|
PR TX INTER/PR/SUBTRCHNTRIC FEMORAL FX SCREW IMPLT
|
Professional
|
Both
|
$5,414.99
|
|
|
Service Code
|
HCPCS 27244
|
| Min. Negotiated Rate |
$1,017.16 |
| Max. Negotiated Rate |
$3,269.43 |
| Rate for Payer: Cash Price |
$1,460.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,453.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,307.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,307.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,380.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,453.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,380.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,453.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,453.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,089.81
|
| Rate for Payer: Healthfirst Commercial |
$1,453.08
|
| Rate for Payer: Healthfirst Essential Plan |
$3,269.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,380.43
|
| Rate for Payer: Healthfirst QHP |
$1,453.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,017.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,453.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,235.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,017.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,453.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,089.81
|
| Rate for Payer: SOMOS Essential |
$1,089.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,453.08
|
|
|
PR TX MISSED ABORTION FIRST TRIMESTER SURGICAL
|
Professional
|
Both
|
$1,775.03
|
|
|
Service Code
|
HCPCS 59820
|
| Min. Negotiated Rate |
$327.59 |
| Max. Negotiated Rate |
$1,052.95 |
| Rate for Payer: Cash Price |
$475.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$467.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$421.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$421.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$444.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$467.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$444.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$467.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$467.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$350.99
|
| Rate for Payer: Healthfirst Commercial |
$467.98
|
| Rate for Payer: Healthfirst Essential Plan |
$1,052.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$444.58
|
| Rate for Payer: Healthfirst QHP |
$467.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$327.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$467.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$397.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$327.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$467.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$350.99
|
| Rate for Payer: SOMOS Essential |
$350.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$467.98
|
|
|
PR TX MISSED ABORTION SECOND TRIMESTER SURGICAL
|
Professional
|
Both
|
$1,744.72
|
|
|
Service Code
|
HCPCS 59821
|
| Min. Negotiated Rate |
$320.77 |
| Max. Negotiated Rate |
$1,031.06 |
| Rate for Payer: Cash Price |
$465.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$458.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$412.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$412.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$435.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$458.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$435.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$458.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$458.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$343.69
|
| Rate for Payer: Healthfirst Commercial |
$458.25
|
| Rate for Payer: Healthfirst Essential Plan |
$1,031.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$435.34
|
| Rate for Payer: Healthfirst QHP |
$458.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$320.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$458.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$389.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$320.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$458.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$343.69
|
| Rate for Payer: SOMOS Essential |
$343.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$458.25
|
|
|
PR TX OPEN TENDON FLEXOR TOE 1 TENDON SPX
|
Professional
|
Both
|
$1,003.28
|
|
|
Service Code
|
HCPCS 28232
|
| Min. Negotiated Rate |
$194.08 |
| Max. Negotiated Rate |
$623.84 |
| Rate for Payer: Cash Price |
$279.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$277.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$249.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$249.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$263.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$277.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$263.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$277.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$277.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$207.94
|
| Rate for Payer: Healthfirst Commercial |
$277.26
|
| Rate for Payer: Healthfirst Essential Plan |
$623.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$263.40
|
| Rate for Payer: Healthfirst QHP |
$277.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$194.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$277.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$235.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$194.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$277.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$207.94
|
| Rate for Payer: SOMOS Essential |
$207.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$277.26
|
|
|
PR TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX
|
Professional
|
Both
|
$1,195.74
|
|
|
Service Code
|
HCPCS 28230
|
| Min. Negotiated Rate |
$230.80 |
| Max. Negotiated Rate |
$741.85 |
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$329.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$296.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$296.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$313.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$329.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$313.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$329.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$329.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$247.28
|
| Rate for Payer: Healthfirst Commercial |
$329.71
|
| Rate for Payer: Healthfirst Essential Plan |
$741.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$313.22
|
| Rate for Payer: Healthfirst QHP |
$329.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$230.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$329.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$280.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$230.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$329.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$247.28
|
| Rate for Payer: SOMOS Essential |
$247.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$329.71
|
|
|
PR TX SEPTIC ABORTION SURGICAL
|
Professional
|
Both
|
$2,150.72
|
|
|
Service Code
|
HCPCS 59830
|
| Min. Negotiated Rate |
$393.11 |
| Max. Negotiated Rate |
$1,263.56 |
| Rate for Payer: Cash Price |
$572.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$561.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$505.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$505.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$533.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$561.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$533.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$561.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$561.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$421.19
|
| Rate for Payer: Healthfirst Commercial |
$561.58
|
| Rate for Payer: Healthfirst Essential Plan |
$1,263.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$533.50
|
| Rate for Payer: Healthfirst QHP |
$561.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$393.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$561.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$477.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$393.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$561.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$421.19
|
| Rate for Payer: SOMOS Essential |
$421.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$561.58
|
|
|
PR TX SLP FEM EPIPHYSIS SINGLE/MULTIPL PINNING SITU
|
Professional
|
Both
|
$4,086.08
|
|
|
Service Code
|
HCPCS 27176
|
| Min. Negotiated Rate |
$768.85 |
| Max. Negotiated Rate |
$2,471.31 |
| Rate for Payer: Cash Price |
$1,102.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,098.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$988.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$988.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,043.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,098.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,043.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,098.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,098.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$823.77
|
| Rate for Payer: Healthfirst Commercial |
$1,098.36
|
| Rate for Payer: Healthfirst Essential Plan |
$2,471.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,043.44
|
| Rate for Payer: Healthfirst QHP |
$1,098.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$768.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,098.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$933.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$768.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,098.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$823.77
|
| Rate for Payer: SOMOS Essential |
$823.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,098.36
|
|
|
PR TX SLP FEMORAL EPIPHYSIS TRCJ W/O REDUCTION
|
Professional
|
Both
|
$2,959.71
|
|
|
Service Code
|
HCPCS 27175
|
| Min. Negotiated Rate |
$557.45 |
| Max. Negotiated Rate |
$1,791.81 |
| Rate for Payer: Cash Price |
$799.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$796.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$716.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$716.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$756.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$796.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$756.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$796.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$796.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$597.27
|
| Rate for Payer: Healthfirst Commercial |
$796.36
|
| Rate for Payer: Healthfirst Essential Plan |
$1,791.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$756.54
|
| Rate for Payer: Healthfirst QHP |
$796.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$557.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$796.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$676.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$557.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$796.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$597.27
|
| Rate for Payer: SOMOS Essential |
$597.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$796.36
|
|
|
PR TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV
|
Professional
|
Both
|
$97.27
|
|
|
Service Code
|
HCPCS 92508
|
| Min. Negotiated Rate |
$18.98 |
| Max. Negotiated Rate |
$61.02 |
| Rate for Payer: Cash Price |
$27.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.34
|
| Rate for Payer: Healthfirst Commercial |
$27.12
|
| Rate for Payer: Healthfirst Essential Plan |
$61.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.76
|
| Rate for Payer: Healthfirst QHP |
$27.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.34
|
| Rate for Payer: SOMOS Essential |
$20.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.12
|
|
|
PR TX SPEECH LANG VOICE COMMJ &/AUDITORY PROC IND
|
Professional
|
Both
|
$308.88
|
|
|
Service Code
|
HCPCS 92507
|
| Min. Negotiated Rate |
$59.55 |
| Max. Negotiated Rate |
$191.41 |
| Rate for Payer: Cash Price |
$84.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$76.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$80.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$80.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.80
|
| Rate for Payer: Healthfirst Commercial |
$85.07
|
| Rate for Payer: Healthfirst Essential Plan |
$191.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$80.82
|
| Rate for Payer: Healthfirst QHP |
$85.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$85.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$72.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.80
|
| Rate for Payer: SOMOS Essential |
$63.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.07
|
|
|
PR TX SPON HIP DISLC ABDCT SPLNT/TRCJ W/MANJ ANES
|
Professional
|
Both
|
$1,596.11
|
|
|
Service Code
|
HCPCS 27257
|
| Min. Negotiated Rate |
$300.31 |
| Max. Negotiated Rate |
$965.27 |
| Rate for Payer: Cash Price |
$431.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$429.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$386.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$386.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$407.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$429.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$407.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$429.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$321.76
|
| Rate for Payer: Healthfirst Commercial |
$429.01
|
| Rate for Payer: Healthfirst Essential Plan |
$965.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$407.56
|
| Rate for Payer: Healthfirst QHP |
$429.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$300.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$429.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$364.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$300.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$429.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$321.76
|
| Rate for Payer: SOMOS Essential |
$321.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$429.01
|
|
|
PR TX SPONTAN HIP DISLC ABDCT SPLNT/TRCJ W/O ANES
|
Professional
|
Both
|
$1,075.55
|
|
|
Service Code
|
HCPCS 27256
|
| Min. Negotiated Rate |
$199.75 |
| Max. Negotiated Rate |
$642.06 |
| Rate for Payer: Cash Price |
$288.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$285.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$256.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$256.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$271.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$285.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$271.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$285.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$285.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$214.02
|
| Rate for Payer: Healthfirst Commercial |
$285.36
|
| Rate for Payer: Healthfirst Essential Plan |
$642.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$271.09
|
| Rate for Payer: Healthfirst QHP |
$285.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$199.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$285.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$242.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$199.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$285.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$214.02
|
| Rate for Payer: SOMOS Essential |
$214.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$285.36
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Professional
|
Both
|
$814.31
|
|
|
Service Code
|
HCPCS 12020
|
| Min. Negotiated Rate |
$154.18 |
| Max. Negotiated Rate |
$495.58 |
| Rate for Payer: Cash Price |
$220.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$220.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$198.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$198.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$209.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$220.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$209.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$220.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$220.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.19
|
| Rate for Payer: Healthfirst Commercial |
$220.26
|
| Rate for Payer: Healthfirst Essential Plan |
$495.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.25
|
| Rate for Payer: Healthfirst QHP |
$220.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$154.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$220.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$187.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$154.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$220.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$165.19
|
| Rate for Payer: SOMOS Essential |
$165.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$220.26
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE W/PACKING
|
Professional
|
Both
|
$609.18
|
|
|
Service Code
|
HCPCS 12021
|
| Min. Negotiated Rate |
$114.53 |
| Max. Negotiated Rate |
$368.12 |
| Rate for Payer: Cash Price |
$165.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$163.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$147.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$147.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$155.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$163.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$155.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$163.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$163.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$122.71
|
| Rate for Payer: Healthfirst Commercial |
$163.61
|
| Rate for Payer: Healthfirst Essential Plan |
$368.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$155.43
|
| Rate for Payer: Healthfirst QHP |
$163.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$114.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$163.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$139.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$114.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$163.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$122.71
|
| Rate for Payer: SOMOS Essential |
$122.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$163.61
|
|
|
PR TX SWALLOWING DYSFUNCTION&/ORAL FUNCJ FEEDING
|
Professional
|
Both
|
$344.09
|
|
|
Service Code
|
HCPCS 92526
|
| Min. Negotiated Rate |
$65.95 |
| Max. Negotiated Rate |
$211.97 |
| Rate for Payer: Cash Price |
$94.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$94.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$84.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$84.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$89.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$94.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$89.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$94.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$94.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$70.66
|
| Rate for Payer: Healthfirst Commercial |
$94.21
|
| Rate for Payer: Healthfirst Essential Plan |
$211.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$89.50
|
| Rate for Payer: Healthfirst QHP |
$94.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$65.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$94.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$80.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$65.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$94.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$70.66
|
| Rate for Payer: SOMOS Essential |
$70.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$94.21
|
|
|
PR TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ
|
Professional
|
Both
|
$1,126.62
|
|
|
Service Code
|
HCPCS 28455
|
| Min. Negotiated Rate |
$186.77 |
| Max. Negotiated Rate |
$600.32 |
| Rate for Payer: Cash Price |
$267.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$266.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$240.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$253.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$266.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$253.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$266.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$266.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$200.11
|
| Rate for Payer: Healthfirst Commercial |
$266.81
|
| Rate for Payer: Healthfirst Essential Plan |
$600.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$253.47
|
| Rate for Payer: Healthfirst QHP |
$266.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$186.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$266.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$226.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$186.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$266.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$200.11
|
| Rate for Payer: SOMOS Essential |
$200.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$266.81
|
|
|
PR TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ
|
Professional
|
Both
|
$831.25
|
|
|
Service Code
|
HCPCS 28450
|
| Min. Negotiated Rate |
$161.33 |
| Max. Negotiated Rate |
$518.56 |
| Rate for Payer: Cash Price |
$230.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$230.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$207.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$207.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$218.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$230.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$218.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$230.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$230.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$172.85
|
| Rate for Payer: Healthfirst Commercial |
$230.47
|
| Rate for Payer: Healthfirst Essential Plan |
$518.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$218.95
|
| Rate for Payer: Healthfirst QHP |
$230.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$161.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$230.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$195.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$161.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$230.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$172.85
|
| Rate for Payer: SOMOS Essential |
$172.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$230.47
|
|
|
PR TX TIBL SHFT FX IMED IMPLT W/WO SCREWS&/CERCLA
|
Professional
|
Both
|
$4,404.93
|
|
|
Service Code
|
HCPCS 27759
|
| Min. Negotiated Rate |
$828.57 |
| Max. Negotiated Rate |
$2,663.26 |
| Rate for Payer: Cash Price |
$1,188.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,183.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,065.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,065.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,124.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,183.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,124.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,183.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,183.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$887.75
|
| Rate for Payer: Healthfirst Commercial |
$1,183.67
|
| Rate for Payer: Healthfirst Essential Plan |
$2,663.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,124.49
|
| Rate for Payer: Healthfirst QHP |
$1,183.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$828.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,183.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,006.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$828.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,183.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$887.75
|
| Rate for Payer: SOMOS Essential |
$887.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,183.67
|
|
|
PR TYMPANIC MEMB RPR W/WO PREPJ PERFOR PATCH
|
Professional
|
Both
|
$1,242.26
|
|
|
Service Code
|
HCPCS 69610
|
| Min. Negotiated Rate |
$232.21 |
| Max. Negotiated Rate |
$746.39 |
| Rate for Payer: Cash Price |
$336.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$331.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$298.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$298.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$315.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$331.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$315.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$331.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$331.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$248.80
|
| Rate for Payer: Healthfirst Commercial |
$331.73
|
| Rate for Payer: Healthfirst Essential Plan |
$746.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$315.14
|
| Rate for Payer: Healthfirst QHP |
$331.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$232.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$331.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$281.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$232.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$331.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$248.80
|
| Rate for Payer: SOMOS Essential |
$248.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$331.73
|
|
|
PR TYMPANIC NEURECTOMY
|
Professional
|
Both
|
$3,625.44
|
|
|
Service Code
|
HCPCS 69676
|
| Min. Negotiated Rate |
$670.95 |
| Max. Negotiated Rate |
$2,156.62 |
| Rate for Payer: Cash Price |
$980.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$958.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$862.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$862.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$910.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$958.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$910.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$958.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$958.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$718.88
|
| Rate for Payer: Healthfirst Commercial |
$958.50
|
| Rate for Payer: Healthfirst Essential Plan |
$2,156.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$910.58
|
| Rate for Payer: Healthfirst QHP |
$958.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$670.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$958.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$814.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$670.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$958.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$718.88
|
| Rate for Payer: SOMOS Essential |
$718.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$958.50
|
|
|
PR TYMPANOLYSIS TRANSCANAL
|
Professional
|
Both
|
$2,386.02
|
|
|
Service Code
|
HCPCS 69450
|
| Min. Negotiated Rate |
$441.57 |
| Max. Negotiated Rate |
$1,419.35 |
| Rate for Payer: Cash Price |
$646.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$630.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$567.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$567.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$599.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$630.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$599.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$630.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$630.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$473.12
|
| Rate for Payer: Healthfirst Commercial |
$630.82
|
| Rate for Payer: Healthfirst Essential Plan |
$1,419.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$599.28
|
| Rate for Payer: Healthfirst QHP |
$630.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$441.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$630.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$536.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$441.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$630.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$473.12
|
| Rate for Payer: SOMOS Essential |
$473.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$630.82
|
|
|
PR TYMPANOMETRY
|
Professional
|
Both
|
$43.61
|
|
|
Service Code
|
HCPCS 92567
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$26.50 |
| Rate for Payer: Amida Care Medicaid |
$10.66
|
| Rate for Payer: Cash Price |
$11.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.84
|
| Rate for Payer: Healthfirst Commercial |
$11.78
|
| Rate for Payer: Healthfirst Essential Plan |
$26.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.19
|
| Rate for Payer: Healthfirst QHP |
$11.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$11.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.84
|
| Rate for Payer: SOMOS Essential |
$8.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.78
|
|
|
PR TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS
|
Professional
|
Both
|
$89.71
|
|
|
Service Code
|
HCPCS 92550
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$53.84 |
| Rate for Payer: Amida Care Medicaid |
$10.74
|
| Rate for Payer: Cash Price |
$24.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$23.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.95
|
| Rate for Payer: Healthfirst Commercial |
$23.93
|
| Rate for Payer: Healthfirst Essential Plan |
$53.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.73
|
| Rate for Payer: Healthfirst QHP |
$23.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.95
|
| Rate for Payer: SOMOS Essential |
$17.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.93
|
|
|
PR TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/OCR
|
Professional
|
Both
|
$6,829.24
|
|
|
Service Code
|
HCPCS 69646
|
| Min. Negotiated Rate |
$1,264.21 |
| Max. Negotiated Rate |
$4,063.52 |
| Rate for Payer: Cash Price |
$1,841.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,806.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,625.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,625.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,715.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,806.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,715.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,806.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,806.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,354.51
|
| Rate for Payer: Healthfirst Commercial |
$1,806.01
|
| Rate for Payer: Healthfirst Essential Plan |
$4,063.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,715.71
|
| Rate for Payer: Healthfirst QHP |
$1,806.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,264.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,806.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,535.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,264.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,806.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,354.51
|
| Rate for Payer: SOMOS Essential |
$1,354.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,806.01
|
|
|
PR TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/O OCR
|
Professional
|
Both
|
$6,425.51
|
|
|
Service Code
|
HCPCS 69645
|
| Min. Negotiated Rate |
$1,196.55 |
| Max. Negotiated Rate |
$3,846.06 |
| Rate for Payer: Cash Price |
$1,729.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,709.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,538.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,538.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,623.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,709.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,623.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,709.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,709.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,282.02
|
| Rate for Payer: Healthfirst Commercial |
$1,709.36
|
| Rate for Payer: Healthfirst Essential Plan |
$3,846.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,623.89
|
| Rate for Payer: Healthfirst QHP |
$1,709.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,196.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,709.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,452.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,196.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,709.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,282.02
|
| Rate for Payer: SOMOS Essential |
$1,282.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,709.36
|
|
