|
PR PARTIAL EXCISION BONE RADIUS
|
Professional
|
Both
|
$2,589.30
|
|
|
Service Code
|
HCPCS 25151
|
| Min. Negotiated Rate |
$490.90 |
| Max. Negotiated Rate |
$1,577.88 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$701.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$631.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$631.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$666.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$701.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$666.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$701.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$701.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$525.96
|
| Rate for Payer: Healthfirst Commercial |
$701.28
|
| Rate for Payer: Healthfirst Essential Plan |
$1,577.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$666.22
|
| Rate for Payer: Healthfirst QHP |
$701.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$490.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$701.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$596.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$490.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$701.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$525.96
|
| Rate for Payer: SOMOS Essential |
$525.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$701.28
|
|
|
PR PARTIAL EXCISION BONE SCAPULA
|
Professional
|
Both
|
$2,984.94
|
|
|
Service Code
|
HCPCS 23182
|
| Min. Negotiated Rate |
$564.89 |
| Max. Negotiated Rate |
$1,815.70 |
| Rate for Payer: Cash Price |
$809.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$806.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$726.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$726.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$766.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$806.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$766.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$806.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$806.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$605.24
|
| Rate for Payer: Healthfirst Commercial |
$806.98
|
| Rate for Payer: Healthfirst Essential Plan |
$1,815.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$766.63
|
| Rate for Payer: Healthfirst QHP |
$806.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$564.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$806.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$685.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$564.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$806.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$605.24
|
| Rate for Payer: SOMOS Essential |
$605.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$806.98
|
|
|
PR PARTIAL EXCISION BONE TALUS/CALCANEUS
|
Professional
|
Both
|
$2,121.39
|
|
|
Service Code
|
HCPCS 28120
|
| Min. Negotiated Rate |
$402.59 |
| Max. Negotiated Rate |
$1,294.04 |
| Rate for Payer: Cash Price |
$579.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$575.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$517.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$517.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$546.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$575.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$546.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$575.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$575.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$431.35
|
| Rate for Payer: Healthfirst Commercial |
$575.13
|
| Rate for Payer: Healthfirst Essential Plan |
$1,294.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$546.37
|
| Rate for Payer: Healthfirst QHP |
$575.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$402.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$575.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$488.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$402.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$575.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$431.35
|
| Rate for Payer: SOMOS Essential |
$431.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$575.13
|
|
|
PR PARTIAL EXCISION BONE TIBIA
|
Professional
|
Both
|
$3,640.60
|
|
|
Service Code
|
HCPCS 27640
|
| Min. Negotiated Rate |
$682.02 |
| Max. Negotiated Rate |
$2,192.20 |
| Rate for Payer: Cash Price |
$986.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$974.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$876.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$876.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$925.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$974.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$925.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$974.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$974.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$730.73
|
| Rate for Payer: Healthfirst Commercial |
$974.31
|
| Rate for Payer: Healthfirst Essential Plan |
$2,192.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$925.59
|
| Rate for Payer: Healthfirst QHP |
$974.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$682.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$974.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$828.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$682.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$974.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$730.73
|
| Rate for Payer: SOMOS Essential |
$730.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$974.31
|
|
|
PR PARTIAL EXCISION BONE ULNA
|
Professional
|
Both
|
$2,513.60
|
|
|
Service Code
|
HCPCS 25150
|
| Min. Negotiated Rate |
$477.64 |
| Max. Negotiated Rate |
$1,535.27 |
| Rate for Payer: Cash Price |
$682.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$682.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$614.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$614.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$648.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$682.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$648.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$682.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$682.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$511.75
|
| Rate for Payer: Healthfirst Commercial |
$682.34
|
| Rate for Payer: Healthfirst Essential Plan |
$1,535.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$648.22
|
| Rate for Payer: Healthfirst QHP |
$682.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$477.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$682.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$579.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$477.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$682.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$511.75
|
| Rate for Payer: SOMOS Essential |
$511.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$682.34
|
|
|
PR PARTIAL EXCISION DEEP PELVIS
|
Professional
|
Both
|
$4,314.77
|
|
|
Service Code
|
HCPCS 27071
|
| Min. Negotiated Rate |
$800.88 |
| Max. Negotiated Rate |
$2,574.27 |
| Rate for Payer: Cash Price |
$1,160.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,144.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,029.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,029.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,086.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,144.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,086.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,144.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,144.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$858.09
|
| Rate for Payer: Healthfirst Commercial |
$1,144.12
|
| Rate for Payer: Healthfirst Essential Plan |
$2,574.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,086.91
|
| Rate for Payer: Healthfirst QHP |
$1,144.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$800.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,144.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$972.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$800.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,144.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$858.09
|
| Rate for Payer: SOMOS Essential |
$858.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,144.12
|
|
|
PR PARTIAL EXCISION DISTAL PHALANX FINGER
|
Professional
|
Both
|
$1,954.82
|
|
|
Service Code
|
HCPCS 26236
|
| Min. Negotiated Rate |
$372.41 |
| Max. Negotiated Rate |
$1,197.02 |
| Rate for Payer: Cash Price |
$533.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$532.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$478.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$478.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$505.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$532.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$505.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$532.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$532.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$399.01
|
| Rate for Payer: Healthfirst Commercial |
$532.01
|
| Rate for Payer: Healthfirst Essential Plan |
$1,197.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$505.41
|
| Rate for Payer: Healthfirst QHP |
$532.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$372.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$532.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$452.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$372.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$532.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$399.01
|
| Rate for Payer: SOMOS Essential |
$399.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$532.01
|
|
|
PR PARTIAL EXCISION PROXIMAL/MIDDLE PHALANX FINGER
|
Professional
|
Both
|
$2,178.40
|
|
|
Service Code
|
HCPCS 26235
|
| Min. Negotiated Rate |
$413.85 |
| Max. Negotiated Rate |
$1,330.22 |
| Rate for Payer: Cash Price |
$593.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$591.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$532.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$532.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$561.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$591.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$561.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$591.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$591.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$443.41
|
| Rate for Payer: Healthfirst Commercial |
$591.21
|
| Rate for Payer: Healthfirst Essential Plan |
$1,330.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$561.65
|
| Rate for Payer: Healthfirst QHP |
$591.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$413.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$591.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$502.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$413.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$591.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$443.41
|
| Rate for Payer: SOMOS Essential |
$443.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$591.21
|
|
|
PR PARTIAL EXCISION SUPERFICIAL PELVIS
|
Professional
|
Both
|
$3,904.18
|
|
|
Service Code
|
HCPCS 27070
|
| Min. Negotiated Rate |
$724.45 |
| Max. Negotiated Rate |
$2,328.59 |
| Rate for Payer: Cash Price |
$1,053.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,034.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$931.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$931.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$983.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,034.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$983.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,034.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,034.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$776.20
|
| Rate for Payer: Healthfirst Commercial |
$1,034.93
|
| Rate for Payer: Healthfirst Essential Plan |
$2,328.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$983.18
|
| Rate for Payer: Healthfirst QHP |
$1,034.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$724.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,034.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$879.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$724.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,034.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$776.20
|
| Rate for Payer: SOMOS Essential |
$776.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,034.93
|
|
|
PR PARTIAL LARYNGECTOMY HEMILARYGECTOMY HORIZONTAL
|
Professional
|
Both
|
$8,815.00
|
|
|
Service Code
|
HCPCS 31370
|
| Min. Negotiated Rate |
$1,641.31 |
| Max. Negotiated Rate |
$5,275.64 |
| Rate for Payer: Cash Price |
$2,375.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,344.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,110.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,110.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,227.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,344.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,227.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,344.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,344.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,758.55
|
| Rate for Payer: Healthfirst Commercial |
$2,344.73
|
| Rate for Payer: Healthfirst Essential Plan |
$5,275.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,227.49
|
| Rate for Payer: Healthfirst QHP |
$2,344.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,641.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,344.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,993.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,641.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,344.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,758.55
|
| Rate for Payer: SOMOS Essential |
$1,758.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,344.73
|
|
|
PR PARTIAL LARYNGECTOMY HEMILARYNG ANTEROVERTICAL
|
Professional
|
Both
|
$8,263.64
|
|
|
Service Code
|
HCPCS 31380
|
| Min. Negotiated Rate |
$1,539.50 |
| Max. Negotiated Rate |
$4,948.40 |
| Rate for Payer: Cash Price |
$2,227.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,199.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,979.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,979.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,089.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,199.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,089.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,199.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,199.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,649.47
|
| Rate for Payer: Healthfirst Commercial |
$2,199.29
|
| Rate for Payer: Healthfirst Essential Plan |
$4,948.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,089.33
|
| Rate for Payer: Healthfirst QHP |
$2,199.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,539.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,199.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,869.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,539.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,199.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,649.47
|
| Rate for Payer: SOMOS Essential |
$1,649.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,199.29
|
|
|
PR PARTIAL LARYNGECTOMY HEMILARYNG LATEROVERTICAL
|
Professional
|
Both
|
$8,379.91
|
|
|
Service Code
|
HCPCS 31375
|
| Min. Negotiated Rate |
$1,561.11 |
| Max. Negotiated Rate |
$5,017.86 |
| Rate for Payer: Cash Price |
$2,258.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,230.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,007.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,007.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,118.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,230.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,118.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,230.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,230.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,672.62
|
| Rate for Payer: Healthfirst Commercial |
$2,230.16
|
| Rate for Payer: Healthfirst Essential Plan |
$5,017.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,118.65
|
| Rate for Payer: Healthfirst QHP |
$2,230.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,561.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,230.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,895.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,561.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,230.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,672.62
|
| Rate for Payer: SOMOS Essential |
$1,672.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,230.16
|
|
|
PR PARTIAL LARYNG HEMILARYNG ANTERO-LATERO-VERTICAL
|
Professional
|
Both
|
$9,043.41
|
|
|
Service Code
|
HCPCS 31382
|
| Min. Negotiated Rate |
$1,684.68 |
| Max. Negotiated Rate |
$5,415.05 |
| Rate for Payer: Cash Price |
$2,438.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,406.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,166.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,166.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,286.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,406.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,286.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,406.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,406.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,805.02
|
| Rate for Payer: Healthfirst Commercial |
$2,406.69
|
| Rate for Payer: Healthfirst Essential Plan |
$5,415.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,286.36
|
| Rate for Payer: Healthfirst QHP |
$2,406.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,684.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,406.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,045.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,684.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,406.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,805.02
|
| Rate for Payer: SOMOS Essential |
$1,805.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,406.69
|
|
|
PR PARTIAL REPAIR OR REMOVAL OF SHOULDER BONE
|
Professional
|
Both
|
$2,748.38
|
|
|
Service Code
|
HCPCS 23130
|
| Min. Negotiated Rate |
$519.41 |
| Max. Negotiated Rate |
$1,669.52 |
| Rate for Payer: Cash Price |
$744.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$742.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$667.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$667.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$704.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$742.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$704.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$742.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$742.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$556.51
|
| Rate for Payer: Healthfirst Commercial |
$742.01
|
| Rate for Payer: Healthfirst Essential Plan |
$1,669.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$704.91
|
| Rate for Payer: Healthfirst QHP |
$742.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$519.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$742.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$630.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$519.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$742.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$556.51
|
| Rate for Payer: SOMOS Essential |
$556.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$742.01
|
|
|
PR PARTICAL EXCISION BONE PHALANX TOE
|
Professional
|
Both
|
$1,392.06
|
|
|
Service Code
|
HCPCS 28124
|
| Min. Negotiated Rate |
$271.22 |
| Max. Negotiated Rate |
$871.78 |
| Rate for Payer: Cash Price |
$386.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$387.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$348.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$348.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$368.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$387.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$368.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$387.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$387.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$290.60
|
| Rate for Payer: Healthfirst Commercial |
$387.46
|
| Rate for Payer: Healthfirst Essential Plan |
$871.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$368.09
|
| Rate for Payer: Healthfirst QHP |
$387.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$271.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$387.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$329.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$271.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$387.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$290.60
|
| Rate for Payer: SOMOS Essential |
$290.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$387.46
|
|
|
PR PATCH/APPLICATION TEST SPECIFY NUMBER TESTS
|
Professional
|
Both
|
$22.86
|
|
|
Service Code
|
HCPCS 95044
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$13.61 |
| Rate for Payer: Amida Care Medicaid |
$3.92
|
| Rate for Payer: Cash Price |
$6.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.54
|
| Rate for Payer: Healthfirst Commercial |
$6.05
|
| Rate for Payer: Healthfirst Essential Plan |
$13.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.75
|
| Rate for Payer: Healthfirst QHP |
$6.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$4.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$6.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$5.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$4.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.54
|
| Rate for Payer: SOMOS Essential |
$4.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.05
|
|
|
PR PATELLECTOMY/HEMIPATELLECTOMY
|
Professional
|
Both
|
$2,906.51
|
|
|
Service Code
|
HCPCS 27350
|
| Min. Negotiated Rate |
$548.49 |
| Max. Negotiated Rate |
$1,763.01 |
| Rate for Payer: Cash Price |
$786.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$783.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$705.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$705.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$744.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$783.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$744.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$783.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$783.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$587.67
|
| Rate for Payer: Healthfirst Commercial |
$783.56
|
| Rate for Payer: Healthfirst Essential Plan |
$1,763.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$744.38
|
| Rate for Payer: Healthfirst QHP |
$783.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$548.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$783.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$666.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$548.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$783.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$587.67
|
| Rate for Payer: SOMOS Essential |
$587.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$783.56
|
|
|
PR PATIENT-INITIATED SPIROMETRIC PHYS/QHP R&I ONLY
|
Professional
|
Both
|
$96.46
|
|
|
Service Code
|
HCPCS 94016
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$58.81 |
| Rate for Payer: Amida Care Medicaid |
$12.46
|
| Rate for Payer: Cash Price |
$26.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.61
|
| Rate for Payer: Healthfirst Commercial |
$26.14
|
| Rate for Payer: Healthfirst Essential Plan |
$58.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.83
|
| Rate for Payer: Healthfirst QHP |
$26.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.61
|
| Rate for Payer: SOMOS Essential |
$19.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.14
|
|
|
PR PATIENT-INITIATED SPIROMETRIC RECORDING
|
Professional
|
Both
|
$133.56
|
|
|
Service Code
|
HCPCS 94015
|
| Min. Negotiated Rate |
$26.24 |
| Max. Negotiated Rate |
$84.35 |
| Rate for Payer: Cash Price |
$37.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.12
|
| Rate for Payer: Healthfirst Commercial |
$37.49
|
| Rate for Payer: Healthfirst Essential Plan |
$84.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.62
|
| Rate for Payer: Healthfirst QHP |
$37.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.12
|
| Rate for Payer: SOMOS Essential |
$28.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.49
|
|
|
PR PATTERN ELECTRORETINOGRAPHY W/I&R
|
Professional
|
Both
|
$83.02
|
|
|
Service Code
|
HCPCS 0509T 26
|
| Min. Negotiated Rate |
$15.79 |
| Max. Negotiated Rate |
$50.74 |
| Rate for Payer: Cash Price |
$22.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.91
|
| Rate for Payer: Healthfirst Commercial |
$22.55
|
| Rate for Payer: Healthfirst Essential Plan |
$50.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.42
|
| Rate for Payer: Healthfirst QHP |
$22.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16.91
|
| Rate for Payer: SOMOS Essential |
$16.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.55
|
|
|
PR PATTERN ELECTRORETINOGRAPHY W/I&R
|
Professional
|
Both
|
$235.62
|
|
|
Service Code
|
HCPCS 0509T TC
|
| Min. Negotiated Rate |
$44.72 |
| Max. Negotiated Rate |
$143.75 |
| Rate for Payer: Cash Price |
$65.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$63.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$57.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$60.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$63.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$60.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.92
|
| Rate for Payer: Healthfirst Commercial |
$63.89
|
| Rate for Payer: Healthfirst Essential Plan |
$143.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.70
|
| Rate for Payer: Healthfirst QHP |
$63.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$44.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$63.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$54.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$44.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$63.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.92
|
| Rate for Payer: SOMOS Essential |
$47.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.89
|
|
|
PR PATTERN ELECTRORETINOGRAPHY W/I&R
|
Professional
|
Both
|
$318.64
|
|
|
Service Code
|
HCPCS 0509T
|
| Min. Negotiated Rate |
$60.51 |
| Max. Negotiated Rate |
$194.49 |
| Rate for Payer: Cash Price |
$88.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$86.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$77.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$82.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$86.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$82.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.83
|
| Rate for Payer: Healthfirst Commercial |
$86.44
|
| Rate for Payer: Healthfirst Essential Plan |
$194.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$82.12
|
| Rate for Payer: Healthfirst QHP |
$86.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$60.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$86.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$73.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$60.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.83
|
| Rate for Payer: SOMOS Essential |
$64.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.44
|
|
|
PR PCV13 VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$940.94
|
|
|
Service Code
|
HCPCS 90670
|
| Min. Negotiated Rate |
$180.59 |
| Max. Negotiated Rate |
$580.48 |
| Rate for Payer: Cash Price |
$257.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$257.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$232.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$232.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$245.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$257.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$245.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$257.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$257.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$193.49
|
| Rate for Payer: Healthfirst Commercial |
$257.99
|
| Rate for Payer: Healthfirst Essential Plan |
$580.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$245.09
|
| Rate for Payer: Healthfirst QHP |
$257.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$180.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$257.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$219.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$180.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$257.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$193.49
|
| Rate for Payer: SOMOS Essential |
$193.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$257.99
|
|
|
PR PCV15 VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$718.62
|
|
|
Service Code
|
HCPCS 90671
|
| Min. Negotiated Rate |
$182.81 |
| Max. Negotiated Rate |
$587.59 |
| Rate for Payer: Cash Price |
$253.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$261.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$235.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$235.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$248.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$261.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$248.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$261.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$261.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$195.86
|
| Rate for Payer: Healthfirst Commercial |
$261.15
|
| Rate for Payer: Healthfirst Essential Plan |
$587.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$248.09
|
| Rate for Payer: Healthfirst QHP |
$261.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$182.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$261.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$221.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$182.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$261.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$195.86
|
| Rate for Payer: SOMOS Essential |
$195.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$261.15
|
|
|
PR PCV20 VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$886.24
|
|
|
Service Code
|
HCPCS 90677
|
| Min. Negotiated Rate |
$219.03 |
| Max. Negotiated Rate |
$704.02 |
| Rate for Payer: Cash Price |
$298.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$312.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$281.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$281.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$297.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$312.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$297.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$312.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$312.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$234.68
|
| Rate for Payer: Healthfirst Commercial |
$312.90
|
| Rate for Payer: Healthfirst Essential Plan |
$704.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$297.25
|
| Rate for Payer: Healthfirst QHP |
$312.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$219.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$312.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$265.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$219.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$312.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$234.68
|
| Rate for Payer: SOMOS Essential |
$234.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$312.90
|
|
