|
PR SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION
|
Professional
|
Both
|
$826.04
|
|
|
Service Code
|
HCPCS 45349
|
| Min. Negotiated Rate |
$155.22 |
| Max. Negotiated Rate |
$498.94 |
| Rate for Payer: Cash Price |
$223.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$221.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$199.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$199.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$210.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$221.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$210.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$221.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$221.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$166.31
|
| Rate for Payer: Healthfirst Commercial |
$221.75
|
| Rate for Payer: Healthfirst Essential Plan |
$498.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$210.66
|
| Rate for Payer: Healthfirst QHP |
$221.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$155.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$221.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$188.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$155.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$221.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$166.31
|
| Rate for Payer: SOMOS Essential |
$166.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$221.75
|
|
|
PR SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<
|
Professional
|
Both
|
$193.69
|
|
|
Service Code
|
HCPCS 11310
|
| Min. Negotiated Rate |
$35.52 |
| Max. Negotiated Rate |
$114.19 |
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$50.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$45.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$48.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$50.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$48.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.06
|
| Rate for Payer: Healthfirst Commercial |
$50.75
|
| Rate for Payer: Healthfirst Essential Plan |
$114.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$48.21
|
| Rate for Payer: Healthfirst QHP |
$50.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$50.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.06
|
| Rate for Payer: SOMOS Essential |
$38.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.75
|
|
|
PR SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM
|
Professional
|
Both
|
$400.40
|
|
|
Service Code
|
HCPCS 11313
|
| Min. Negotiated Rate |
$75.47 |
| Max. Negotiated Rate |
$242.59 |
| Rate for Payer: Cash Price |
$108.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$107.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$97.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$97.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.86
|
| Rate for Payer: Healthfirst Commercial |
$107.82
|
| Rate for Payer: Healthfirst Essential Plan |
$242.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$102.43
|
| Rate for Payer: Healthfirst QHP |
$107.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$107.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$91.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$80.86
|
| Rate for Payer: SOMOS Essential |
$80.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.82
|
|
|
PR SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<
|
Professional
|
Both
|
$153.86
|
|
|
Service Code
|
HCPCS 11305
|
| Min. Negotiated Rate |
$28.68 |
| Max. Negotiated Rate |
$92.18 |
| Rate for Payer: Cash Price |
$41.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.73
|
| Rate for Payer: Healthfirst Commercial |
$40.97
|
| Rate for Payer: Healthfirst Essential Plan |
$92.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.92
|
| Rate for Payer: Healthfirst QHP |
$40.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.73
|
| Rate for Payer: SOMOS Essential |
$30.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.97
|
|
|
PR SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM
|
Professional
|
Both
|
$205.10
|
|
|
Service Code
|
HCPCS 11306
|
| Min. Negotiated Rate |
$37.75 |
| Max. Negotiated Rate |
$121.34 |
| Rate for Payer: Cash Price |
$54.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.45
|
| Rate for Payer: Healthfirst Commercial |
$53.93
|
| Rate for Payer: Healthfirst Essential Plan |
$121.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.23
|
| Rate for Payer: Healthfirst QHP |
$53.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.45
|
| Rate for Payer: SOMOS Essential |
$40.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.93
|
|
|
PR SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM
|
Professional
|
Both
|
$260.75
|
|
|
Service Code
|
HCPCS 11307
|
| Min. Negotiated Rate |
$48.26 |
| Max. Negotiated Rate |
$155.12 |
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$68.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.70
|
| Rate for Payer: Healthfirst Commercial |
$68.94
|
| Rate for Payer: Healthfirst Essential Plan |
$155.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.49
|
| Rate for Payer: Healthfirst QHP |
$68.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$68.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$68.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.70
|
| Rate for Payer: SOMOS Essential |
$51.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.94
|
|
|
PR SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM
|
Professional
|
Both
|
$286.13
|
|
|
Service Code
|
HCPCS 11308
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$172.28 |
| Rate for Payer: Cash Price |
$77.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$76.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$68.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$76.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.43
|
| Rate for Payer: Healthfirst Commercial |
$76.57
|
| Rate for Payer: Healthfirst Essential Plan |
$172.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.74
|
| Rate for Payer: Healthfirst QHP |
$76.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$76.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$65.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$76.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$57.43
|
| Rate for Payer: SOMOS Essential |
$57.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76.57
|
|
|
PR SHAVING SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5CM/<
|
Professional
|
Both
|
$143.19
|
|
|
Service Code
|
HCPCS 11300
|
| Min. Negotiated Rate |
$26.57 |
| Max. Negotiated Rate |
$85.41 |
| Rate for Payer: Cash Price |
$38.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.47
|
| Rate for Payer: Healthfirst Commercial |
$37.96
|
| Rate for Payer: Healthfirst Essential Plan |
$85.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.06
|
| Rate for Payer: Healthfirst QHP |
$37.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.47
|
| Rate for Payer: SOMOS Essential |
$28.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.96
|
|
|
PR SHORTENING TENDON EXTENSOR HAND/FINGER EACH
|
Professional
|
Both
|
$2,771.72
|
|
|
Service Code
|
HCPCS 26477
|
| Min. Negotiated Rate |
$517.29 |
| Max. Negotiated Rate |
$1,662.70 |
| Rate for Payer: Cash Price |
$753.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$738.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$665.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$665.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$702.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$738.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$702.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$738.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$738.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$554.24
|
| Rate for Payer: Healthfirst Commercial |
$738.98
|
| Rate for Payer: Healthfirst Essential Plan |
$1,662.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$702.03
|
| Rate for Payer: Healthfirst QHP |
$738.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$517.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$738.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$628.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$517.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$738.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$554.24
|
| Rate for Payer: SOMOS Essential |
$554.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$738.98
|
|
|
PR SHORTENING TENDON FLEXOR HAND/FINGER EACH
|
Professional
|
Both
|
$3,006.43
|
|
|
Service Code
|
HCPCS 26479
|
| Min. Negotiated Rate |
$558.20 |
| Max. Negotiated Rate |
$1,794.22 |
| Rate for Payer: Cash Price |
$811.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$797.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$717.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$717.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$757.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$797.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$757.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$797.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$797.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$598.07
|
| Rate for Payer: Healthfirst Commercial |
$797.43
|
| Rate for Payer: Healthfirst Essential Plan |
$1,794.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$757.56
|
| Rate for Payer: Healthfirst QHP |
$797.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$558.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$797.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$677.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$558.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$797.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$598.07
|
| Rate for Payer: SOMOS Essential |
$598.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$797.43
|
|
|
PR SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS
|
Professional
|
Both
|
$107.59
|
|
|
Service Code
|
HCPCS 95926 26
|
| Min. Negotiated Rate |
$19.87 |
| Max. Negotiated Rate |
$80.92 |
| Rate for Payer: Amida Care Medicaid |
$80.92
|
| Rate for Payer: Cash Price |
$29.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.29
|
| Rate for Payer: Healthfirst Commercial |
$28.38
|
| Rate for Payer: Healthfirst Essential Plan |
$63.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.96
|
| Rate for Payer: Healthfirst QHP |
$28.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.29
|
| Rate for Payer: SOMOS Essential |
$21.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.38
|
|
|
PR SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS
|
Professional
|
Both
|
$557.20
|
|
|
Service Code
|
HCPCS 95926 TC
|
| Min. Negotiated Rate |
$80.92 |
| Max. Negotiated Rate |
$301.12 |
| Rate for Payer: Amida Care Medicaid |
$80.92
|
| Rate for Payer: Cash Price |
$155.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$133.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$120.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$120.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$127.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$133.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$127.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$133.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$100.37
|
| Rate for Payer: Healthfirst Commercial |
$133.83
|
| Rate for Payer: Healthfirst Essential Plan |
$301.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.14
|
| Rate for Payer: Healthfirst QHP |
$133.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$93.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$133.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$113.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$93.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$133.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$100.37
|
| Rate for Payer: SOMOS Essential |
$100.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$133.83
|
|
|
PR SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS
|
Professional
|
Both
|
$664.79
|
|
|
Service Code
|
HCPCS 95926
|
| Min. Negotiated Rate |
$80.92 |
| Max. Negotiated Rate |
$364.97 |
| Rate for Payer: Amida Care Medicaid |
$80.92
|
| Rate for Payer: Cash Price |
$184.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$162.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$145.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$145.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$154.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$162.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$154.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$162.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$162.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$121.66
|
| Rate for Payer: Healthfirst Commercial |
$162.21
|
| Rate for Payer: Healthfirst Essential Plan |
$364.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$154.10
|
| Rate for Payer: Healthfirst QHP |
$162.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$113.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$162.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$137.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$113.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$162.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$121.66
|
| Rate for Payer: SOMOS Essential |
$121.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$162.21
|
|
|
PR SHORT-LATENCY SOMATOSENS EP STD TRNK/HEAD
|
Professional
|
Both
|
$710.82
|
|
|
Service Code
|
HCPCS 95927
|
| Min. Negotiated Rate |
$83.68 |
| Max. Negotiated Rate |
$459.81 |
| Rate for Payer: Amida Care Medicaid |
$83.68
|
| Rate for Payer: Cash Price |
$213.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$204.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$183.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$183.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$194.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$204.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$194.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$204.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$204.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$153.27
|
| Rate for Payer: Healthfirst Commercial |
$204.36
|
| Rate for Payer: Healthfirst Essential Plan |
$459.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$194.14
|
| Rate for Payer: Healthfirst QHP |
$204.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$143.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$204.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$173.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$143.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$204.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$153.27
|
| Rate for Payer: SOMOS Essential |
$153.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$204.36
|
|
|
PR SHORT-LATENCY SOMATOSENS EP STD TRNK/HEAD
|
Professional
|
Both
|
$604.63
|
|
|
Service Code
|
HCPCS 95927 TC
|
| Min. Negotiated Rate |
$83.68 |
| Max. Negotiated Rate |
$394.20 |
| Rate for Payer: Amida Care Medicaid |
$83.68
|
| Rate for Payer: Cash Price |
$184.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$175.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$157.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$157.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$166.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$175.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$166.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$131.40
|
| Rate for Payer: Healthfirst Commercial |
$175.20
|
| Rate for Payer: Healthfirst Essential Plan |
$394.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$166.44
|
| Rate for Payer: Healthfirst QHP |
$175.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$122.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$175.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$148.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$122.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$175.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$131.40
|
| Rate for Payer: SOMOS Essential |
$131.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$175.20
|
|
|
PR SHORT-LATENCY SOMATOSENS EP STD TRNK/HEAD
|
Professional
|
Both
|
$106.16
|
|
|
Service Code
|
HCPCS 95927 26
|
| Min. Negotiated Rate |
$20.41 |
| Max. Negotiated Rate |
$83.68 |
| Rate for Payer: Amida Care Medicaid |
$83.68
|
| Rate for Payer: Cash Price |
$29.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.86
|
| Rate for Payer: Healthfirst Commercial |
$29.15
|
| Rate for Payer: Healthfirst Essential Plan |
$65.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.69
|
| Rate for Payer: Healthfirst QHP |
$29.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.86
|
| Rate for Payer: SOMOS Essential |
$21.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.15
|
|
|
PR SHORT-LATENCY SOMATOSENS EP STD UPR LIMBS
|
Professional
|
Both
|
$114.52
|
|
|
Service Code
|
HCPCS 95925 26
|
| Min. Negotiated Rate |
$20.84 |
| Max. Negotiated Rate |
$82.13 |
| Rate for Payer: Amida Care Medicaid |
$82.13
|
| Rate for Payer: Cash Price |
$30.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.33
|
| Rate for Payer: Healthfirst Commercial |
$29.77
|
| Rate for Payer: Healthfirst Essential Plan |
$66.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.28
|
| Rate for Payer: Healthfirst QHP |
$29.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.33
|
| Rate for Payer: SOMOS Essential |
$22.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.77
|
|
|
PR SHORT-LATENCY SOMATOSENS EP STD UPR LIMBS
|
Professional
|
Both
|
$650.62
|
|
|
Service Code
|
HCPCS 95925 TC
|
| Min. Negotiated Rate |
$82.13 |
| Max. Negotiated Rate |
$332.55 |
| Rate for Payer: Amida Care Medicaid |
$82.13
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$133.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$110.85
|
| Rate for Payer: Healthfirst Commercial |
$147.80
|
| Rate for Payer: Healthfirst Essential Plan |
$332.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$140.41
|
| Rate for Payer: Healthfirst QHP |
$147.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$103.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$125.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$103.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$110.85
|
| Rate for Payer: SOMOS Essential |
$110.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.80
|
|
|
PR SHORT-LATENCY SOMATOSENS EP STD UPR LIMBS
|
Professional
|
Both
|
$765.14
|
|
|
Service Code
|
HCPCS 95925
|
| Min. Negotiated Rate |
$82.13 |
| Max. Negotiated Rate |
$399.53 |
| Rate for Payer: Amida Care Medicaid |
$82.13
|
| Rate for Payer: Cash Price |
$206.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$177.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$159.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$159.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$168.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$177.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$168.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$133.18
|
| Rate for Payer: Healthfirst Commercial |
$177.57
|
| Rate for Payer: Healthfirst Essential Plan |
$399.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$168.69
|
| Rate for Payer: Healthfirst QHP |
$177.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$124.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$177.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$150.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$124.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$177.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$133.18
|
| Rate for Payer: SOMOS Essential |
$133.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$177.57
|
|
|
PR SHORT-LATENCY SOMATOSENS EP STD UPR & LOW LIMB
|
Professional
|
Both
|
$179.03
|
|
|
Service Code
|
HCPCS 95938 26
|
| Min. Negotiated Rate |
$34.15 |
| Max. Negotiated Rate |
$137.90 |
| Rate for Payer: Amida Care Medicaid |
$137.90
|
| Rate for Payer: Cash Price |
$49.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$48.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.59
|
| Rate for Payer: Healthfirst Commercial |
$48.79
|
| Rate for Payer: Healthfirst Essential Plan |
$109.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.35
|
| Rate for Payer: Healthfirst QHP |
$48.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.59
|
| Rate for Payer: SOMOS Essential |
$36.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.79
|
|
|
PR SHORT-LATENCY SOMATOSENS EP STD UPR & LOW LIMB
|
Professional
|
Both
|
$1,379.46
|
|
|
Service Code
|
HCPCS 95938 TC
|
| Min. Negotiated Rate |
$137.90 |
| Max. Negotiated Rate |
$861.46 |
| Rate for Payer: Amida Care Medicaid |
$137.90
|
| Rate for Payer: Cash Price |
$390.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$382.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$344.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$344.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$363.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$382.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$363.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$382.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$382.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$287.15
|
| Rate for Payer: Healthfirst Commercial |
$382.87
|
| Rate for Payer: Healthfirst Essential Plan |
$861.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$363.73
|
| Rate for Payer: Healthfirst QHP |
$382.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$268.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$382.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$325.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$268.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$382.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$287.15
|
| Rate for Payer: SOMOS Essential |
$287.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$382.87
|
|
|
PR SHORT-LATENCY SOMATOSENS EP STD UPR & LOW LIMB
|
Professional
|
Both
|
$1,558.48
|
|
|
Service Code
|
HCPCS 95938
|
| Min. Negotiated Rate |
$137.90 |
| Max. Negotiated Rate |
$971.24 |
| Rate for Payer: Amida Care Medicaid |
$137.90
|
| Rate for Payer: Cash Price |
$440.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$431.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$388.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$388.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$431.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$431.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$431.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$323.75
|
| Rate for Payer: Healthfirst Commercial |
$431.66
|
| Rate for Payer: Healthfirst Essential Plan |
$971.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$410.08
|
| Rate for Payer: Healthfirst QHP |
$431.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$302.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$431.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$366.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$302.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$431.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$323.75
|
| Rate for Payer: SOMOS Essential |
$323.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$431.66
|
|
|
PR SHUNT ASCENDING AORTA PULMONARY ARTERY
|
Professional
|
Both
|
$5,870.13
|
|
|
Service Code
|
HCPCS 33755
|
| Min. Negotiated Rate |
$1,085.87 |
| Max. Negotiated Rate |
$3,490.29 |
| Rate for Payer: Cash Price |
$1,565.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,551.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,396.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,396.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,473.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,551.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,473.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,551.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,551.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,163.43
|
| Rate for Payer: Healthfirst Commercial |
$1,551.24
|
| Rate for Payer: Healthfirst Essential Plan |
$3,490.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,473.68
|
| Rate for Payer: Healthfirst QHP |
$1,551.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,085.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,551.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,318.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,085.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,551.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,163.43
|
| Rate for Payer: SOMOS Essential |
$1,163.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,551.24
|
|
|
PR SHUNT CENTRAL W/PROSTHETIC GRAFT
|
Professional
|
Both
|
$5,870.13
|
|
|
Service Code
|
HCPCS 33764
|
| Min. Negotiated Rate |
$1,085.87 |
| Max. Negotiated Rate |
$3,490.29 |
| Rate for Payer: Cash Price |
$1,565.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,551.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,396.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,396.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,473.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,551.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,473.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,551.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,551.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,163.43
|
| Rate for Payer: Healthfirst Commercial |
$1,551.24
|
| Rate for Payer: Healthfirst Essential Plan |
$3,490.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,473.68
|
| Rate for Payer: Healthfirst QHP |
$1,551.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,085.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,551.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,318.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,085.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,551.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,163.43
|
| Rate for Payer: SOMOS Essential |
$1,163.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,551.24
|
|
|
PR SHUNT DESCENDING AORTA PULMONARY ARTERY
|
Professional
|
Both
|
$5,710.60
|
|
|
Service Code
|
HCPCS 33762
|
| Min. Negotiated Rate |
$1,052.72 |
| Max. Negotiated Rate |
$3,383.73 |
| Rate for Payer: Cash Price |
$1,519.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,503.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,353.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,353.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,428.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,503.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,428.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,503.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,503.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,127.91
|
| Rate for Payer: Healthfirst Commercial |
$1,503.88
|
| Rate for Payer: Healthfirst Essential Plan |
$3,383.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,428.69
|
| Rate for Payer: Healthfirst QHP |
$1,503.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,052.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,503.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,278.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,052.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,503.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,127.91
|
| Rate for Payer: SOMOS Essential |
$1,127.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,503.88
|
|
