|
PR SUB GRFT F/S/N/H/F/G/M/D >= 100SCM ADL 100SQ CM
|
Professional
|
Both
|
$243.36
|
|
|
Service Code
|
HCPCS 15278
|
| Min. Negotiated Rate |
$45.70 |
| Max. Negotiated Rate |
$146.90 |
| Rate for Payer: Cash Price |
$65.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$65.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.97
|
| Rate for Payer: Healthfirst Commercial |
$65.29
|
| Rate for Payer: Healthfirst Essential Plan |
$146.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.03
|
| Rate for Payer: Healthfirst QHP |
$65.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.97
|
| Rate for Payer: SOMOS Essential |
$48.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.29
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D <100SQ CM 1ST 25 SQ CM
|
Professional
|
Both
|
$386.12
|
|
|
Service Code
|
HCPCS 15275
|
| Min. Negotiated Rate |
$73.38 |
| Max. Negotiated Rate |
$235.87 |
| Rate for Payer: Cash Price |
$105.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$104.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$94.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$94.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$99.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$104.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$99.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$78.62
|
| Rate for Payer: Healthfirst Commercial |
$104.83
|
| Rate for Payer: Healthfirst Essential Plan |
$235.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$99.59
|
| Rate for Payer: Healthfirst QHP |
$104.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$73.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$104.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$89.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$73.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$104.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$78.62
|
| Rate for Payer: SOMOS Essential |
$78.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$104.83
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D<100SQ CM EA ADDL25SQ CM
|
Professional
|
Both
|
$106.23
|
|
|
Service Code
|
HCPCS 15276
|
| Min. Negotiated Rate |
$19.54 |
| Max. Negotiated Rate |
$62.82 |
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.94
|
| Rate for Payer: Healthfirst Commercial |
$27.92
|
| Rate for Payer: Healthfirst Essential Plan |
$62.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.52
|
| Rate for Payer: Healthfirst QHP |
$27.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.94
|
| Rate for Payer: SOMOS Essential |
$20.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.92
|
|
|
PR SUBMUCOSAL ABLTJ TONGUE RF 1/> SITES PR SESSION
|
Professional
|
Both
|
$1,629.29
|
|
|
Service Code
|
HCPCS 41530
|
| Min. Negotiated Rate |
$306.01 |
| Max. Negotiated Rate |
$983.61 |
| Rate for Payer: Cash Price |
$441.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$437.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$393.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$393.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$415.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$437.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$415.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$437.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$437.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$327.87
|
| Rate for Payer: Healthfirst Commercial |
$437.16
|
| Rate for Payer: Healthfirst Essential Plan |
$983.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$415.30
|
| Rate for Payer: Healthfirst QHP |
$437.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$306.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$437.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$371.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$306.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$437.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$327.87
|
| Rate for Payer: SOMOS Essential |
$327.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$437.16
|
|
|
PR SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL
|
Professional
|
Both
|
$765.10
|
|
|
Service Code
|
HCPCS 30140
|
| Min. Negotiated Rate |
$143.82 |
| Max. Negotiated Rate |
$462.29 |
| Rate for Payer: Cash Price |
$206.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$205.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$184.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$184.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$195.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$205.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$195.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$205.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$205.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$154.09
|
| Rate for Payer: Healthfirst Commercial |
$205.46
|
| Rate for Payer: Healthfirst Essential Plan |
$462.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$195.19
|
| Rate for Payer: Healthfirst QHP |
$205.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$143.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$205.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$174.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$143.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$205.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$154.09
|
| Rate for Payer: SOMOS Essential |
$154.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$205.46
|
|
|
PR SUBQ HOSPITAL CARE PER DAY E/M NORMAL NEWBORN
|
Professional
|
Both
|
$166.18
|
|
|
Service Code
|
HCPCS 99462
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$98.26 |
| Rate for Payer: Amida Care Medicaid |
$12.38
|
| Rate for Payer: Cash Price |
$45.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.75
|
| Rate for Payer: Healthfirst Commercial |
$43.67
|
| Rate for Payer: Healthfirst Essential Plan |
$98.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.49
|
| Rate for Payer: Healthfirst QHP |
$43.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.75
|
| Rate for Payer: SOMOS Essential |
$32.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.67
|
|
|
PR SUBQ INFUSION ADDITIONAL PUMP INFUSION SITE
|
Professional
|
Both
|
$241.50
|
|
|
Service Code
|
HCPCS 96371
|
| Min. Negotiated Rate |
$46.89 |
| Max. Negotiated Rate |
$150.73 |
| Rate for Payer: Cash Price |
$71.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$66.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$63.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$66.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$63.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.24
|
| Rate for Payer: Healthfirst Commercial |
$66.99
|
| Rate for Payer: Healthfirst Essential Plan |
$150.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$63.64
|
| Rate for Payer: Healthfirst QHP |
$66.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$66.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$56.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$66.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$50.24
|
| Rate for Payer: SOMOS Essential |
$50.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.99
|
|
|
PR SUBQ I/P CRITICAL CARE PR DAY AGE 28 DAYS/<
|
Professional
|
Both
|
$1,565.34
|
|
|
Service Code
|
HCPCS 99469
|
| Min. Negotiated Rate |
$156.57 |
| Max. Negotiated Rate |
$945.95 |
| Rate for Payer: Amida Care Medicaid |
$156.57
|
| Rate for Payer: Cash Price |
$427.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$420.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$378.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$378.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$399.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$420.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$399.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$420.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$420.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$315.31
|
| Rate for Payer: Healthfirst Commercial |
$420.42
|
| Rate for Payer: Healthfirst Essential Plan |
$945.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$399.40
|
| Rate for Payer: Healthfirst QHP |
$420.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$294.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$420.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$357.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$294.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$420.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$315.31
|
| Rate for Payer: SOMOS Essential |
$315.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$420.42
|
|
|
PR SUBSEQUENT INTENSIVE CARE INFANT 1500-2500 GRAMS
|
Professional
|
Both
|
$493.19
|
|
|
Service Code
|
HCPCS 99479
|
| Min. Negotiated Rate |
$62.50 |
| Max. Negotiated Rate |
$294.64 |
| Rate for Payer: Amida Care Medicaid |
$62.50
|
| Rate for Payer: Cash Price |
$133.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$130.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$117.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$117.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$124.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$130.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$124.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$98.21
|
| Rate for Payer: Healthfirst Commercial |
$130.95
|
| Rate for Payer: Healthfirst Essential Plan |
$294.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$124.40
|
| Rate for Payer: Healthfirst QHP |
$130.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$91.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$130.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$111.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$91.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$130.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$98.21
|
| Rate for Payer: SOMOS Essential |
$98.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.95
|
|
|
PR SUBSEQUENT INTENSIVE CARE INFANT < 1500 GRAMS
|
Professional
|
Both
|
$540.16
|
|
|
Service Code
|
HCPCS 99478
|
| Min. Negotiated Rate |
$71.18 |
| Max. Negotiated Rate |
$324.65 |
| Rate for Payer: Amida Care Medicaid |
$71.18
|
| Rate for Payer: Cash Price |
$147.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$144.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$129.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$129.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$137.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$144.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$137.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$108.22
|
| Rate for Payer: Healthfirst Commercial |
$144.29
|
| Rate for Payer: Healthfirst Essential Plan |
$324.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$137.08
|
| Rate for Payer: Healthfirst QHP |
$144.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$101.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$144.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$122.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$101.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$144.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$108.22
|
| Rate for Payer: SOMOS Essential |
$108.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$144.29
|
|
|
PR SUBSEQUENT INTENSIVE CARE INFANT 2501-5000 GRAMS
|
Professional
|
Both
|
$476.35
|
|
|
Service Code
|
HCPCS 99480
|
| Min. Negotiated Rate |
$60.11 |
| Max. Negotiated Rate |
$284.26 |
| Rate for Payer: Amida Care Medicaid |
$60.11
|
| Rate for Payer: Cash Price |
$128.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$126.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$113.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$120.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$126.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$120.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.75
|
| Rate for Payer: Healthfirst Commercial |
$126.34
|
| Rate for Payer: Healthfirst Essential Plan |
$284.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$120.02
|
| Rate for Payer: Healthfirst QHP |
$126.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$88.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$126.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$107.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$88.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$126.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$94.75
|
| Rate for Payer: SOMOS Essential |
$94.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$126.34
|
|
|
PR SUBSEQUENT PED CRITICAL CARE 2 THRU 5 YEARS
|
Professional
|
Both
|
$1,373.96
|
|
|
Service Code
|
HCPCS 99476
|
| Min. Negotiated Rate |
$262.05 |
| Max. Negotiated Rate |
$842.29 |
| Rate for Payer: Cash Price |
$374.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$374.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$336.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$336.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$355.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$374.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$355.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$374.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$374.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$280.76
|
| Rate for Payer: Healthfirst Commercial |
$374.35
|
| Rate for Payer: Healthfirst Essential Plan |
$842.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$355.63
|
| Rate for Payer: Healthfirst QHP |
$374.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$262.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$374.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$318.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$262.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$374.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$280.76
|
| Rate for Payer: SOMOS Essential |
$280.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$374.35
|
|
|
PR SUBSQ PED CRITICAL CARE 29 DAYS THRU 24 MO
|
Professional
|
Both
|
$1,596.14
|
|
|
Service Code
|
HCPCS 99472
|
| Min. Negotiated Rate |
$158.13 |
| Max. Negotiated Rate |
$998.68 |
| Rate for Payer: Amida Care Medicaid |
$158.13
|
| Rate for Payer: Cash Price |
$441.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$443.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$399.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$399.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$421.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$443.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$421.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$443.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$443.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$332.89
|
| Rate for Payer: Healthfirst Commercial |
$443.86
|
| Rate for Payer: Healthfirst Essential Plan |
$998.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$421.67
|
| Rate for Payer: Healthfirst QHP |
$443.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$310.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$443.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$377.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$310.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$443.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$332.89
|
| Rate for Payer: SOMOS Essential |
$332.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$443.86
|
|
|
PR SUBTEMPORAL CRANIAL DECOMPRESSION
|
Professional
|
Both
|
$6,949.53
|
|
|
Service Code
|
HCPCS 61340
|
| Min. Negotiated Rate |
$1,272.90 |
| Max. Negotiated Rate |
$4,091.47 |
| Rate for Payer: Cash Price |
$1,833.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,818.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,636.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,636.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,727.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,818.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,727.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,818.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,818.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,363.82
|
| Rate for Payer: Healthfirst Commercial |
$1,818.43
|
| Rate for Payer: Healthfirst Essential Plan |
$4,091.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,727.51
|
| Rate for Payer: Healthfirst QHP |
$1,818.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,272.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,818.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,545.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,272.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,818.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,363.82
|
| Rate for Payer: SOMOS Essential |
$1,363.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,818.43
|
|
|
PR SUPRACERVICAL ABDL HYSTER W/WO RMVL TUBE OVARY
|
Professional
|
Both
|
$4,179.95
|
|
|
Service Code
|
HCPCS 58180
|
| Min. Negotiated Rate |
$781.32 |
| Max. Negotiated Rate |
$2,511.38 |
| Rate for Payer: Cash Price |
$1,130.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,116.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,004.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,004.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,060.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,116.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,060.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,116.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,116.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$837.13
|
| Rate for Payer: Healthfirst Commercial |
$1,116.17
|
| Rate for Payer: Healthfirst Essential Plan |
$2,511.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,060.36
|
| Rate for Payer: Healthfirst QHP |
$1,116.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$781.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,116.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$948.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$781.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,116.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$837.13
|
| Rate for Payer: SOMOS Essential |
$837.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,116.17
|
|
|
PR SUPRAHYOID LYMPHADENECTOMY
|
Professional
|
Both
|
$3,483.27
|
|
|
Service Code
|
HCPCS 38700
|
| Min. Negotiated Rate |
$654.56 |
| Max. Negotiated Rate |
$2,103.95 |
| Rate for Payer: Cash Price |
$941.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$935.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$841.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$841.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$888.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$935.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$888.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$935.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$935.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$701.32
|
| Rate for Payer: Healthfirst Commercial |
$935.09
|
| Rate for Payer: Healthfirst Essential Plan |
$2,103.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$888.34
|
| Rate for Payer: Healthfirst QHP |
$935.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$654.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$935.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$794.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$654.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$935.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$701.32
|
| Rate for Payer: SOMOS Essential |
$701.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$935.09
|
|
|
PR SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I
|
Professional
|
Both
|
$1,455.79
|
|
|
Service Code
|
HCPCS 36253
|
| Min. Negotiated Rate |
$272.59 |
| Max. Negotiated Rate |
$876.17 |
| Rate for Payer: Cash Price |
$392.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$389.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$350.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$350.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$369.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$389.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$369.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$389.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$389.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$292.06
|
| Rate for Payer: Healthfirst Commercial |
$389.41
|
| Rate for Payer: Healthfirst Essential Plan |
$876.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$369.94
|
| Rate for Payer: Healthfirst QHP |
$389.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$272.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$389.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$331.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$272.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$389.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$292.06
|
| Rate for Payer: SOMOS Essential |
$292.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$389.41
|
|
|
PR SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I
|
Professional
|
Both
|
$1,807.51
|
|
|
Service Code
|
HCPCS 36254
|
| Min. Negotiated Rate |
$335.57 |
| Max. Negotiated Rate |
$1,078.63 |
| Rate for Payer: Cash Price |
$482.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$479.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$431.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$431.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$455.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$479.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$455.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$479.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$479.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$359.54
|
| Rate for Payer: Healthfirst Commercial |
$479.39
|
| Rate for Payer: Healthfirst Essential Plan |
$1,078.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$455.42
|
| Rate for Payer: Healthfirst QHP |
$479.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$335.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$479.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$407.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$335.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$479.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$359.54
|
| Rate for Payer: SOMOS Essential |
$359.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$479.39
|
|
|
PR SURG CLSR TRACHEOSTOMY/FISTULA W/O PLASTIC RPR
|
Professional
|
Both
|
$1,440.99
|
|
|
Service Code
|
HCPCS 31820
|
| Min. Negotiated Rate |
$269.13 |
| Max. Negotiated Rate |
$865.06 |
| Rate for Payer: Cash Price |
$391.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$384.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$346.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$346.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$365.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$384.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$365.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$384.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$384.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$288.35
|
| Rate for Payer: Healthfirst Commercial |
$384.47
|
| Rate for Payer: Healthfirst Essential Plan |
$865.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$365.25
|
| Rate for Payer: Healthfirst QHP |
$384.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$269.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$384.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$326.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$269.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$384.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$288.35
|
| Rate for Payer: SOMOS Essential |
$288.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$384.47
|
|
|
PR SURG CLSR TRACHEOSTOMY/FISTULA W/PLASTIC RPR
|
Professional
|
Both
|
$2,107.04
|
|
|
Service Code
|
HCPCS 31825
|
| Min. Negotiated Rate |
$394.71 |
| Max. Negotiated Rate |
$1,268.71 |
| Rate for Payer: Cash Price |
$571.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$563.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$507.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$507.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$535.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$563.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$535.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$563.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$563.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$422.90
|
| Rate for Payer: Healthfirst Commercial |
$563.87
|
| Rate for Payer: Healthfirst Essential Plan |
$1,268.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$535.68
|
| Rate for Payer: Healthfirst QHP |
$563.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$394.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$563.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$479.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$394.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$563.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$422.90
|
| Rate for Payer: SOMOS Essential |
$422.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$563.87
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER BICEPS TENODESIS
|
Professional
|
Both
|
$4,035.47
|
|
|
Service Code
|
HCPCS 29828
|
| Min. Negotiated Rate |
$759.06 |
| Max. Negotiated Rate |
$2,439.83 |
| Rate for Payer: Cash Price |
$1,090.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,084.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$975.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$975.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,030.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,084.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,030.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,084.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,084.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$813.28
|
| Rate for Payer: Healthfirst Commercial |
$1,084.37
|
| Rate for Payer: Healthfirst Essential Plan |
$2,439.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,030.15
|
| Rate for Payer: Healthfirst QHP |
$1,084.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$759.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,084.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$921.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$759.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,084.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$813.28
|
| Rate for Payer: SOMOS Essential |
$813.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,084.37
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER CAPSULORRHAPHY
|
Professional
|
Both
|
$4,662.88
|
|
|
Service Code
|
HCPCS 29806
|
| Min. Negotiated Rate |
$877.31 |
| Max. Negotiated Rate |
$2,819.93 |
| Rate for Payer: Cash Price |
$1,261.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,253.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,127.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,127.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,190.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,253.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,190.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,253.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,253.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$939.98
|
| Rate for Payer: Healthfirst Commercial |
$1,253.30
|
| Rate for Payer: Healthfirst Essential Plan |
$2,819.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,190.63
|
| Rate for Payer: Healthfirst QHP |
$1,253.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$877.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,253.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,065.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$877.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,253.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$939.98
|
| Rate for Payer: SOMOS Essential |
$939.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,253.30
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER COMPL SYNOVECTOMY
|
Professional
|
Both
|
$2,628.57
|
|
|
Service Code
|
HCPCS 29821
|
| Min. Negotiated Rate |
$496.59 |
| Max. Negotiated Rate |
$1,596.19 |
| Rate for Payer: Cash Price |
$709.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$709.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$638.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$638.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$673.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$709.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$673.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$709.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$709.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$532.07
|
| Rate for Payer: Healthfirst Commercial |
$709.42
|
| Rate for Payer: Healthfirst Essential Plan |
$1,596.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$673.95
|
| Rate for Payer: Healthfirst QHP |
$709.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$496.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$709.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$603.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$496.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$709.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$532.07
|
| Rate for Payer: SOMOS Essential |
$532.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$709.42
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER DSTL CLAVICULC
|
Professional
|
Both
|
$2,995.20
|
|
|
Service Code
|
HCPCS 29824
|
| Min. Negotiated Rate |
$565.39 |
| Max. Negotiated Rate |
$1,817.33 |
| Rate for Payer: Cash Price |
$810.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$807.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$726.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$726.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$767.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$807.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$767.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$807.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$807.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$605.77
|
| Rate for Payer: Healthfirst Commercial |
$807.70
|
| Rate for Payer: Healthfirst Essential Plan |
$1,817.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$767.32
|
| Rate for Payer: Healthfirst QHP |
$807.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$565.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$807.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$686.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$565.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$807.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$605.77
|
| Rate for Payer: SOMOS Essential |
$605.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$807.70
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER LMTD DBRDMT 1/2
|
Professional
|
Both
|
$2,394.00
|
|
|
Service Code
|
HCPCS 29822
|
| Min. Negotiated Rate |
$453.56 |
| Max. Negotiated Rate |
$1,457.87 |
| Rate for Payer: Cash Price |
$649.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$647.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$583.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$583.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$615.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$647.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$615.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$647.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$647.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$485.95
|
| Rate for Payer: Healthfirst Commercial |
$647.94
|
| Rate for Payer: Healthfirst Essential Plan |
$1,457.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$615.54
|
| Rate for Payer: Healthfirst QHP |
$647.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$453.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$647.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$550.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$453.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$647.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$485.95
|
| Rate for Payer: SOMOS Essential |
$485.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$647.94
|
|
