|
PR STEREOTACTIC RADIOSURGERY 1 SPINAL LESION
|
Professional
|
Both
|
$5,431.13
|
|
|
Service Code
|
HCPCS 63620
|
| Min. Negotiated Rate |
$996.33 |
| Max. Negotiated Rate |
$3,202.49 |
| Rate for Payer: Cash Price |
$1,434.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,423.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,281.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,281.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,352.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,423.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,352.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,423.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,423.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,067.50
|
| Rate for Payer: Healthfirst Commercial |
$1,423.33
|
| Rate for Payer: Healthfirst Essential Plan |
$3,202.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,352.16
|
| Rate for Payer: Healthfirst QHP |
$1,423.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$996.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,423.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,209.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$996.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,423.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,067.50
|
| Rate for Payer: SOMOS Essential |
$1,067.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,423.33
|
|
|
PR STEREOTACTIC RADIOSURGERY EA ADDL SPINAL LESION
|
Professional
|
Both
|
$1,218.95
|
|
|
Service Code
|
HCPCS 63621
|
| Min. Negotiated Rate |
$220.68 |
| Max. Negotiated Rate |
$709.31 |
| Rate for Payer: Cash Price |
$318.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$315.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$283.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$283.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$299.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$315.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$299.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$315.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$315.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$236.44
|
| Rate for Payer: Healthfirst Commercial |
$315.25
|
| Rate for Payer: Healthfirst Essential Plan |
$709.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$299.49
|
| Rate for Payer: Healthfirst QHP |
$315.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$220.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$315.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$267.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$220.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$315.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$236.44
|
| Rate for Payer: SOMOS Essential |
$236.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$315.25
|
|
|
PR STERNAL DEBRIDEMENT
|
Professional
|
Both
|
$2,425.50
|
|
|
Service Code
|
HCPCS 21627
|
| Min. Negotiated Rate |
$457.67 |
| Max. Negotiated Rate |
$1,471.10 |
| Rate for Payer: Cash Price |
$656.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$653.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$588.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$588.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$621.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$653.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$621.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$653.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$653.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$490.37
|
| Rate for Payer: Healthfirst Commercial |
$653.82
|
| Rate for Payer: Healthfirst Essential Plan |
$1,471.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$621.13
|
| Rate for Payer: Healthfirst QHP |
$653.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$457.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$653.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$555.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$457.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$653.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$490.37
|
| Rate for Payer: SOMOS Essential |
$490.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$653.82
|
|
|
PR STIMULUS EVOKED RESPONSE
|
Professional
|
Both
|
$948.19
|
|
|
Service Code
|
HCPCS 51792 TC
|
| Min. Negotiated Rate |
$160.79 |
| Max. Negotiated Rate |
$516.83 |
| Rate for Payer: Cash Price |
$259.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$229.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$206.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$206.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$218.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$229.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$218.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$229.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$229.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$172.28
|
| Rate for Payer: Healthfirst Commercial |
$229.70
|
| Rate for Payer: Healthfirst Essential Plan |
$516.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$218.22
|
| Rate for Payer: Healthfirst QHP |
$229.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$160.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$229.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$195.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$160.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$229.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$172.28
|
| Rate for Payer: SOMOS Essential |
$172.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$229.70
|
|
|
PR STIMULUS EVOKED RESPONSE
|
Professional
|
Both
|
$221.20
|
|
|
Service Code
|
HCPCS 51792 26
|
| Min. Negotiated Rate |
$44.59 |
| Max. Negotiated Rate |
$143.32 |
| Rate for Payer: Cash Price |
$62.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$63.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$57.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$60.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$63.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$60.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.77
|
| Rate for Payer: Healthfirst Commercial |
$63.70
|
| Rate for Payer: Healthfirst Essential Plan |
$143.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.52
|
| Rate for Payer: Healthfirst QHP |
$63.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$44.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$63.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$54.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$44.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$63.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.77
|
| Rate for Payer: SOMOS Essential |
$47.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.70
|
|
|
PR STIMULUS EVOKED RESPONSE
|
Professional
|
Both
|
$1,169.39
|
|
|
Service Code
|
HCPCS 51792
|
| Min. Negotiated Rate |
$205.38 |
| Max. Negotiated Rate |
$660.15 |
| Rate for Payer: Cash Price |
$322.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$293.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$264.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$264.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$278.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$293.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$278.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$293.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$293.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$220.05
|
| Rate for Payer: Healthfirst Commercial |
$293.40
|
| Rate for Payer: Healthfirst Essential Plan |
$660.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$278.73
|
| Rate for Payer: Healthfirst QHP |
$293.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$205.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$293.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$249.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$205.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$293.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$220.05
|
| Rate for Payer: SOMOS Essential |
$220.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$293.40
|
|
|
PR STOT/TOT HYSTERECTOMY AFTER CESAREAN DELIVERY
|
Professional
|
Both
|
$2,239.02
|
|
|
Service Code
|
HCPCS 59525
|
| Min. Negotiated Rate |
$407.15 |
| Max. Negotiated Rate |
$1,308.71 |
| Rate for Payer: Cash Price |
$590.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$581.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$523.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$523.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$552.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$581.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$552.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$581.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$581.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$436.24
|
| Rate for Payer: Healthfirst Commercial |
$581.65
|
| Rate for Payer: Healthfirst Essential Plan |
$1,308.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$552.57
|
| Rate for Payer: Healthfirst QHP |
$581.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$407.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$581.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$494.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$407.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$581.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$436.24
|
| Rate for Payer: SOMOS Essential |
$436.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$581.65
|
|
|
PR STRABISMUS ANY SUPERIOR OBLIQUE MUSCLE
|
Professional
|
Both
|
$2,819.81
|
|
|
Service Code
|
HCPCS 67318
|
| Min. Negotiated Rate |
$536.30 |
| Max. Negotiated Rate |
$1,723.82 |
| Rate for Payer: Cash Price |
$777.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$766.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$689.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$689.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$727.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$766.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$727.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$766.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$766.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$574.61
|
| Rate for Payer: Healthfirst Commercial |
$766.14
|
| Rate for Payer: Healthfirst Essential Plan |
$1,723.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$727.83
|
| Rate for Payer: Healthfirst QHP |
$766.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$536.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$766.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$651.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$536.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$766.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$574.61
|
| Rate for Payer: SOMOS Essential |
$574.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$766.14
|
|
|
PR STRABISMUS EXPL&/RPR DETACHED EXTROCULAR MUSC
|
Professional
|
Both
|
$1,183.18
|
|
|
Service Code
|
HCPCS 67340
|
| Min. Negotiated Rate |
$225.21 |
| Max. Negotiated Rate |
$723.89 |
| Rate for Payer: Cash Price |
$324.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$321.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$289.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$289.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$305.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$321.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$305.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$321.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$321.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$241.30
|
| Rate for Payer: Healthfirst Commercial |
$321.73
|
| Rate for Payer: Healthfirst Essential Plan |
$723.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$305.64
|
| Rate for Payer: Healthfirst QHP |
$321.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$225.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$321.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$273.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$225.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$321.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$241.30
|
| Rate for Payer: SOMOS Essential |
$241.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$321.73
|
|
|
PR STRABISMUS POST FIXJ SUTR TQ W/WO MUSC RECESSION
|
Professional
|
Both
|
$790.41
|
|
|
Service Code
|
HCPCS 67334
|
| Min. Negotiated Rate |
$96.27 |
| Max. Negotiated Rate |
$309.44 |
| Rate for Payer: Cash Price |
$173.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$137.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$123.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$130.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$137.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$130.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.15
|
| Rate for Payer: Healthfirst Commercial |
$137.53
|
| Rate for Payer: Healthfirst Essential Plan |
$309.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.65
|
| Rate for Payer: Healthfirst QHP |
$137.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$96.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$137.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$116.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$96.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$137.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$103.15
|
| Rate for Payer: SOMOS Essential |
$103.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.53
|
|
|
PR STRABISMUS PREVIOUS EYE X INVOLVE EO MUSC
|
Professional
|
Both
|
$803.01
|
|
|
Service Code
|
HCPCS 67331
|
| Min. Negotiated Rate |
$97.81 |
| Max. Negotiated Rate |
$314.39 |
| Rate for Payer: Cash Price |
$176.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$139.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$125.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$132.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$139.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$132.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$139.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$104.80
|
| Rate for Payer: Healthfirst Commercial |
$139.73
|
| Rate for Payer: Healthfirst Essential Plan |
$314.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$132.74
|
| Rate for Payer: Healthfirst QHP |
$139.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$97.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$139.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$118.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$97.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$139.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$104.80
|
| Rate for Payer: SOMOS Essential |
$104.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$139.73
|
|
|
PR STRABISMUS RECESSION/RESCJ 1 HRZNTL MUSC
|
Professional
|
Both
|
$1,872.22
|
|
|
Service Code
|
HCPCS 67311
|
| Min. Negotiated Rate |
$358.58 |
| Max. Negotiated Rate |
$1,152.59 |
| Rate for Payer: Cash Price |
$516.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$512.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$461.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$461.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$486.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$512.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$486.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$512.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$512.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$384.19
|
| Rate for Payer: Healthfirst Commercial |
$512.26
|
| Rate for Payer: Healthfirst Essential Plan |
$1,152.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$486.65
|
| Rate for Payer: Healthfirst QHP |
$512.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$358.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$512.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$435.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$358.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$512.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$384.19
|
| Rate for Payer: SOMOS Essential |
$384.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$512.26
|
|
|
PR STRABISMUS RECESSION/RESCJ 1 VER MUSC
|
Professional
|
Both
|
$1,872.22
|
|
|
Service Code
|
HCPCS 67314
|
| Min. Negotiated Rate |
$358.58 |
| Max. Negotiated Rate |
$1,152.59 |
| Rate for Payer: Cash Price |
$516.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$512.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$461.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$461.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$486.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$512.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$486.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$512.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$512.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$384.19
|
| Rate for Payer: Healthfirst Commercial |
$512.26
|
| Rate for Payer: Healthfirst Essential Plan |
$1,152.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$486.65
|
| Rate for Payer: Healthfirst QHP |
$512.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$358.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$512.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$435.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$358.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$512.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$384.19
|
| Rate for Payer: SOMOS Essential |
$384.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$512.26
|
|
|
PR STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC
|
Professional
|
Both
|
$2,725.03
|
|
|
Service Code
|
HCPCS 67312
|
| Min. Negotiated Rate |
$518.80 |
| Max. Negotiated Rate |
$1,667.57 |
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$741.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$667.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$667.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$704.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$741.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$704.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$741.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$741.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$555.86
|
| Rate for Payer: Healthfirst Commercial |
$741.14
|
| Rate for Payer: Healthfirst Essential Plan |
$1,667.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$704.08
|
| Rate for Payer: Healthfirst QHP |
$741.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$518.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$741.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$629.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$518.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$741.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$555.86
|
| Rate for Payer: SOMOS Essential |
$555.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$741.14
|
|
|
PR STRABISMUS RECESSION/RESCJ 2/MORE VER MUSC
|
Professional
|
Both
|
$2,920.51
|
|
|
Service Code
|
HCPCS 67316
|
| Min. Negotiated Rate |
$554.02 |
| Max. Negotiated Rate |
$1,780.79 |
| Rate for Payer: Cash Price |
$803.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$791.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$712.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$712.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$751.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$791.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$751.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$791.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$791.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$593.60
|
| Rate for Payer: Healthfirst Commercial |
$791.46
|
| Rate for Payer: Healthfirst Essential Plan |
$1,780.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$751.89
|
| Rate for Payer: Healthfirst QHP |
$791.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$554.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$791.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$672.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$554.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$791.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$593.60
|
| Rate for Payer: SOMOS Essential |
$593.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$791.46
|
|
|
PR STRABISMUS SCARRING EO MUSC/RSTCV MYOPATHY
|
Professional
|
Both
|
$855.82
|
|
|
Service Code
|
HCPCS 67332
|
| Min. Negotiated Rate |
$157.38 |
| Max. Negotiated Rate |
$505.87 |
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$224.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$202.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$202.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$213.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$224.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$213.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$224.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$224.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$168.62
|
| Rate for Payer: Healthfirst Commercial |
$224.83
|
| Rate for Payer: Healthfirst Essential Plan |
$505.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$213.59
|
| Rate for Payer: Healthfirst QHP |
$224.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$157.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$224.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$191.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$157.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$224.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$168.62
|
| Rate for Payer: SOMOS Essential |
$168.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$224.83
|
|
|
PR STRAPPING ANKLE &/FOOT
|
Professional
|
Both
|
$72.73
|
|
|
Service Code
|
HCPCS 29540
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$43.13 |
| Rate for Payer: Cash Price |
$19.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.38
|
| Rate for Payer: Healthfirst Commercial |
$19.17
|
| Rate for Payer: Healthfirst Essential Plan |
$43.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.21
|
| Rate for Payer: Healthfirst QHP |
$19.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.38
|
| Rate for Payer: SOMOS Essential |
$14.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.17
|
|
|
PR STRAPPING ELBOW/WRIST
|
Professional
|
Both
|
$79.91
|
|
|
Service Code
|
HCPCS 29260
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$46.62 |
| Rate for Payer: Cash Price |
$20.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.54
|
| Rate for Payer: Healthfirst Commercial |
$20.72
|
| Rate for Payer: Healthfirst Essential Plan |
$46.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.68
|
| Rate for Payer: Healthfirst QHP |
$20.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.54
|
| Rate for Payer: SOMOS Essential |
$15.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.72
|
|
|
PR STRAPPING HAND/FINGER
|
Professional
|
Both
|
$82.78
|
|
|
Service Code
|
HCPCS 29280
|
| Min. Negotiated Rate |
$15.48 |
| Max. Negotiated Rate |
$49.77 |
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.59
|
| Rate for Payer: Healthfirst Commercial |
$22.12
|
| Rate for Payer: Healthfirst Essential Plan |
$49.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.01
|
| Rate for Payer: Healthfirst QHP |
$22.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$18.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16.59
|
| Rate for Payer: SOMOS Essential |
$16.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.12
|
|
|
PR STRAPPING HIP
|
Professional
|
Both
|
$73.01
|
|
|
Service Code
|
HCPCS 29520
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$45.25 |
| Rate for Payer: Cash Price |
$19.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.08
|
| Rate for Payer: Healthfirst Commercial |
$20.11
|
| Rate for Payer: Healthfirst Essential Plan |
$45.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.10
|
| Rate for Payer: Healthfirst QHP |
$20.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.08
|
| Rate for Payer: SOMOS Essential |
$15.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.11
|
|
|
PR STRAPPING KNEE
|
Professional
|
Both
|
$73.01
|
|
|
Service Code
|
HCPCS 29530
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$44.37 |
| Rate for Payer: Cash Price |
$19.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.79
|
| Rate for Payer: Healthfirst Commercial |
$19.72
|
| Rate for Payer: Healthfirst Essential Plan |
$44.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.73
|
| Rate for Payer: Healthfirst QHP |
$19.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.79
|
| Rate for Payer: SOMOS Essential |
$14.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.72
|
|
|
PR STRAPPING SHOULDER
|
Professional
|
Both
|
$73.01
|
|
|
Service Code
|
HCPCS 29240
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$42.98 |
| Rate for Payer: Cash Price |
$19.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.32
|
| Rate for Payer: Healthfirst Commercial |
$19.10
|
| Rate for Payer: Healthfirst Essential Plan |
$42.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.14
|
| Rate for Payer: Healthfirst QHP |
$19.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.32
|
| Rate for Payer: SOMOS Essential |
$14.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.10
|
|
|
PR STRAPPING THORAX
|
Professional
|
Both
|
$74.45
|
|
|
Service Code
|
HCPCS 29200
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$42.98 |
| Rate for Payer: Cash Price |
$19.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.32
|
| Rate for Payer: Healthfirst Commercial |
$19.10
|
| Rate for Payer: Healthfirst Essential Plan |
$42.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.14
|
| Rate for Payer: Healthfirst QHP |
$19.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.32
|
| Rate for Payer: SOMOS Essential |
$14.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.10
|
|
|
PR STRAPPING TOES
|
Professional
|
Both
|
$45.40
|
|
|
Service Code
|
HCPCS 29550
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$27.41 |
| Rate for Payer: Cash Price |
$12.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.13
|
| Rate for Payer: Healthfirst Commercial |
$12.18
|
| Rate for Payer: Healthfirst Essential Plan |
$27.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.57
|
| Rate for Payer: Healthfirst QHP |
$12.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.13
|
| Rate for Payer: SOMOS Essential |
$9.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.18
|
|
|
PR STRAPPING UNNA BOOT
|
Professional
|
Both
|
$111.06
|
|
|
Service Code
|
HCPCS 29580
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$65.81 |
| Rate for Payer: Cash Price |
$29.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.94
|
| Rate for Payer: Healthfirst Commercial |
$29.25
|
| Rate for Payer: Healthfirst Essential Plan |
$65.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.79
|
| Rate for Payer: Healthfirst QHP |
$29.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.94
|
| Rate for Payer: SOMOS Essential |
$21.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.25
|
|
