|
PR SLP STDY UNATND W/MIN HRT RATE/O2 SAT/RESP ANAL
|
Professional
|
Both
|
$390.25
|
|
|
Service Code
|
HCPCS 95801
|
| Min. Negotiated Rate |
$77.55 |
| Max. Negotiated Rate |
$249.25 |
| Rate for Payer: Cash Price |
$112.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$110.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$99.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$99.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$105.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$110.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$105.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.08
|
| Rate for Payer: Healthfirst Commercial |
$110.78
|
| Rate for Payer: Healthfirst Essential Plan |
$249.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$105.24
|
| Rate for Payer: Healthfirst QHP |
$110.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$77.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$110.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$94.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$77.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$110.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.08
|
| Rate for Payer: SOMOS Essential |
$83.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$110.78
|
|
|
PR SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM
|
Professional
|
Both
|
$259.04
|
|
|
Service Code
|
HCPCS 12002
|
| Min. Negotiated Rate |
$47.88 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Cash Price |
$69.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$68.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.30
|
| Rate for Payer: Healthfirst Commercial |
$68.40
|
| Rate for Payer: Healthfirst Essential Plan |
$153.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$64.98
|
| Rate for Payer: Healthfirst QHP |
$68.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$68.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$68.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.30
|
| Rate for Payer: SOMOS Essential |
$51.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.40
|
|
|
PR SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM
|
Professional
|
Both
|
$415.56
|
|
|
Service Code
|
HCPCS 12005
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$247.12 |
| Rate for Payer: Cash Price |
$111.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$109.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$98.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$98.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$104.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$109.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$104.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.37
|
| Rate for Payer: Healthfirst Commercial |
$109.83
|
| Rate for Payer: Healthfirst Essential Plan |
$247.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$104.34
|
| Rate for Payer: Healthfirst QHP |
$109.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$76.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$109.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$93.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$76.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$109.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.37
|
| Rate for Payer: SOMOS Essential |
$82.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$109.83
|
|
|
PR SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM
|
Professional
|
Both
|
$512.89
|
|
|
Service Code
|
HCPCS 12006
|
| Min. Negotiated Rate |
$95.57 |
| Max. Negotiated Rate |
$307.19 |
| Rate for Payer: Cash Price |
$136.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$136.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$122.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$122.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$129.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$136.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$129.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.40
|
| Rate for Payer: Healthfirst Commercial |
$136.53
|
| Rate for Payer: Healthfirst Essential Plan |
$307.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$129.70
|
| Rate for Payer: Healthfirst QHP |
$136.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$95.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$136.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$116.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$95.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$136.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.40
|
| Rate for Payer: SOMOS Essential |
$102.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$136.53
|
|
|
PR SNIP INCISION LACRIMAL PUNCTUM
|
Professional
|
Both
|
$416.15
|
|
|
Service Code
|
HCPCS 68440
|
| Min. Negotiated Rate |
$79.34 |
| Max. Negotiated Rate |
$255.04 |
| Rate for Payer: Cash Price |
$115.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$113.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$102.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$102.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$107.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$113.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$107.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.01
|
| Rate for Payer: Healthfirst Commercial |
$113.35
|
| Rate for Payer: Healthfirst Essential Plan |
$255.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$107.68
|
| Rate for Payer: Healthfirst QHP |
$113.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$79.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$113.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$96.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$79.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$113.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$85.01
|
| Rate for Payer: SOMOS Essential |
$85.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$113.35
|
|
|
PR SPECIAL STAINS,GROUP I
|
Professional
|
Both
|
$101.99
|
|
|
Service Code
|
HCPCS 88312 26
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$62.46 |
| Rate for Payer: Cash Price |
$28.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.82
|
| Rate for Payer: Healthfirst Commercial |
$27.76
|
| Rate for Payer: Healthfirst Essential Plan |
$62.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.37
|
| Rate for Payer: Healthfirst QHP |
$27.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.82
|
| Rate for Payer: SOMOS Essential |
$20.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.76
|
|
|
PR SPECIAL STAINS,GROUP I
|
Professional
|
Both
|
$372.16
|
|
|
Service Code
|
HCPCS 88312 TC
|
| Min. Negotiated Rate |
$70.42 |
| Max. Negotiated Rate |
$226.35 |
| Rate for Payer: Cash Price |
$102.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$100.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$90.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$90.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$95.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$100.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$95.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.45
|
| Rate for Payer: Healthfirst Commercial |
$100.60
|
| Rate for Payer: Healthfirst Essential Plan |
$226.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$95.57
|
| Rate for Payer: Healthfirst QHP |
$100.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$70.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$100.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$85.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$70.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$100.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$75.45
|
| Rate for Payer: SOMOS Essential |
$75.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$100.60
|
|
|
PR SPECIAL STAINS,GROUP I
|
Professional
|
Both
|
$474.18
|
|
|
Service Code
|
HCPCS 88312
|
| Min. Negotiated Rate |
$89.85 |
| Max. Negotiated Rate |
$288.81 |
| Rate for Payer: Cash Price |
$130.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$128.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$115.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$115.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$121.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$128.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$121.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$128.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.27
|
| Rate for Payer: Healthfirst Commercial |
$128.36
|
| Rate for Payer: Healthfirst Essential Plan |
$288.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$121.94
|
| Rate for Payer: Healthfirst QHP |
$128.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$89.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$128.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$109.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$89.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$128.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$96.27
|
| Rate for Payer: SOMOS Essential |
$96.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$128.36
|
|
|
PR SPECIAL STAINS,GROUP II
|
Professional
|
Both
|
$47.18
|
|
|
Service Code
|
HCPCS 88313 26
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$28.73 |
| Rate for Payer: Cash Price |
$12.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.58
|
| Rate for Payer: Healthfirst Commercial |
$12.77
|
| Rate for Payer: Healthfirst Essential Plan |
$28.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.13
|
| Rate for Payer: Healthfirst QHP |
$12.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.58
|
| Rate for Payer: SOMOS Essential |
$9.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.77
|
|
|
PR SPECIAL STAINS,GROUP II
|
Professional
|
Both
|
$348.92
|
|
|
Service Code
|
HCPCS 88313
|
| Min. Negotiated Rate |
$66.43 |
| Max. Negotiated Rate |
$213.53 |
| Rate for Payer: Cash Price |
$97.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$94.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$85.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$85.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$90.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$94.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$90.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$94.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$94.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$71.17
|
| Rate for Payer: Healthfirst Commercial |
$94.90
|
| Rate for Payer: Healthfirst Essential Plan |
$213.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$90.16
|
| Rate for Payer: Healthfirst QHP |
$94.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$66.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$94.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$80.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$66.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$94.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$71.17
|
| Rate for Payer: SOMOS Essential |
$71.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$94.90
|
|
|
PR SPECIAL STAINS,GROUP II
|
Professional
|
Both
|
$301.74
|
|
|
Service Code
|
HCPCS 88313 TC
|
| Min. Negotiated Rate |
$57.49 |
| Max. Negotiated Rate |
$184.79 |
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$82.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$78.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$82.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$78.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.60
|
| Rate for Payer: Healthfirst Commercial |
$82.13
|
| Rate for Payer: Healthfirst Essential Plan |
$184.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$78.02
|
| Rate for Payer: Healthfirst QHP |
$82.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$82.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$82.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$61.60
|
| Rate for Payer: SOMOS Essential |
$61.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.13
|
|
|
PR SPEECH AUDIOMETRY THRESHOLD
|
Professional
|
Both
|
$119.18
|
|
|
Service Code
|
HCPCS 92555
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$79.99 |
| Rate for Payer: Amida Care Medicaid |
$9.05
|
| Rate for Payer: Cash Price |
$34.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.66
|
| Rate for Payer: Healthfirst Commercial |
$35.55
|
| Rate for Payer: Healthfirst Essential Plan |
$79.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.77
|
| Rate for Payer: Healthfirst QHP |
$35.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.66
|
| Rate for Payer: SOMOS Essential |
$26.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.55
|
|
|
PR SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ
|
Professional
|
Both
|
$183.86
|
|
|
Service Code
|
HCPCS 92556
|
| Min. Negotiated Rate |
$15.15 |
| Max. Negotiated Rate |
$123.66 |
| Rate for Payer: Amida Care Medicaid |
$15.15
|
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$52.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.22
|
| Rate for Payer: Healthfirst Commercial |
$54.96
|
| Rate for Payer: Healthfirst Essential Plan |
$123.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.21
|
| Rate for Payer: Healthfirst QHP |
$54.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$54.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$46.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.22
|
| Rate for Payer: SOMOS Essential |
$41.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.96
|
|
|
PR SPERM WASHING ARTIFICIAL INSEMINATION
|
Professional
|
Both
|
$52.68
|
|
|
Service Code
|
HCPCS 58323
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$31.25 |
| Rate for Payer: Cash Price |
$14.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.42
|
| Rate for Payer: Healthfirst Commercial |
$13.89
|
| Rate for Payer: Healthfirst Essential Plan |
$31.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.20
|
| Rate for Payer: Healthfirst QHP |
$13.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.42
|
| Rate for Payer: SOMOS Essential |
$10.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.89
|
|
|
PR SPHINCTEROPLASTY ANAL MUSCLE TRANSPLANT
|
Professional
|
Both
|
$4,704.91
|
|
|
Service Code
|
HCPCS 46760
|
| Min. Negotiated Rate |
$887.50 |
| Max. Negotiated Rate |
$2,852.66 |
| Rate for Payer: Cash Price |
$1,276.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,267.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,141.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,141.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,204.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,267.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,204.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,267.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,267.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$950.89
|
| Rate for Payer: Healthfirst Commercial |
$1,267.85
|
| Rate for Payer: Healthfirst Essential Plan |
$2,852.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,204.46
|
| Rate for Payer: Healthfirst QHP |
$1,267.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$887.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,267.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,077.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$887.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,267.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$950.89
|
| Rate for Payer: SOMOS Essential |
$950.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,267.85
|
|
|
PR SPHINCTEROTOMY ANAL DIVISION SPHINCTER SPX
|
Professional
|
Both
|
$699.69
|
|
|
Service Code
|
HCPCS 46080
|
| Min. Negotiated Rate |
$130.77 |
| Max. Negotiated Rate |
$420.32 |
| Rate for Payer: Cash Price |
$186.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$186.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$168.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$168.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$177.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$186.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$177.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$186.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$186.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$140.11
|
| Rate for Payer: Healthfirst Commercial |
$186.81
|
| Rate for Payer: Healthfirst Essential Plan |
$420.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$177.47
|
| Rate for Payer: Healthfirst QHP |
$186.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$130.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$186.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$158.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$130.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$186.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$140.11
|
| Rate for Payer: SOMOS Essential |
$140.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$186.81
|
|
|
PR SPHNCTROP ANAL INCONTINENCE/PROLAPSE ADULT
|
Professional
|
Both
|
$3,242.96
|
|
|
Service Code
|
HCPCS 46750
|
| Min. Negotiated Rate |
$607.61 |
| Max. Negotiated Rate |
$1,953.02 |
| Rate for Payer: Cash Price |
$876.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$868.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$781.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$781.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$824.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$868.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$824.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$868.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$868.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$651.01
|
| Rate for Payer: Healthfirst Commercial |
$868.01
|
| Rate for Payer: Healthfirst Essential Plan |
$1,953.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$824.61
|
| Rate for Payer: Healthfirst QHP |
$868.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$607.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$868.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$737.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$607.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$868.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$651.01
|
| Rate for Payer: SOMOS Essential |
$651.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$868.01
|
|
|
PR SPHNCTROP ANAL INCONTINENCE/PROLAPSE CHLD
|
Professional
|
Both
|
$3,025.51
|
|
|
Service Code
|
HCPCS 46751
|
| Min. Negotiated Rate |
$564.29 |
| Max. Negotiated Rate |
$1,813.79 |
| Rate for Payer: Cash Price |
$808.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$806.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$725.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$725.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$765.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$806.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$765.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$806.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$806.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$604.60
|
| Rate for Payer: Healthfirst Commercial |
$806.13
|
| Rate for Payer: Healthfirst Essential Plan |
$1,813.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$765.82
|
| Rate for Payer: Healthfirst QHP |
$806.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$564.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$806.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$685.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$564.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$806.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$604.60
|
| Rate for Payer: SOMOS Essential |
$604.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$806.13
|
|
|
PR SPHNCTROP ANAL LEVATOR MUSC IMBRCJ
|
Professional
|
Both
|
$3,966.41
|
|
|
Service Code
|
HCPCS 46761
|
| Min. Negotiated Rate |
$739.89 |
| Max. Negotiated Rate |
$2,378.20 |
| Rate for Payer: Cash Price |
$1,066.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,056.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$951.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$951.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,004.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,056.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,004.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,056.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,056.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$792.74
|
| Rate for Payer: Healthfirst Commercial |
$1,056.98
|
| Rate for Payer: Healthfirst Essential Plan |
$2,378.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,004.13
|
| Rate for Payer: Healthfirst QHP |
$1,056.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$739.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,056.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$898.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$739.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,056.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$792.74
|
| Rate for Payer: SOMOS Essential |
$792.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,056.98
|
|
|
PR SPLENC TOT EN BLOC EXTNSV DS CONJUNCT W/OTH PX
|
Professional
|
Both
|
$1,171.17
|
|
|
Service Code
|
HCPCS 38102
|
| Min. Negotiated Rate |
$215.22 |
| Max. Negotiated Rate |
$691.78 |
| Rate for Payer: Cash Price |
$310.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$307.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$276.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$276.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$292.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$307.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$292.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$307.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$230.59
|
| Rate for Payer: Healthfirst Commercial |
$307.46
|
| Rate for Payer: Healthfirst Essential Plan |
$691.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$292.09
|
| Rate for Payer: Healthfirst QHP |
$307.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$215.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$307.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$261.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$215.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$307.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$230.59
|
| Rate for Payer: SOMOS Essential |
$230.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$307.46
|
|
|
PR SPLENECTOMY TOTAL EN BLOC W/OTHER PROCEDURE
|
Professional
|
Both
|
$5,269.81
|
|
|
Service Code
|
HCPCS 38101
|
| Min. Negotiated Rate |
$974.71 |
| Max. Negotiated Rate |
$3,132.99 |
| Rate for Payer: Cash Price |
$1,401.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,392.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,253.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,253.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,322.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,392.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,322.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,392.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,392.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,044.33
|
| Rate for Payer: Healthfirst Commercial |
$1,392.44
|
| Rate for Payer: Healthfirst Essential Plan |
$3,132.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,322.82
|
| Rate for Payer: Healthfirst QHP |
$1,392.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$974.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,392.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,183.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$974.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,392.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,044.33
|
| Rate for Payer: SOMOS Essential |
$1,044.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,392.44
|
|
|
PR SPLENECTOMY TOTAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$5,170.48
|
|
|
Service Code
|
HCPCS 38100
|
| Min. Negotiated Rate |
$956.47 |
| Max. Negotiated Rate |
$3,074.36 |
| Rate for Payer: Cash Price |
$1,376.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,366.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,229.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,229.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,298.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,366.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,298.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,366.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,366.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,024.79
|
| Rate for Payer: Healthfirst Commercial |
$1,366.38
|
| Rate for Payer: Healthfirst Essential Plan |
$3,074.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,298.06
|
| Rate for Payer: Healthfirst QHP |
$1,366.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$956.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,366.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,161.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$956.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,366.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,024.79
|
| Rate for Payer: SOMOS Essential |
$1,024.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,366.38
|
|
|
PR SPLIT AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/</1 %
|
Professional
|
Both
|
$2,979.38
|
|
|
Service Code
|
HCPCS 15120
|
| Min. Negotiated Rate |
$562.71 |
| Max. Negotiated Rate |
$1,808.71 |
| Rate for Payer: Cash Price |
$808.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$803.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$723.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$723.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$763.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$803.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$763.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$803.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$803.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$602.90
|
| Rate for Payer: Healthfirst Commercial |
$803.87
|
| Rate for Payer: Healthfirst Essential Plan |
$1,808.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$763.68
|
| Rate for Payer: Healthfirst QHP |
$803.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$562.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$803.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$683.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$562.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$803.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$602.90
|
| Rate for Payer: SOMOS Essential |
$602.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$803.87
|
|
|
PR SPLIT AGRFT F/S/N/H/F/G/M/D GT EA 100 CM/EA 1 %
|
Professional
|
Both
|
$585.62
|
|
|
Service Code
|
HCPCS 15121
|
| Min. Negotiated Rate |
$107.43 |
| Max. Negotiated Rate |
$345.31 |
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$153.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$138.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$138.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$145.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$153.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$145.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$153.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$153.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$115.10
|
| Rate for Payer: Healthfirst Commercial |
$153.47
|
| Rate for Payer: Healthfirst Essential Plan |
$345.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$145.80
|
| Rate for Payer: Healthfirst QHP |
$153.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$107.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$153.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$130.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$107.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$153.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$115.10
|
| Rate for Payer: SOMOS Essential |
$115.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$153.47
|
|
|
PR SPLIT AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD
|
Professional
|
Both
|
$3,136.95
|
|
|
Service Code
|
HCPCS 15100
|
| Min. Negotiated Rate |
$589.72 |
| Max. Negotiated Rate |
$1,895.51 |
| Rate for Payer: Cash Price |
$846.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$842.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$758.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$758.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$800.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$842.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$800.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$842.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$842.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$631.84
|
| Rate for Payer: Healthfirst Commercial |
$842.45
|
| Rate for Payer: Healthfirst Essential Plan |
$1,895.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$800.33
|
| Rate for Payer: Healthfirst QHP |
$842.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$589.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$842.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$716.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$589.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$842.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$631.84
|
| Rate for Payer: SOMOS Essential |
$631.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$842.45
|
|
