cash Price |
$94.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$90.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$90.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.59
|
| Rate for Payer: Healthfirst Commercial |
$90.12
|
| Rate for Payer: Healthfirst Essential Plan |
$202.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.61
|
| Rate for Payer: Healthfirst QHP |
$90.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$90.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$76.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.59
|
| Rate for Payer: SOMOS Essential |
$67.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.12
|
|
|
PR M/PHMTRC ALYS ISH CPTR-ASST TECH 1ST PROBE STAIN
|
Professional
|
Both
|
$476.39
|
|
|
Service Code
|
HCPCS 88367
|
| Min. Negotiated Rate |
$87.10 |
| Max. Negotiated Rate |
$279.97 |
| Rate for Payer: Cash Price |
$128.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$124.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$111.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$111.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$118.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$124.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$118.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$93.32
|
| Rate for Payer: Healthfirst Commercial |
$124.43
|
| Rate for Payer: Healthfirst Essential Plan |
$279.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$118.21
|
| Rate for Payer: Healthfirst QHP |
$124.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$87.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$124.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$105.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$87.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$124.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$93.32
|
| Rate for Payer: SOMOS Essential |
$93.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$124.43
|
|
|
PR M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST
|
Professional
|
Both
|
$166.29
|
|
|
Service Code
|
HCPCS 88361 26
|
| Min. Negotiated Rate |
$31.22 |
| Max. Negotiated Rate |
$100.35 |
| Rate for Payer: Cash Price |
$45.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$44.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.45
|
| Rate for Payer: Healthfirst Commercial |
$44.60
|
| Rate for Payer: Healthfirst Essential Plan |
$100.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.37
|
| Rate for Payer: Healthfirst QHP |
$44.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.45
|
| Rate for Payer: SOMOS Essential |
$33.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.60
|
|
|
PR M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST
|
Professional
|
Both
|
$324.73
|
|
|
Service Code
|
HCPCS 88361 TC
|
| Min. Negotiated Rate |
$60.48 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Cash Price |
$91.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$86.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$77.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$82.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$86.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$82.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.80
|
| Rate for Payer: Healthfirst Commercial |
$86.40
|
| Rate for Payer: Healthfirst Essential Plan |
$194.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$82.08
|
| Rate for Payer: Healthfirst QHP |
$86.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$60.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$86.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$73.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$60.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.80
|
| Rate for Payer: SOMOS Essential |
$64.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.40
|
|
|
PR M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST
|
Professional
|
Both
|
$491.02
|
|
|
Service Code
|
HCPCS 88361
|
| Min. Negotiated Rate |
$91.70 |
| Max. Negotiated Rate |
$294.75 |
| Rate for Payer: Cash Price |
$136.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$131.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$117.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$117.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$124.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$131.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$124.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$131.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$98.25
|
| Rate for Payer: Healthfirst Commercial |
$131.00
|
| Rate for Payer: Healthfirst Essential Plan |
$294.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$124.45
|
| Rate for Payer: Healthfirst QHP |
$131.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$91.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$131.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$111.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$91.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$131.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$98.25
|
| Rate for Payer: SOMOS Essential |
$98.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$131.00
|
|
|
PR M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL
|
Professional
|
Both
|
$159.50
|
|
|
Service Code
|
HCPCS 88360 26
|
| Min. Negotiated Rate |
$30.17 |
| Max. Negotiated Rate |
$96.97 |
| Rate for Payer: Cash Price |
$43.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.33
|
| Rate for Payer: Healthfirst Commercial |
$43.10
|
| Rate for Payer: Healthfirst Essential Plan |
$96.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.95
|
| Rate for Payer: Healthfirst QHP |
$43.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.33
|
| Rate for Payer: SOMOS Essential |
$32.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.10
|
|
|
PR M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL
|
Professional
|
Both
|
$333.38
|
|
|
Service Code
|
HCPCS 88360 TC
|
| Min. Negotiated Rate |
$64.55 |
| Max. Negotiated Rate |
$207.50 |
| Rate for Payer: Cash Price |
$94.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.17
|
| Rate for Payer: Healthfirst Commercial |
$92.22
|
| Rate for Payer: Healthfirst Essential Plan |
$207.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.61
|
| Rate for Payer: Healthfirst QHP |
$92.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.17
|
| Rate for Payer: SOMOS Essential |
$69.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.22
|
|
|
PR M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL
|
Professional
|
Both
|
$492.87
|
|
|
Service Code
|
HCPCS 88360
|
| Min. Negotiated Rate |
$94.72 |
| Max. Negotiated Rate |
$304.47 |
| Rate for Payer: Cash Price |
$138.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$135.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$121.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$121.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$128.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$135.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$128.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$135.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$101.49
|
| Rate for Payer: Healthfirst Commercial |
$135.32
|
| Rate for Payer: Healthfirst Essential Plan |
$304.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$128.55
|
| Rate for Payer: Healthfirst QHP |
$135.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$94.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$135.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$115.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$94.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$135.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$101.49
|
| Rate for Payer: SOMOS Essential |
$101.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$135.32
|
|
|
PR MULTIFETAL PREGNANCY REDUCTION
|
Professional
|
Both
|
$1,102.78
|
|
|
Service Code
|
HCPCS 59866
|
| Min. Negotiated Rate |
$202.42 |
| Max. Negotiated Rate |
$650.63 |
| Rate for Payer: Cash Price |
$292.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$289.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$260.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$260.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$274.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$289.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$274.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$289.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$289.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$216.88
|
| Rate for Payer: Healthfirst Commercial |
$289.17
|
| Rate for Payer: Healthfirst Essential Plan |
$650.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$274.71
|
| Rate for Payer: Healthfirst QHP |
$289.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$202.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$289.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$245.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$202.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$289.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$216.88
|
| Rate for Payer: SOMOS Essential |
$216.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$289.17
|
|
|
PR MULTIFOCAL ELECTRORETINOGRAPHY W/I&R
|
Professional
|
Both
|
$129.47
|
|
|
Service Code
|
HCPCS 92274 26
|
| Min. Negotiated Rate |
$24.93 |
| Max. Negotiated Rate |
$80.12 |
| Rate for Payer: Amida Care Medicaid |
$59.22
|
| Rate for Payer: Cash Price |
$35.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.71
|
| Rate for Payer: Healthfirst Commercial |
$35.61
|
| Rate for Payer: Healthfirst Essential Plan |
$80.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.83
|
| Rate for Payer: Healthfirst QHP |
$35.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.71
|
| Rate for Payer: SOMOS Essential |
$26.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.61
|
|
|
PR MULTIFOCAL ELECTRORETINOGRAPHY W/I&R
|
Professional
|
Both
|
$242.80
|
|
|
Service Code
|
HCPCS 92274 TC
|
| Min. Negotiated Rate |
$46.35 |
| Max. Negotiated Rate |
$149.00 |
| Rate for Payer: Amida Care Medicaid |
$59.22
|
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$66.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$66.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.66
|
| Rate for Payer: Healthfirst Commercial |
$66.22
|
| Rate for Payer: Healthfirst Essential Plan |
$149.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.91
|
| Rate for Payer: Healthfirst QHP |
$66.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$66.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$56.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$66.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$49.66
|
| Rate for Payer: SOMOS Essential |
$49.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.22
|
|
|
PR MULTIFOCAL ELECTRORETINOGRAPHY W/I&R
|
Professional
|
Both
|
$372.26
|
|
|
Service Code
|
HCPCS 92274
|
| Min. Negotiated Rate |
$59.22 |
| Max. Negotiated Rate |
$229.09 |
| Rate for Payer: Amida Care Medicaid |
$59.22
|
| Rate for Payer: Cash Price |
$103.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$101.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$91.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$91.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$96.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$101.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$96.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$101.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$101.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$76.36
|
| Rate for Payer: Healthfirst Commercial |
$101.82
|
| Rate for Payer: Healthfirst Essential Plan |
$229.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$96.73
|
| Rate for Payer: Healthfirst QHP |
$101.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$71.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$101.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$86.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$71.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$101.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$76.36
|
| Rate for Payer: SOMOS Essential |
$76.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$101.82
|
|
|
PR MULTIPLE FAMILY GROUP PSYCHOTHERAPY
|
Professional
|
Both
|
$113.86
|
|
|
Service Code
|
HCPCS 90849
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$74.11 |
| Rate for Payer: Amida Care Medicaid |
$15.08
|
| Rate for Payer: Cash Price |
$32.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.70
|
| Rate for Payer: Healthfirst Commercial |
$32.94
|
| Rate for Payer: Healthfirst Essential Plan |
$74.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.29
|
| Rate for Payer: Healthfirst QHP |
$32.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.70
|
| Rate for Payer: SOMOS Essential |
$24.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.94
|
|
|
PR MULTIPLE PUNCTURES ANTERIOR CORNEA
|
Professional
|
Both
|
$1,398.74
|
|
|
Service Code
|
HCPCS 65600
|
| Min. Negotiated Rate |
$269.89 |
| Max. Negotiated Rate |
$867.51 |
| Rate for Payer: Cash Price |
$388.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$385.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$347.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$347.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$366.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$385.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$366.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$385.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$385.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$289.17
|
| Rate for Payer: Healthfirst Commercial |
$385.56
|
| Rate for Payer: Healthfirst Essential Plan |
$867.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$366.28
|
| Rate for Payer: Healthfirst QHP |
$385.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$269.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$385.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$327.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$269.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$385.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$289.17
|
| Rate for Payer: SOMOS Essential |
$289.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$385.56
|
|
|
PR MUSCLE/TENDON TRANSFER UPPER ARM/ELBOW SINGLE
|
Professional
|
Both
|
$3,339.91
|
|
|
Service Code
|
HCPCS 24301
|
| Min. Negotiated Rate |
$627.12 |
| Max. Negotiated Rate |
$2,015.75 |
| Rate for Payer: Cash Price |
$899.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$895.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$806.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$806.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$851.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$895.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$851.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$895.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$895.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$671.92
|
| Rate for Payer: Healthfirst Commercial |
$895.89
|
| Rate for Payer: Healthfirst Essential Plan |
$2,015.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$851.10
|
| Rate for Payer: Healthfirst QHP |
$895.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$627.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$895.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$761.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$627.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$895.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$671.92
|
| Rate for Payer: SOMOS Essential |
$671.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$895.89
|
|
|
PR MUSCLE TRANSFER SHOULDER/UPPER ARM MULTIPLE
|
Professional
|
Both
|
$5,029.99
|
|
|
Service Code
|
HCPCS 23397
|
| Min. Negotiated Rate |
$943.03 |
| Max. Negotiated Rate |
$3,031.18 |
| Rate for Payer: Cash Price |
$1,360.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,347.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,212.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,212.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,279.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,347.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,279.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,347.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,347.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,010.39
|
| Rate for Payer: Healthfirst Commercial |
$1,347.19
|
| Rate for Payer: Healthfirst Essential Plan |
$3,031.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,279.83
|
| Rate for Payer: Healthfirst QHP |
$1,347.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$943.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,347.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,145.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$943.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,347.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,010.39
|
| Rate for Payer: SOMOS Essential |
$1,010.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,347.19
|
|
|
PR MUSCLE TRANSFER SHOULDER/UPPER ARM SINGLE
|
Professional
|
Both
|
$5,639.03
|
|
|
Service Code
|
HCPCS 23395
|
| Min. Negotiated Rate |
$1,064.42 |
| Max. Negotiated Rate |
$3,421.35 |
| Rate for Payer: Cash Price |
$1,527.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,520.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,368.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,368.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,444.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,520.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,444.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,520.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,520.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,140.45
|
| Rate for Payer: Healthfirst Commercial |
$1,520.60
|
| Rate for Payer: Healthfirst Essential Plan |
$3,421.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,444.57
|
| Rate for Payer: Healthfirst QHP |
$1,520.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,064.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,520.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,292.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,064.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,520.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,140.45
|
| Rate for Payer: SOMOS Essential |
$1,140.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,520.60
|
|
|
PR MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP LXTR
|
Professional
|
Both
|
$5,556.46
|
|
|
Service Code
|
HCPCS 15738
|
| Min. Negotiated Rate |
$1,036.32 |
| Max. Negotiated Rate |
$3,331.03 |
| Rate for Payer: Cash Price |
$1,494.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,480.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,332.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,332.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,406.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,480.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,406.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,480.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,480.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,110.35
|
| Rate for Payer: Healthfirst Commercial |
$1,480.46
|
| Rate for Payer: Healthfirst Essential Plan |
$3,331.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,406.44
|
| Rate for Payer: Healthfirst QHP |
$1,480.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,036.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,480.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,258.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,036.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,480.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,110.35
|
| Rate for Payer: SOMOS Essential |
$1,110.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,480.46
|
|
|
PR MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP TRUNK
|
Professional
|
Both
|
$6,641.43
|
|
|
Service Code
|
HCPCS 15734
|
| Min. Negotiated Rate |
$1,240.89 |
| Max. Negotiated Rate |
$3,988.57 |
| Rate for Payer: Cash Price |
$1,782.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,772.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,595.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,595.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,684.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,772.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,684.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,772.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,772.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,329.53
|
| Rate for Payer: Healthfirst Commercial |
$1,772.70
|
| Rate for Payer: Healthfirst Essential Plan |
$3,988.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,684.07
|
| Rate for Payer: Healthfirst QHP |
$1,772.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,240.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,772.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,506.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,240.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,772.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,329.53
|
| Rate for Payer: SOMOS Essential |
$1,329.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,772.70
|
|
|
PR MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP UXTR
|
Professional
|
Both
|
$5,325.04
|
|
|
Service Code
|
HCPCS 15736
|
| Min. Negotiated Rate |
$1,000.39 |
| Max. Negotiated Rate |
$3,215.54 |
| Rate for Payer: Cash Price |
$1,439.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,429.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,286.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,286.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,357.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,429.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,357.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,429.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,429.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,071.85
|
| Rate for Payer: Healthfirst Commercial |
$1,429.13
|
| Rate for Payer: Healthfirst Essential Plan |
$3,215.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,357.67
|
| Rate for Payer: Healthfirst QHP |
$1,429.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,000.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,429.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,214.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,000.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,429.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,071.85
|
| Rate for Payer: SOMOS Essential |
$1,071.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,429.13
|
|
