|
PR PRTL ESOPHECT DSTL W/WO PROX GASTRECT/PYLORPLSTY
|
Professional
|
Both
|
$14,506.87
|
|
|
Service Code
|
HCPCS 43117
|
| Min. Negotiated Rate |
$2,676.34 |
| Max. Negotiated Rate |
$8,602.54 |
| Rate for Payer: Cash Price |
$3,862.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,823.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,441.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,441.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,632.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,823.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,632.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,823.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,823.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,867.51
|
| Rate for Payer: Healthfirst Commercial |
$3,823.35
|
| Rate for Payer: Healthfirst Essential Plan |
$8,602.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,632.18
|
| Rate for Payer: Healthfirst QHP |
$3,823.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,676.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,823.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,249.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,676.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,823.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,867.51
|
| Rate for Payer: SOMOS Essential |
$2,867.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,823.35
|
|
|
PR PRTL ESOPHG THORACOABD W/WO PROXGASTREC/PYLOROPL
|
Professional
|
Both
|
$11,400.76
|
|
|
Service Code
|
HCPCS 43122
|
| Min. Negotiated Rate |
$2,131.67 |
| Max. Negotiated Rate |
$6,851.79 |
| Rate for Payer: Cash Price |
$3,061.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,045.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,740.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,740.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,892.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,045.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,892.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,045.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,045.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,283.93
|
| Rate for Payer: Healthfirst Commercial |
$3,045.24
|
| Rate for Payer: Healthfirst Essential Plan |
$6,851.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,892.98
|
| Rate for Payer: Healthfirst QHP |
$3,045.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,131.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,045.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,588.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,131.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,045.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,283.93
|
| Rate for Payer: SOMOS Essential |
$2,283.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,045.24
|
|
|
PR PRTL ESPHG THORACOABDL/ABDL APPR NTRPSTJ/RCNSTJ
|
Professional
|
Both
|
$20,068.69
|
|
|
Service Code
|
HCPCS 43123
|
| Min. Negotiated Rate |
$3,684.63 |
| Max. Negotiated Rate |
$11,843.46 |
| Rate for Payer: Cash Price |
$5,321.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,263.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,737.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,737.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,000.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,263.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,000.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,263.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,263.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,947.82
|
| Rate for Payer: Healthfirst Commercial |
$5,263.76
|
| Rate for Payer: Healthfirst Essential Plan |
$11,843.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,000.57
|
| Rate for Payer: Healthfirst QHP |
$5,263.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,684.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5,263.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4,474.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3,684.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,263.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,947.82
|
| Rate for Payer: SOMOS Essential |
$3,947.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,263.76
|
|
|
PR PRTL EXC B1 TARSAL/METAR B1 XCP TALUS/CALCANEUS
|
Professional
|
Both
|
$1,845.80
|
|
|
Service Code
|
HCPCS 28122
|
| Min. Negotiated Rate |
$355.13 |
| Max. Negotiated Rate |
$1,141.49 |
| Rate for Payer: Cash Price |
$509.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$507.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$456.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$456.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$481.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$507.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$481.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$507.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$507.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$380.50
|
| Rate for Payer: Healthfirst Commercial |
$507.33
|
| Rate for Payer: Healthfirst Essential Plan |
$1,141.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$481.96
|
| Rate for Payer: Healthfirst QHP |
$507.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$355.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$507.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$431.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$355.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$507.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$380.50
|
| Rate for Payer: SOMOS Essential |
$380.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$507.33
|
|
|
PR PRTL EXC BONE FEMUR PROX TIBIA&/FIBULA
|
Professional
|
Both
|
$4,001.24
|
|
|
Service Code
|
HCPCS 27360
|
| Min. Negotiated Rate |
$748.87 |
| Max. Negotiated Rate |
$2,407.07 |
| Rate for Payer: Cash Price |
$1,079.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,069.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$962.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$962.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,016.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,069.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,016.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,069.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,069.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$802.36
|
| Rate for Payer: Healthfirst Commercial |
$1,069.81
|
| Rate for Payer: Healthfirst Essential Plan |
$2,407.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,016.32
|
| Rate for Payer: Healthfirst QHP |
$1,069.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$748.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,069.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$909.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$748.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,069.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$802.36
|
| Rate for Payer: SOMOS Essential |
$802.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,069.81
|
|
|
PR PRTL EXCHANGE TRANSFUSE BLOOD/PLSM/CRYST NEWBORN
|
Professional
|
Both
|
$393.75
|
|
|
Service Code
|
HCPCS 36456
|
| Min. Negotiated Rate |
$74.28 |
| Max. Negotiated Rate |
$238.77 |
| Rate for Payer: Cash Price |
$107.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$106.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$95.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$95.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$100.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$106.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$100.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.59
|
| Rate for Payer: Healthfirst Commercial |
$106.12
|
| Rate for Payer: Healthfirst Essential Plan |
$238.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$100.81
|
| Rate for Payer: Healthfirst QHP |
$106.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$106.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$90.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$74.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$106.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$79.59
|
| Rate for Payer: SOMOS Essential |
$79.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$106.12
|
|
|
PR PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM CRV
|
Professional
|
Both
|
$3,945.52
|
|
|
Service Code
|
HCPCS 22100
|
| Min. Negotiated Rate |
$832.54 |
| Max. Negotiated Rate |
$2,676.01 |
| Rate for Payer: Cash Price |
$1,195.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,189.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,070.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,070.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,129.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,189.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,129.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,189.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,189.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$892.00
|
| Rate for Payer: Healthfirst Commercial |
$1,189.34
|
| Rate for Payer: Healthfirst Essential Plan |
$2,676.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,129.87
|
| Rate for Payer: Healthfirst QHP |
$1,189.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$832.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,189.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,010.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$832.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,189.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$892.00
|
| Rate for Payer: SOMOS Essential |
$892.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,189.34
|
|
|
PR PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM EA
|
Professional
|
Both
|
$611.21
|
|
|
Service Code
|
HCPCS 22103
|
| Min. Negotiated Rate |
$110.28 |
| Max. Negotiated Rate |
$354.46 |
| Rate for Payer: Cash Price |
$160.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$141.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$149.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$149.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$118.16
|
| Rate for Payer: Healthfirst Commercial |
$157.54
|
| Rate for Payer: Healthfirst Essential Plan |
$354.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$149.66
|
| Rate for Payer: Healthfirst QHP |
$157.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$110.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$157.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$133.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$110.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$118.16
|
| Rate for Payer: SOMOS Essential |
$118.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.54
|
|
|
PR PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM LMBR
|
Professional
|
Both
|
$3,446.49
|
|
|
Service Code
|
HCPCS 22102
|
| Min. Negotiated Rate |
$630.63 |
| Max. Negotiated Rate |
$2,027.03 |
| Rate for Payer: Cash Price |
$920.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$900.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$810.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$810.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$855.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$900.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$855.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$900.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$900.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$675.67
|
| Rate for Payer: Healthfirst Commercial |
$900.90
|
| Rate for Payer: Healthfirst Essential Plan |
$2,027.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$855.86
|
| Rate for Payer: Healthfirst QHP |
$900.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$630.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$900.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$765.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$630.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$900.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$675.67
|
| Rate for Payer: SOMOS Essential |
$675.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$900.90
|
|
|
PR PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM THRC
|
Professional
|
Both
|
$3,971.35
|
|
|
Service Code
|
HCPCS 22101
|
| Min. Negotiated Rate |
$767.75 |
| Max. Negotiated Rate |
$2,467.76 |
| Rate for Payer: Cash Price |
$1,080.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,096.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$987.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$987.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,041.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,096.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,041.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,096.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,096.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$822.59
|
| Rate for Payer: Healthfirst Commercial |
$1,096.78
|
| Rate for Payer: Healthfirst Essential Plan |
$2,467.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,041.94
|
| Rate for Payer: Healthfirst QHP |
$1,096.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$767.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,096.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$932.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$767.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,096.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$822.59
|
| Rate for Payer: SOMOS Essential |
$822.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,096.78
|
|
|
PR PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM CRV
|
Professional
|
Both
|
$4,937.07
|
|
|
Service Code
|
HCPCS 22110
|
| Min. Negotiated Rate |
$910.95 |
| Max. Negotiated Rate |
$2,928.06 |
| Rate for Payer: Cash Price |
$1,313.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,301.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,171.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,171.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,236.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,301.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,236.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,301.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,301.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$976.02
|
| Rate for Payer: Healthfirst Commercial |
$1,301.36
|
| Rate for Payer: Healthfirst Essential Plan |
$2,928.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,236.29
|
| Rate for Payer: Healthfirst QHP |
$1,301.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$910.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,301.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,106.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$910.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,301.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$976.02
|
| Rate for Payer: SOMOS Essential |
$976.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,301.36
|
|
|
PR PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM EA
|
Professional
|
Both
|
$658.21
|
|
|
Service Code
|
HCPCS 22116
|
| Min. Negotiated Rate |
$121.92 |
| Max. Negotiated Rate |
$391.88 |
| Rate for Payer: Cash Price |
$172.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$174.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$156.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$156.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$165.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$174.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$165.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$130.63
|
| Rate for Payer: Healthfirst Commercial |
$174.17
|
| Rate for Payer: Healthfirst Essential Plan |
$391.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$165.46
|
| Rate for Payer: Healthfirst QHP |
$174.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$121.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$174.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$148.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$121.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$174.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$130.63
|
| Rate for Payer: SOMOS Essential |
$130.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$174.17
|
|
|
PR PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM LMBR
|
Professional
|
Both
|
$5,419.33
|
|
|
Service Code
|
HCPCS 22114
|
| Min. Negotiated Rate |
$1,002.12 |
| Max. Negotiated Rate |
$3,221.10 |
| Rate for Payer: Cash Price |
$1,441.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,431.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,288.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,288.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,360.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,431.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,360.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,431.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,431.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,073.70
|
| Rate for Payer: Healthfirst Commercial |
$1,431.60
|
| Rate for Payer: Healthfirst Essential Plan |
$3,221.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,360.02
|
| Rate for Payer: Healthfirst QHP |
$1,431.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,002.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,431.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,216.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,002.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,431.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,073.70
|
| Rate for Payer: SOMOS Essential |
$1,073.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,431.60
|
|
|
PR PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM THRC
|
Professional
|
Both
|
$5,419.33
|
|
|
Service Code
|
HCPCS 22112
|
| Min. Negotiated Rate |
$1,002.12 |
| Max. Negotiated Rate |
$3,221.10 |
| Rate for Payer: Cash Price |
$1,441.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,431.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,288.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,288.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,360.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,431.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,360.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,431.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,431.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,073.70
|
| Rate for Payer: Healthfirst Commercial |
$1,431.60
|
| Rate for Payer: Healthfirst Essential Plan |
$3,221.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,360.02
|
| Rate for Payer: Healthfirst QHP |
$1,431.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,002.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,431.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,216.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,002.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,431.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,073.70
|
| Rate for Payer: SOMOS Essential |
$1,073.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,431.60
|
|
|
PR PRTL HYMENECTOMY/REVJ HYMENAL RING
|
Professional
|
Both
|
$888.37
|
|
|
Service Code
|
HCPCS 56700
|
| Min. Negotiated Rate |
$166.04 |
| Max. Negotiated Rate |
$533.70 |
| Rate for Payer: Cash Price |
$240.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$237.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$213.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$213.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$225.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$237.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$225.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$237.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$237.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$177.90
|
| Rate for Payer: Healthfirst Commercial |
$237.20
|
| Rate for Payer: Healthfirst Essential Plan |
$533.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.34
|
| Rate for Payer: Healthfirst QHP |
$237.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$166.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$237.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$201.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$166.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$237.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$177.90
|
| Rate for Payer: SOMOS Essential |
$177.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$237.20
|
|
|
PR PRTL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY
|
Professional
|
Both
|
$3,132.05
|
|
|
Service Code
|
HCPCS 60210
|
| Min. Negotiated Rate |
$585.74 |
| Max. Negotiated Rate |
$1,882.73 |
| Rate for Payer: Cash Price |
$841.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$836.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$753.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$753.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$794.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$836.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$794.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$836.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$836.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$627.58
|
| Rate for Payer: Healthfirst Commercial |
$836.77
|
| Rate for Payer: Healthfirst Essential Plan |
$1,882.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$794.93
|
| Rate for Payer: Healthfirst QHP |
$836.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$585.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$836.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$711.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$585.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$836.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$627.58
|
| Rate for Payer: SOMOS Essential |
$627.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$836.77
|
|
|
PR PRTL THYROID LOBEC UNI W/CONTRATLAT STOT LOBEC
|
Professional
|
Both
|
$4,649.79
|
|
|
Service Code
|
HCPCS 60212
|
| Min. Negotiated Rate |
$860.19 |
| Max. Negotiated Rate |
$2,764.89 |
| Rate for Payer: Cash Price |
$1,238.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,228.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,105.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,105.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,167.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,228.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,167.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,228.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,228.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$921.63
|
| Rate for Payer: Healthfirst Commercial |
$1,228.84
|
| Rate for Payer: Healthfirst Essential Plan |
$2,764.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,167.40
|
| Rate for Payer: Healthfirst QHP |
$1,228.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$860.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,228.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,044.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$860.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,228.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$921.63
|
| Rate for Payer: SOMOS Essential |
$921.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,228.84
|
|
|
PR PSYCHIATRIC DIAGNOSTIC EVALUATION
|
Professional
|
Both
|
$581.63
|
|
|
Service Code
|
HCPCS 90791
|
| Min. Negotiated Rate |
$60.38 |
| Max. Negotiated Rate |
$353.48 |
| Rate for Payer: Amida Care Medicaid |
$60.38
|
| Rate for Payer: Cash Price |
$159.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$141.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$149.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$149.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$117.83
|
| Rate for Payer: Healthfirst Commercial |
$157.10
|
| Rate for Payer: Healthfirst Essential Plan |
$353.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$149.25
|
| Rate for Payer: Healthfirst QHP |
$157.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$109.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$157.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$133.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$109.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$117.83
|
| Rate for Payer: SOMOS Essential |
$117.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.10
|
|
|
PR PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES
|
Professional
|
Both
|
$676.66
|
|
|
Service Code
|
HCPCS 90792
|
| Min. Negotiated Rate |
$116.22 |
| Max. Negotiated Rate |
$409.32 |
| Rate for Payer: Amida Care Medicaid |
$116.22
|
| Rate for Payer: Cash Price |
$185.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$181.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$163.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$163.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$172.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$181.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$172.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$181.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$181.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$136.44
|
| Rate for Payer: Healthfirst Commercial |
$181.92
|
| Rate for Payer: Healthfirst Essential Plan |
$409.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$172.82
|
| Rate for Payer: Healthfirst QHP |
$181.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$127.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$181.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$154.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$127.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$181.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$136.44
|
| Rate for Payer: SOMOS Essential |
$136.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$181.92
|
|
|
PR PSYCHOANALYSIS
|
Professional
|
Both
|
$324.00
|
|
|
Service Code
|
HCPCS 90845
|
| Min. Negotiated Rate |
$67.30 |
| Max. Negotiated Rate |
$216.31 |
| Rate for Payer: Cash Price |
$94.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$96.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$86.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.11
|
| Rate for Payer: Healthfirst Commercial |
$96.14
|
| Rate for Payer: Healthfirst Essential Plan |
$216.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$91.33
|
| Rate for Payer: Healthfirst QHP |
$96.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$67.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$96.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$81.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$67.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.11
|
| Rate for Payer: SOMOS Essential |
$72.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.14
|
|
|
PR PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR
|
Professional
|
Both
|
$293.79
|
|
|
Service Code
|
HCPCS 96131
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$178.45 |
| Rate for Payer: Amida Care Medicaid |
$44.34
|
| Rate for Payer: Cash Price |
$80.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$79.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.48
|
| Rate for Payer: Healthfirst Commercial |
$79.31
|
| Rate for Payer: Healthfirst Essential Plan |
$178.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$75.34
|
| Rate for Payer: Healthfirst QHP |
$79.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$79.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$67.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$59.48
|
| Rate for Payer: SOMOS Essential |
$59.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.31
|
|
|
PR PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR
|
Professional
|
Both
|
$427.07
|
|
|
Service Code
|
HCPCS 96130
|
| Min. Negotiated Rate |
$58.30 |
| Max. Negotiated Rate |
$268.04 |
| Rate for Payer: Amida Care Medicaid |
$58.30
|
| Rate for Payer: Cash Price |
$119.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$119.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$107.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$107.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$119.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.35
|
| Rate for Payer: Healthfirst Commercial |
$119.13
|
| Rate for Payer: Healthfirst Essential Plan |
$268.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$113.17
|
| Rate for Payer: Healthfirst QHP |
$119.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$83.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$119.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$101.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$83.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$119.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$89.35
|
| Rate for Payer: SOMOS Essential |
$89.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$119.13
|
|
|
PR PSYCHOTHERAPY COMPLEX INTERACTIVE
|
Professional
|
Both
|
$51.24
|
|
|
Service Code
|
HCPCS 90785
|
| Min. Negotiated Rate |
$9.48 |
| Max. Negotiated Rate |
$30.46 |
| Rate for Payer: Amida Care Medicaid |
$11.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.15
|
| Rate for Payer: Healthfirst Commercial |
$13.54
|
| Rate for Payer: Healthfirst Essential Plan |
$30.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.86
|
| Rate for Payer: Healthfirst QHP |
$13.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.15
|
| Rate for Payer: SOMOS Essential |
$10.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.54
|
|
|
PR PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES
|
Professional
|
Both
|
$248.57
|
|
|
Service Code
|
HCPCS 90840
|
| Min. Negotiated Rate |
$50.30 |
| Max. Negotiated Rate |
$161.66 |
| Rate for Payer: Cash Price |
$71.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$71.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$64.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$68.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$71.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$68.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.89
|
| Rate for Payer: Healthfirst Commercial |
$71.85
|
| Rate for Payer: Healthfirst Essential Plan |
$161.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.26
|
| Rate for Payer: Healthfirst QHP |
$71.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$50.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$71.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$61.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$71.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$53.89
|
| Rate for Payer: SOMOS Essential |
$53.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.85
|
|
|
PR PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES
|
Professional
|
Both
|
$485.52
|
|
|
Service Code
|
HCPCS 90839
|
| Min. Negotiated Rate |
$100.62 |
| Max. Negotiated Rate |
$323.44 |
| Rate for Payer: Cash Price |
$139.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$143.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$129.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$129.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$136.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$143.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$136.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$143.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$143.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$107.81
|
| Rate for Payer: Healthfirst Commercial |
$143.75
|
| Rate for Payer: Healthfirst Essential Plan |
$323.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$136.56
|
| Rate for Payer: Healthfirst QHP |
$143.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$100.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$143.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$122.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$100.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$143.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$107.81
|
| Rate for Payer: SOMOS Essential |
$107.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$143.75
|
|
