|
PR VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK
|
Professional
|
Both
|
$306.64
|
|
|
Service Code
|
HCPCS 92540 26
|
| Min. Negotiated Rate |
$57.41 |
| Max. Negotiated Rate |
$184.54 |
| Rate for Payer: Amida Care Medicaid |
$74.56
|
| Rate for Payer: Cash Price |
$83.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$82.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$82.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.52
|
| Rate for Payer: Healthfirst Commercial |
$82.02
|
| Rate for Payer: Healthfirst Essential Plan |
$184.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$77.92
|
| Rate for Payer: Healthfirst QHP |
$82.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$82.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$82.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$61.52
|
| Rate for Payer: SOMOS Essential |
$61.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.02
|
|
|
PR VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK
|
Professional
|
Both
|
$137.87
|
|
|
Service Code
|
HCPCS 92540 TC
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Amida Care Medicaid |
$74.56
|
| Rate for Payer: Cash Price |
$36.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.50
|
| Rate for Payer: Healthfirst Commercial |
$34.00
|
| Rate for Payer: Healthfirst Essential Plan |
$76.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.30
|
| Rate for Payer: Healthfirst QHP |
$34.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.50
|
| Rate for Payer: SOMOS Essential |
$25.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.00
|
|
|
PR VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK
|
Professional
|
Both
|
$444.50
|
|
|
Service Code
|
HCPCS 92540
|
| Min. Negotiated Rate |
$74.56 |
| Max. Negotiated Rate |
$261.05 |
| Rate for Payer: Amida Care Medicaid |
$74.56
|
| Rate for Payer: Cash Price |
$119.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$116.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$104.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$104.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$110.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$116.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$110.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$116.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$116.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$87.02
|
| Rate for Payer: Healthfirst Commercial |
$116.02
|
| Rate for Payer: Healthfirst Essential Plan |
$261.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.22
|
| Rate for Payer: Healthfirst QHP |
$116.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$81.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$116.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$98.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$81.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$116.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$87.02
|
| Rate for Payer: SOMOS Essential |
$87.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$116.02
|
|
|
PR VTRECTOMY MCHNL PARS PLNA ENDOLASER PANRTA PC
|
Professional
|
Both
|
$4,245.71
|
|
|
Service Code
|
HCPCS 67040
|
| Min. Negotiated Rate |
$806.98 |
| Max. Negotiated Rate |
$2,593.87 |
| Rate for Payer: Cash Price |
$1,168.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,152.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,037.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,037.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,095.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,152.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,095.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,152.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,152.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$864.62
|
| Rate for Payer: Healthfirst Commercial |
$1,152.83
|
| Rate for Payer: Healthfirst Essential Plan |
$2,593.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,095.19
|
| Rate for Payer: Healthfirst QHP |
$1,152.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$806.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,152.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$979.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$806.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,152.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$864.62
|
| Rate for Payer: SOMOS Essential |
$864.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,152.83
|
|
|
PR VULVECTOMY RAD COMPL BI INGUINOFEM LMPHADECTOMY
|
Professional
|
Both
|
$6,588.26
|
|
|
Service Code
|
HCPCS 56637
|
| Min. Negotiated Rate |
$1,239.39 |
| Max. Negotiated Rate |
$3,983.76 |
| Rate for Payer: Cash Price |
$1,790.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,770.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,593.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,593.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,682.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,770.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,682.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,770.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,770.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,327.92
|
| Rate for Payer: Healthfirst Commercial |
$1,770.56
|
| Rate for Payer: Healthfirst Essential Plan |
$3,983.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,682.03
|
| Rate for Payer: Healthfirst QHP |
$1,770.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,239.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,770.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,504.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,239.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,770.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,327.92
|
| Rate for Payer: SOMOS Essential |
$1,327.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,770.56
|
|
|
PR VULVECTOMY RAD COMPL ILIAC & PELVIC LMPHADECTOMY
|
Professional
|
Both
|
$6,627.95
|
|
|
Service Code
|
HCPCS 56640
|
| Min. Negotiated Rate |
$1,244.47 |
| Max. Negotiated Rate |
$4,000.07 |
| Rate for Payer: Cash Price |
$1,799.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,777.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,600.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,600.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,688.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,777.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,688.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,777.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,777.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,333.36
|
| Rate for Payer: Healthfirst Commercial |
$1,777.81
|
| Rate for Payer: Healthfirst Essential Plan |
$4,000.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,688.92
|
| Rate for Payer: Healthfirst QHP |
$1,777.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,244.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,777.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,511.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,244.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,777.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,333.36
|
| Rate for Payer: SOMOS Essential |
$1,333.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,777.81
|
|
|
PR VULVECTOMY RAD COMPL UNI INGUINOFEM LMPHADECTOMY
|
Professional
|
Both
|
$5,625.31
|
|
|
Service Code
|
HCPCS 56634
|
| Min. Negotiated Rate |
$1,058.20 |
| Max. Negotiated Rate |
$3,401.35 |
| Rate for Payer: Cash Price |
$1,529.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,511.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,360.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,360.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,436.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,511.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,436.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,511.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,511.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,133.78
|
| Rate for Payer: Healthfirst Commercial |
$1,511.71
|
| Rate for Payer: Healthfirst Essential Plan |
$3,401.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,436.12
|
| Rate for Payer: Healthfirst QHP |
$1,511.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,058.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,511.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,284.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,058.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,511.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,133.78
|
| Rate for Payer: SOMOS Essential |
$1,133.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,511.71
|
|
|
PR VULVECTOMY RADICAL COMPLETE
|
Professional
|
Both
|
$5,360.95
|
|
|
Service Code
|
HCPCS 56633
|
| Min. Negotiated Rate |
$941.65 |
| Max. Negotiated Rate |
$3,026.72 |
| Rate for Payer: Cash Price |
$1,462.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,345.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,210.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,210.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,277.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,345.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,277.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,345.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,345.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,008.91
|
| Rate for Payer: Healthfirst Commercial |
$1,345.21
|
| Rate for Payer: Healthfirst Essential Plan |
$3,026.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,277.95
|
| Rate for Payer: Healthfirst QHP |
$1,345.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$941.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,345.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,143.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$941.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,345.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,008.91
|
| Rate for Payer: SOMOS Essential |
$1,008.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,345.21
|
|
|
PR VULVECTOMY RADICAL PARTIAL
|
Professional
|
Both
|
$4,187.23
|
|
|
Service Code
|
HCPCS 56630
|
| Min. Negotiated Rate |
$782.49 |
| Max. Negotiated Rate |
$2,515.14 |
| Rate for Payer: Cash Price |
$1,135.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,117.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,006.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,006.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,061.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,117.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,061.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,117.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,117.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$838.38
|
| Rate for Payer: Healthfirst Commercial |
$1,117.84
|
| Rate for Payer: Healthfirst Essential Plan |
$2,515.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,061.95
|
| Rate for Payer: Healthfirst QHP |
$1,117.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$782.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,117.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$950.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$782.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,117.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$838.38
|
| Rate for Payer: SOMOS Essential |
$838.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,117.84
|
|
|
PR VULVECTOMY RAD PRTL BI INGUINOFEM LMPHADECTOMY
|
Professional
|
Both
|
$6,247.05
|
|
|
Service Code
|
HCPCS 56632
|
| Min. Negotiated Rate |
$1,170.29 |
| Max. Negotiated Rate |
$3,761.64 |
| Rate for Payer: Cash Price |
$1,694.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,671.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,504.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,504.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,588.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,671.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,588.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,671.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,671.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,253.88
|
| Rate for Payer: Healthfirst Commercial |
$1,671.84
|
| Rate for Payer: Healthfirst Essential Plan |
$3,761.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,588.25
|
| Rate for Payer: Healthfirst QHP |
$1,671.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,170.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,671.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,421.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,170.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,671.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,253.88
|
| Rate for Payer: SOMOS Essential |
$1,253.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,671.84
|
|
|
PR VULVECTOMY RAD PRTL UNI INGUINOFEM LMPHADECTOMY
|
Professional
|
Both
|
$5,155.64
|
|
|
Service Code
|
HCPCS 56631
|
| Min. Negotiated Rate |
$968.59 |
| Max. Negotiated Rate |
$3,113.32 |
| Rate for Payer: Cash Price |
$1,400.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,383.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,245.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,245.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,314.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,383.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,314.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,383.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,383.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,037.78
|
| Rate for Payer: Healthfirst Commercial |
$1,383.70
|
| Rate for Payer: Healthfirst Essential Plan |
$3,113.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,314.52
|
| Rate for Payer: Healthfirst QHP |
$1,383.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$968.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,383.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,176.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$968.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,383.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,037.78
|
| Rate for Payer: SOMOS Essential |
$1,037.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,383.70
|
|
|
PR VULVECTOMY SIMPLE COMPLETE
|
Professional
|
Both
|
$2,905.67
|
|
|
Service Code
|
HCPCS 56625
|
| Min. Negotiated Rate |
$545.67 |
| Max. Negotiated Rate |
$1,753.94 |
| Rate for Payer: Cash Price |
$791.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$779.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$701.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$701.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$740.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$779.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$740.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$779.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$779.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$584.65
|
| Rate for Payer: Healthfirst Commercial |
$779.53
|
| Rate for Payer: Healthfirst Essential Plan |
$1,753.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$740.55
|
| Rate for Payer: Healthfirst QHP |
$779.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$545.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$779.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$662.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$545.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$779.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$584.65
|
| Rate for Payer: SOMOS Essential |
$584.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$779.53
|
|
|
PR VULVECTOMY SIMPLE PARTIAL
|
Professional
|
Both
|
$2,560.18
|
|
|
Service Code
|
HCPCS 56620
|
| Min. Negotiated Rate |
$479.44 |
| Max. Negotiated Rate |
$1,541.07 |
| Rate for Payer: Cash Price |
$696.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$684.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$616.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$616.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$650.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$684.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$650.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$684.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$684.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$513.69
|
| Rate for Payer: Healthfirst Commercial |
$684.92
|
| Rate for Payer: Healthfirst Essential Plan |
$1,541.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$650.67
|
| Rate for Payer: Healthfirst QHP |
$684.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$479.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$684.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$582.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$479.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$684.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$513.69
|
| Rate for Payer: SOMOS Essential |
$513.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$684.92
|
|
|
PR WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG
|
Professional
|
Both
|
$887.78
|
|
|
Service Code
|
HCPCS 95958 26
|
| Min. Negotiated Rate |
$168.72 |
| Max. Negotiated Rate |
$542.32 |
| Rate for Payer: Amida Care Medicaid |
$277.23
|
| Rate for Payer: Cash Price |
$244.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$241.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$216.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$216.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$228.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$241.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$228.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$241.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$241.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$180.77
|
| Rate for Payer: Healthfirst Commercial |
$241.03
|
| Rate for Payer: Healthfirst Essential Plan |
$542.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$228.98
|
| Rate for Payer: Healthfirst QHP |
$241.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$168.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$241.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$204.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$168.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$241.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$180.77
|
| Rate for Payer: SOMOS Essential |
$180.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$241.03
|
|
|
PR WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG
|
Professional
|
Both
|
$1,946.70
|
|
|
Service Code
|
HCPCS 95958 TC
|
| Min. Negotiated Rate |
$277.23 |
| Max. Negotiated Rate |
$1,287.97 |
| Rate for Payer: Amida Care Medicaid |
$277.23
|
| Rate for Payer: Cash Price |
$569.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$572.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$515.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$515.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$543.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$572.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$543.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$572.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$572.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$429.32
|
| Rate for Payer: Healthfirst Commercial |
$572.43
|
| Rate for Payer: Healthfirst Essential Plan |
$1,287.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$543.81
|
| Rate for Payer: Healthfirst QHP |
$572.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$400.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$572.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$486.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$400.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$572.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$429.32
|
| Rate for Payer: SOMOS Essential |
$429.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$572.43
|
|
|
PR WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG
|
Professional
|
Both
|
$2,834.48
|
|
|
Service Code
|
HCPCS 95958
|
| Min. Negotiated Rate |
$277.23 |
| Max. Negotiated Rate |
$1,830.29 |
| Rate for Payer: Amida Care Medicaid |
$277.23
|
| Rate for Payer: Cash Price |
$813.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$813.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$732.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$732.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$772.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$813.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$772.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$813.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$813.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$610.10
|
| Rate for Payer: Healthfirst Commercial |
$813.46
|
| Rate for Payer: Healthfirst Essential Plan |
$1,830.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$772.79
|
| Rate for Payer: Healthfirst QHP |
$813.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$569.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$813.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$691.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$569.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$813.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$610.10
|
| Rate for Payer: SOMOS Essential |
$610.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$813.46
|
|
|
PR WEDGE EXCISION SKIN NAIL FOLD
|
Professional
|
Both
|
$384.30
|
|
|
Service Code
|
HCPCS 11765
|
| Min. Negotiated Rate |
$74.50 |
| Max. Negotiated Rate |
$239.47 |
| Rate for Payer: Cash Price |
$106.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$106.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$95.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$95.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$101.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$106.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$101.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.82
|
| Rate for Payer: Healthfirst Commercial |
$106.43
|
| Rate for Payer: Healthfirst Essential Plan |
$239.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$101.11
|
| Rate for Payer: Healthfirst QHP |
$106.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$106.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$90.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$74.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$106.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$79.82
|
| Rate for Payer: SOMOS Essential |
$79.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$106.43
|
|
|
PR WEDGE RESCJ/BISCTJ OVARY UNI/BI
|
Professional
|
Both
|
$3,123.93
|
|
|
Service Code
|
HCPCS 58920
|
| Min. Negotiated Rate |
$579.85 |
| Max. Negotiated Rate |
$1,863.79 |
| Rate for Payer: Cash Price |
$841.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$828.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$745.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$745.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$786.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$828.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$786.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$828.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$828.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$621.26
|
| Rate for Payer: Healthfirst Commercial |
$828.35
|
| Rate for Payer: Healthfirst Essential Plan |
$1,863.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$786.93
|
| Rate for Payer: Healthfirst QHP |
$828.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$579.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$828.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$704.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$579.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$828.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$621.26
|
| Rate for Payer: SOMOS Essential |
$621.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$828.35
|
|
|
PR WEDGING CAST EXCEPT CLUBFOOT CASTS
|
Professional
|
Both
|
$302.54
|
|
|
Service Code
|
HCPCS 29740
|
| Min. Negotiated Rate |
$56.36 |
| Max. Negotiated Rate |
$181.17 |
| Rate for Payer: Cash Price |
$81.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$80.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.39
|
| Rate for Payer: Healthfirst Commercial |
$80.52
|
| Rate for Payer: Healthfirst Essential Plan |
$181.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.49
|
| Rate for Payer: Healthfirst QHP |
$80.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.39
|
| Rate for Payer: SOMOS Essential |
$60.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.52
|
|
|
PR WEDGING CLUBFOOT CAST
|
Professional
|
Both
|
$338.35
|
|
|
Service Code
|
HCPCS 29750
|
| Min. Negotiated Rate |
$63.21 |
| Max. Negotiated Rate |
$203.18 |
| Rate for Payer: Cash Price |
$90.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$90.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$90.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.72
|
| Rate for Payer: Healthfirst Commercial |
$90.30
|
| Rate for Payer: Healthfirst Essential Plan |
$203.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.78
|
| Rate for Payer: Healthfirst QHP |
$90.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$90.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$76.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.72
|
| Rate for Payer: SOMOS Essential |
$67.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.30
|
|
|
PR WHEELCHAIR MGMT EA 15 MIN
|
Professional
|
Both
|
$128.98
|
|
|
Service Code
|
HCPCS 97542
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$78.77 |
| Rate for Payer: Amida Care Medicaid |
$13.80
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.26
|
| Rate for Payer: Healthfirst Commercial |
$35.01
|
| Rate for Payer: Healthfirst Essential Plan |
$78.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.26
|
| Rate for Payer: Healthfirst QHP |
$35.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.26
|
| Rate for Payer: SOMOS Essential |
$26.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.01
|
|
|
PR WHOLE BODY INTEGUMENTARY PHOTOGRAPHY
|
Professional
|
Both
|
$303.17
|
|
|
Service Code
|
HCPCS 96904
|
| Min. Negotiated Rate |
$54.23 |
| Max. Negotiated Rate |
$174.31 |
| Rate for Payer: Cash Price |
$81.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$77.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$69.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$69.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$73.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$77.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$73.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.10
|
| Rate for Payer: Healthfirst Commercial |
$77.47
|
| Rate for Payer: Healthfirst Essential Plan |
$174.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.60
|
| Rate for Payer: Healthfirst QHP |
$77.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$54.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$77.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$65.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$54.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$77.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$58.10
|
| Rate for Payer: SOMOS Essential |
$58.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$77.47
|
|
|
PR WINDOWING CAST
|
Professional
|
Both
|
$191.45
|
|
|
Service Code
|
HCPCS 29730
|
| Min. Negotiated Rate |
$36.21 |
| Max. Negotiated Rate |
$116.39 |
| Rate for Payer: Cash Price |
$52.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$51.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.80
|
| Rate for Payer: Healthfirst Commercial |
$51.73
|
| Rate for Payer: Healthfirst Essential Plan |
$116.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.14
|
| Rate for Payer: Healthfirst QHP |
$51.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$51.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.80
|
| Rate for Payer: SOMOS Essential |
$38.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.73
|
|
|
PR WOUND CLOSURE BY ADHESIVE
|
Professional
|
Both
|
$65.31
|
|
|
Service Code
|
HCPCS G0168
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$37.10 |
| Rate for Payer: Cash Price |
$17.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.37
|
| Rate for Payer: Healthfirst Commercial |
$16.49
|
| Rate for Payer: Healthfirst Essential Plan |
$37.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.67
|
| Rate for Payer: Healthfirst QHP |
$16.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.37
|
| Rate for Payer: SOMOS Essential |
$12.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.49
|
|
|
PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH CPLX WO ECP
|
Professional
|
Both
|
$3,057.04
|
|
|
Service Code
|
HCPCS 66982
|
| Min. Negotiated Rate |
$581.60 |
| Max. Negotiated Rate |
$1,869.41 |
| Rate for Payer: Cash Price |
$841.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$830.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$747.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$747.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$789.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$830.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$789.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$830.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$830.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$623.14
|
| Rate for Payer: Healthfirst Commercial |
$830.85
|
| Rate for Payer: Healthfirst Essential Plan |
$1,869.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$789.31
|
| Rate for Payer: Healthfirst QHP |
$830.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$581.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$830.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$706.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$581.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$830.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$623.14
|
| Rate for Payer: SOMOS Essential |
$623.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$830.85
|
|
