|
PR TENOTOMY OPEN HAMSTRING KNEE HIP MULTIPLE BI
|
Professional
|
Both
|
$3,168.69
|
|
|
Service Code
|
HCPCS 27392
|
| Min. Negotiated Rate |
$597.87 |
| Max. Negotiated Rate |
$1,921.72 |
| Rate for Payer: Cash Price |
$858.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$854.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$768.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$768.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$811.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$854.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$811.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$854.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$854.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$640.58
|
| Rate for Payer: Healthfirst Commercial |
$854.10
|
| Rate for Payer: Healthfirst Essential Plan |
$1,921.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$811.39
|
| Rate for Payer: Healthfirst QHP |
$854.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$597.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$854.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$725.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$597.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$854.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$640.58
|
| Rate for Payer: SOMOS Essential |
$640.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$854.10
|
|
|
PR TENOTOMY OPEN HAMSTRING KNEE HIP SINGLE TENDON
|
Professional
|
Both
|
$2,006.76
|
|
|
Service Code
|
HCPCS 27390
|
| Min. Negotiated Rate |
$381.46 |
| Max. Negotiated Rate |
$1,226.12 |
| Rate for Payer: Cash Price |
$546.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$544.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$490.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$490.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$517.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$544.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$517.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$544.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$544.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$408.70
|
| Rate for Payer: Healthfirst Commercial |
$544.94
|
| Rate for Payer: Healthfirst Essential Plan |
$1,226.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$517.69
|
| Rate for Payer: Healthfirst QHP |
$544.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$381.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$544.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$463.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$381.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$544.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$408.70
|
| Rate for Payer: SOMOS Essential |
$408.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$544.94
|
|
|
PR TENOTOMY OPN HAMSTRING KNEE HIP MULTIPLE 1 LEG
|
Professional
|
Both
|
$2,581.78
|
|
|
Service Code
|
HCPCS 27391
|
| Min. Negotiated Rate |
$487.28 |
| Max. Negotiated Rate |
$1,566.27 |
| Rate for Payer: Cash Price |
$698.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$696.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$626.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$626.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$661.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$696.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$661.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$696.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$696.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$522.09
|
| Rate for Payer: Healthfirst Commercial |
$696.12
|
| Rate for Payer: Healthfirst Essential Plan |
$1,566.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$661.31
|
| Rate for Payer: Healthfirst QHP |
$696.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$487.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$696.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$591.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$487.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$696.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$522.09
|
| Rate for Payer: SOMOS Essential |
$522.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$696.12
|
|
|
PR TENOTOMY PERCUTANEOUS SINGLE EACH DIGIT
|
Professional
|
Both
|
$1,121.40
|
|
|
Service Code
|
HCPCS 26060
|
| Min. Negotiated Rate |
$213.53 |
| Max. Negotiated Rate |
$686.36 |
| Rate for Payer: Cash Price |
$307.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$305.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$274.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$274.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$289.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$305.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$289.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$305.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$305.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$228.79
|
| Rate for Payer: Healthfirst Commercial |
$305.05
|
| Rate for Payer: Healthfirst Essential Plan |
$686.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$289.80
|
| Rate for Payer: Healthfirst QHP |
$305.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$213.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$305.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$259.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$213.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$305.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$228.79
|
| Rate for Payer: SOMOS Essential |
$228.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$305.05
|
|
|
PR TENOTOMY PERCUTANEOUS TOE MULTIPLE TENDON
|
Professional
|
Both
|
$1,162.00
|
|
|
Service Code
|
HCPCS 28011
|
| Min. Negotiated Rate |
$226.32 |
| Max. Negotiated Rate |
$727.47 |
| Rate for Payer: Cash Price |
$322.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$323.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$290.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$290.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$307.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$323.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$307.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$323.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$323.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$242.49
|
| Rate for Payer: Healthfirst Commercial |
$323.32
|
| Rate for Payer: Healthfirst Essential Plan |
$727.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$307.15
|
| Rate for Payer: Healthfirst QHP |
$323.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$226.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$323.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$274.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$226.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$323.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$242.49
|
| Rate for Payer: SOMOS Essential |
$242.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$323.32
|
|
|
PR TENOTOMY PERCUTANEOUS TOE SINGLE TENDON
|
Professional
|
Both
|
$867.34
|
|
|
Service Code
|
HCPCS 28010
|
| Min. Negotiated Rate |
$168.57 |
| Max. Negotiated Rate |
$541.82 |
| Rate for Payer: Cash Price |
$241.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$240.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$216.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$216.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$228.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$240.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$228.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$240.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$240.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$180.61
|
| Rate for Payer: Healthfirst Commercial |
$240.81
|
| Rate for Payer: Healthfirst Essential Plan |
$541.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$228.77
|
| Rate for Payer: Healthfirst QHP |
$240.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$168.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$240.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$204.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$168.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$240.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$180.61
|
| Rate for Payer: SOMOS Essential |
$180.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$240.81
|
|
|
PR TENOTOMY PRQ ACHILLES TENDON SPX GENERAL ANES
|
Professional
|
Both
|
$1,171.59
|
|
|
Service Code
|
HCPCS 27606
|
| Min. Negotiated Rate |
$221.79 |
| Max. Negotiated Rate |
$712.91 |
| Rate for Payer: Cash Price |
$316.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$316.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$285.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$285.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$301.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$316.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$301.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$316.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$316.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$237.64
|
| Rate for Payer: Healthfirst Commercial |
$316.85
|
| Rate for Payer: Healthfirst Essential Plan |
$712.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$301.01
|
| Rate for Payer: Healthfirst QHP |
$316.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$221.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$316.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$269.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$221.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$316.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$237.64
|
| Rate for Payer: SOMOS Essential |
$237.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$316.85
|
|
|
PR TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES
|
Professional
|
Both
|
$765.91
|
|
|
Service Code
|
HCPCS 27605
|
| Min. Negotiated Rate |
$147.08 |
| Max. Negotiated Rate |
$472.77 |
| Rate for Payer: Cash Price |
$210.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$210.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$189.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$189.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$199.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$199.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$210.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$210.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$157.59
|
| Rate for Payer: Healthfirst Commercial |
$210.12
|
| Rate for Payer: Healthfirst Essential Plan |
$472.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$199.61
|
| Rate for Payer: Healthfirst QHP |
$210.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$147.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$210.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$178.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$147.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$210.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$157.59
|
| Rate for Payer: SOMOS Essential |
$157.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$210.12
|
|
|
PR TENOTOMY PRQ ADDUCTOR/HAMSTRING 1 TENDON SPX
|
Professional
|
Both
|
$1,429.26
|
|
|
Service Code
|
HCPCS 27306
|
| Min. Negotiated Rate |
$281.03 |
| Max. Negotiated Rate |
$903.31 |
| Rate for Payer: Cash Price |
$402.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$401.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$361.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$361.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$381.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$401.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$381.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$401.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$401.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$301.10
|
| Rate for Payer: Healthfirst Commercial |
$401.47
|
| Rate for Payer: Healthfirst Essential Plan |
$903.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$381.40
|
| Rate for Payer: Healthfirst QHP |
$401.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$281.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$401.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$341.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$281.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$401.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$301.10
|
| Rate for Payer: SOMOS Essential |
$301.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$401.47
|
|
|
PR TENOTOMY PRQ ADDUCTOR/HAMSTRING MULTIPLE TENDON
|
Professional
|
Both
|
$1,743.28
|
|
|
Service Code
|
HCPCS 27307
|
| Min. Negotiated Rate |
$334.52 |
| Max. Negotiated Rate |
$1,075.23 |
| Rate for Payer: Cash Price |
$476.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$477.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$430.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$430.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$453.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$477.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$453.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$477.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$477.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$358.41
|
| Rate for Payer: Healthfirst Commercial |
$477.88
|
| Rate for Payer: Healthfirst Essential Plan |
$1,075.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$453.99
|
| Rate for Payer: Healthfirst QHP |
$477.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$334.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$477.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$406.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$334.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$477.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$358.41
|
| Rate for Payer: SOMOS Essential |
$358.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$477.88
|
|
|
PR TENOTOMY SHOULDER AREA 1 TENDON
|
Professional
|
Both
|
$2,714.29
|
|
|
Service Code
|
HCPCS 23405
|
| Min. Negotiated Rate |
$509.61 |
| Max. Negotiated Rate |
$1,638.05 |
| Rate for Payer: Cash Price |
$733.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$728.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$655.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$655.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$691.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$728.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$691.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$728.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$728.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$546.01
|
| Rate for Payer: Healthfirst Commercial |
$728.02
|
| Rate for Payer: Healthfirst Essential Plan |
$1,638.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$691.62
|
| Rate for Payer: Healthfirst QHP |
$728.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$509.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$728.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$618.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$509.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$728.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$546.01
|
| Rate for Payer: SOMOS Essential |
$546.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$728.02
|
|
|
PR TENOTOMY SHOULDER MULTIPLE THRU SAME INCISION
|
Professional
|
Both
|
$3,257.38
|
|
|
Service Code
|
HCPCS 23406
|
| Min. Negotiated Rate |
$603.08 |
| Max. Negotiated Rate |
$1,938.46 |
| Rate for Payer: Cash Price |
$860.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$861.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$775.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$775.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$818.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$861.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$818.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$861.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$861.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$646.15
|
| Rate for Payer: Healthfirst Commercial |
$861.54
|
| Rate for Payer: Healthfirst Essential Plan |
$1,938.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$818.46
|
| Rate for Payer: Healthfirst QHP |
$861.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$603.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$861.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$732.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$603.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$861.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$646.15
|
| Rate for Payer: SOMOS Essential |
$646.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$861.54
|
|
|
PR TESTING AUTONOMIC NERVOUS SYSTEM FUNCTION
|
Professional
|
Both
|
$176.86
|
|
|
Service Code
|
HCPCS 95923 26
|
| Min. Negotiated Rate |
$33.49 |
| Max. Negotiated Rate |
$107.64 |
| Rate for Payer: Amida Care Medicaid |
$91.59
|
| Rate for Payer: Cash Price |
$48.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.88
|
| Rate for Payer: Healthfirst Commercial |
$47.84
|
| Rate for Payer: Healthfirst Essential Plan |
$107.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.45
|
| Rate for Payer: Healthfirst QHP |
$47.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.88
|
| Rate for Payer: SOMOS Essential |
$35.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.84
|
|
|
PR TESTING AUTONOMIC NERVOUS SYSTEM FUNCTION
|
Professional
|
Both
|
$341.99
|
|
|
Service Code
|
HCPCS 95923 TC
|
| Min. Negotiated Rate |
$60.48 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Amida Care Medicaid |
$91.59
|
| Rate for Payer: Cash Price |
$92.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$86.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$77.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$82.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$86.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$82.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.80
|
| Rate for Payer: Healthfirst Commercial |
$86.40
|
| Rate for Payer: Healthfirst Essential Plan |
$194.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$82.08
|
| Rate for Payer: Healthfirst QHP |
$86.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$60.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$86.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$73.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$60.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.80
|
| Rate for Payer: SOMOS Essential |
$64.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.40
|
|
|
PR TESTING AUTONOMIC NERVOUS SYSTEM FUNCTION
|
Professional
|
Both
|
$518.84
|
|
|
Service Code
|
HCPCS 95923
|
| Min. Negotiated Rate |
$91.59 |
| Max. Negotiated Rate |
$302.04 |
| Rate for Payer: Amida Care Medicaid |
$91.59
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$134.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$120.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$120.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$127.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$134.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$127.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$134.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$134.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$100.68
|
| Rate for Payer: Healthfirst Commercial |
$134.24
|
| Rate for Payer: Healthfirst Essential Plan |
$302.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.53
|
| Rate for Payer: Healthfirst QHP |
$134.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$93.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$134.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$114.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$93.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$134.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$100.68
|
| Rate for Payer: SOMOS Essential |
$100.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$134.24
|
|
|
PR TEST SELECT & ADMN FUNCTL BRAIN MAP PHYS/QHP
|
Professional
|
Both
|
$626.05
|
|
|
Service Code
|
HCPCS 96020 26
|
| Min. Negotiated Rate |
$118.01 |
| Max. Negotiated Rate |
$379.31 |
| Rate for Payer: Cash Price |
$169.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$168.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$151.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$151.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$168.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$168.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$168.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$126.44
|
| Rate for Payer: Healthfirst Commercial |
$168.58
|
| Rate for Payer: Healthfirst Essential Plan |
$379.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$160.15
|
| Rate for Payer: Healthfirst QHP |
$168.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$118.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$168.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$143.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$118.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$168.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$126.44
|
| Rate for Payer: SOMOS Essential |
$126.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$168.58
|
|
|
PR THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN
|
Professional
|
Both
|
$152.71
|
|
|
Service Code
|
HCPCS 97530
|
| Min. Negotiated Rate |
$27.89 |
| Max. Negotiated Rate |
$89.64 |
| Rate for Payer: Cash Price |
$41.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.88
|
| Rate for Payer: Healthfirst Commercial |
$39.84
|
| Rate for Payer: Healthfirst Essential Plan |
$89.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.85
|
| Rate for Payer: Healthfirst QHP |
$39.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.88
|
| Rate for Payer: SOMOS Essential |
$29.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.84
|
|
|
PR THERAPEUTIC APHERESIS PLASMA PHERESIS
|
Professional
|
Both
|
$378.56
|
|
|
Service Code
|
HCPCS 36514
|
| Min. Negotiated Rate |
$72.31 |
| Max. Negotiated Rate |
$232.43 |
| Rate for Payer: Cash Price |
$103.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$103.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$92.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$98.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$98.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.47
|
| Rate for Payer: Healthfirst Commercial |
$103.30
|
| Rate for Payer: Healthfirst Essential Plan |
$232.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$98.14
|
| Rate for Payer: Healthfirst QHP |
$103.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$103.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$87.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.47
|
| Rate for Payer: SOMOS Essential |
$77.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.30
|
|
|
PR THERAPEUTIC APHERESIS PLATELETS
|
Professional
|
Both
|
$436.17
|
|
|
Service Code
|
HCPCS 36513
|
| Min. Negotiated Rate |
$84.32 |
| Max. Negotiated Rate |
$271.04 |
| Rate for Payer: Cash Price |
$118.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$120.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$114.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$120.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$114.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$90.34
|
| Rate for Payer: Healthfirst Commercial |
$120.46
|
| Rate for Payer: Healthfirst Essential Plan |
$271.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$114.44
|
| Rate for Payer: Healthfirst QHP |
$120.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$84.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$120.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$102.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$84.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$120.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$90.34
|
| Rate for Payer: SOMOS Essential |
$90.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$120.46
|
|
|
PR THERAPEUTIC APHERESIS RED BLOOD CELLS
|
Professional
|
Both
|
$428.51
|
|
|
Service Code
|
HCPCS 36512
|
| Min. Negotiated Rate |
$81.30 |
| Max. Negotiated Rate |
$261.31 |
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$116.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$104.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$104.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$110.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$116.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$110.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$116.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$116.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$87.11
|
| Rate for Payer: Healthfirst Commercial |
$116.14
|
| Rate for Payer: Healthfirst Essential Plan |
$261.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.33
|
| Rate for Payer: Healthfirst QHP |
$116.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$81.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$116.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$98.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$81.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$116.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$87.11
|
| Rate for Payer: SOMOS Essential |
$87.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$116.14
|
|
|
PR THERAPEUTIC APHERESIS WHITE BLOOD CELLS
|
Professional
|
Both
|
$441.46
|
|
|
Service Code
|
HCPCS 36511
|
| Min. Negotiated Rate |
$85.92 |
| Max. Negotiated Rate |
$276.17 |
| Rate for Payer: Cash Price |
$123.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$122.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$110.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$116.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$122.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$116.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.06
|
| Rate for Payer: Healthfirst Commercial |
$122.74
|
| Rate for Payer: Healthfirst Essential Plan |
$276.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$116.60
|
| Rate for Payer: Healthfirst QHP |
$122.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$85.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$122.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$104.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$85.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$122.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$92.06
|
| Rate for Payer: SOMOS Essential |
$92.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.74
|
|
|
PR THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG
|
Professional
|
Both
|
$65.59
|
|
|
Service Code
|
HCPCS 96375
|
| Min. Negotiated Rate |
$11.81 |
| Max. Negotiated Rate |
$37.96 |
| Rate for Payer: Cash Price |
$17.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.65
|
| Rate for Payer: Healthfirst Commercial |
$16.87
|
| Rate for Payer: Healthfirst Essential Plan |
$37.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.03
|
| Rate for Payer: Healthfirst QHP |
$16.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.65
|
| Rate for Payer: SOMOS Essential |
$12.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.87
|
|
|
PR THERAPEUTIC PROCD STRG ENDUR
|
Professional
|
Both
|
$47.29
|
|
|
Service Code
|
HCPCS G0237
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$31.09 |
| Rate for Payer: Cash Price |
$13.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.37
|
| Rate for Payer: Healthfirst Commercial |
$13.82
|
| Rate for Payer: Healthfirst Essential Plan |
$31.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.13
|
| Rate for Payer: Healthfirst QHP |
$13.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.37
|
| Rate for Payer: SOMOS Essential |
$10.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.82
|
|
|
PR THERAPEUTIC PROCEDURES GROUP 2/> INDIVIDUALS
|
Professional
|
Both
|
$72.14
|
|
|
Service Code
|
HCPCS 97150
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$44.82 |
| Rate for Payer: Cash Price |
$20.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.94
|
| Rate for Payer: Healthfirst Commercial |
$19.92
|
| Rate for Payer: Healthfirst Essential Plan |
$44.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.92
|
| Rate for Payer: Healthfirst QHP |
$19.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.94
|
| Rate for Payer: SOMOS Essential |
$14.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.92
|
|
|
PR THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM
|
Professional
|
Both
|
$58.52
|
|
|
Service Code
|
HCPCS 96372
|
| Min. Negotiated Rate |
$11.33 |
| Max. Negotiated Rate |
$36.41 |
| Rate for Payer: Cash Price |
$16.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.13
|
| Rate for Payer: Healthfirst Commercial |
$16.18
|
| Rate for Payer: Healthfirst Essential Plan |
$36.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.37
|
| Rate for Payer: Healthfirst QHP |
$16.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.13
|
| Rate for Payer: SOMOS Essential |
$12.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.18
|
|
