|
PR ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC
|
Professional
|
Both
|
$665.11
|
|
|
Service Code
|
HCPCS 30801
|
| Min. Negotiated Rate |
$121.63 |
| Max. Negotiated Rate |
$390.96 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$173.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$156.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$156.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$165.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$173.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$165.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$173.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$173.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$130.32
|
| Rate for Payer: Healthfirst Commercial |
$173.76
|
| Rate for Payer: Healthfirst Essential Plan |
$390.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$165.07
|
| Rate for Payer: Healthfirst QHP |
$173.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$121.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$173.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$147.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$121.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$173.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$130.32
|
| Rate for Payer: SOMOS Essential |
$130.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$173.76
|
|
|
PR ABRASION 1 LESION
|
Professional
|
Both
|
$565.08
|
|
|
Service Code
|
HCPCS 15786
|
| Min. Negotiated Rate |
$107.88 |
| Max. Negotiated Rate |
$346.77 |
| Rate for Payer: Cash Price |
$154.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$154.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$138.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$138.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$146.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$154.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$146.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$115.59
|
| Rate for Payer: Healthfirst Commercial |
$154.12
|
| Rate for Payer: Healthfirst Essential Plan |
$346.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$146.41
|
| Rate for Payer: Healthfirst QHP |
$154.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$107.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$154.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$131.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$107.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$154.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$115.59
|
| Rate for Payer: SOMOS Essential |
$115.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$154.12
|
|
|
PR ABRASION EACH ADDITIONAL 4 LESIONS OR LESS
|
Professional
|
Both
|
$66.92
|
|
|
Service Code
|
HCPCS 15787
|
| Min. Negotiated Rate |
$13.33 |
| Max. Negotiated Rate |
$42.84 |
| Rate for Payer: Cash Price |
$18.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.28
|
| Rate for Payer: Healthfirst Commercial |
$19.04
|
| Rate for Payer: Healthfirst Essential Plan |
$42.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.09
|
| Rate for Payer: Healthfirst QHP |
$19.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.28
|
| Rate for Payer: SOMOS Essential |
$14.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.04
|
|
|
PR ACETABULOPLASTY
|
Professional
|
Both
|
$5,733.98
|
|
|
Service Code
|
HCPCS 27120
|
| Min. Negotiated Rate |
$1,075.35 |
| Max. Negotiated Rate |
$3,456.47 |
| Rate for Payer: Cash Price |
$1,544.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,536.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,382.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,382.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,459.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,536.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,459.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,536.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,536.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,152.16
|
| Rate for Payer: Healthfirst Commercial |
$1,536.21
|
| Rate for Payer: Healthfirst Essential Plan |
$3,456.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,459.40
|
| Rate for Payer: Healthfirst QHP |
$1,536.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,075.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,536.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,305.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,075.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,536.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,152.16
|
| Rate for Payer: SOMOS Essential |
$1,152.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,536.21
|
|
|
PR ACETABULOPLASTY RESECTION FEMORAL HEAD
|
Professional
|
Both
|
$4,871.41
|
|
|
Service Code
|
HCPCS 27122
|
| Min. Negotiated Rate |
$914.94 |
| Max. Negotiated Rate |
$2,940.89 |
| Rate for Payer: Cash Price |
$1,315.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,307.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,176.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,176.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,241.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,307.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,241.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,307.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,307.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$980.29
|
| Rate for Payer: Healthfirst Commercial |
$1,307.06
|
| Rate for Payer: Healthfirst Essential Plan |
$2,940.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,241.71
|
| Rate for Payer: Healthfirst QHP |
$1,307.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$914.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,307.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,111.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$914.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,307.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$980.29
|
| Rate for Payer: SOMOS Essential |
$980.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,307.06
|
|
|
PR ACNE SURGERY
|
Professional
|
Both
|
$217.53
|
|
|
Service Code
|
HCPCS 10040
|
| Min. Negotiated Rate |
$41.22 |
| Max. Negotiated Rate |
$132.48 |
| Rate for Payer: Cash Price |
$59.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$58.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$52.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$58.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.16
|
| Rate for Payer: Healthfirst Commercial |
$58.88
|
| Rate for Payer: Healthfirst Essential Plan |
$132.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$55.94
|
| Rate for Payer: Healthfirst QHP |
$58.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$58.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$58.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.16
|
| Rate for Payer: SOMOS Essential |
$44.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.88
|
|
|
PR ACOUSTIC IMMIT TEST TYMPANOM/ACOUST REFLX/DECAY
|
Professional
|
Both
|
$116.06
|
|
|
Service Code
|
HCPCS 92570
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$70.74 |
| Rate for Payer: Amida Care Medicaid |
$12.09
|
| Rate for Payer: Cash Price |
$31.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.58
|
| Rate for Payer: Healthfirst Commercial |
$31.44
|
| Rate for Payer: Healthfirst Essential Plan |
$70.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.87
|
| Rate for Payer: Healthfirst QHP |
$31.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.58
|
| Rate for Payer: SOMOS Essential |
$23.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.44
|
|
|
PR ACOUSTIC REFLEX THRESHOLD
|
Professional
|
Both
|
$61.92
|
|
|
Service Code
|
HCPCS 92568
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$36.97 |
| Rate for Payer: Amida Care Medicaid |
$10.80
|
| Rate for Payer: Cash Price |
$16.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.32
|
| Rate for Payer: Healthfirst Commercial |
$16.43
|
| Rate for Payer: Healthfirst Essential Plan |
$36.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.61
|
| Rate for Payer: Healthfirst QHP |
$16.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.32
|
| Rate for Payer: SOMOS Essential |
$12.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.43
|
|
|
PR ACTIGRAPHY TESTING RECORDING ANALYSIS I&R
|
Professional
|
Both
|
$583.80
|
|
|
Service Code
|
HCPCS 95803
|
| Min. Negotiated Rate |
$103.97 |
| Max. Negotiated Rate |
$334.19 |
| Rate for Payer: Cash Price |
$156.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$148.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$133.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$141.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$148.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$141.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$148.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$148.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$111.40
|
| Rate for Payer: Healthfirst Commercial |
$148.53
|
| Rate for Payer: Healthfirst Essential Plan |
$334.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$141.10
|
| Rate for Payer: Healthfirst QHP |
$148.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$103.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$148.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$126.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$103.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$148.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$111.40
|
| Rate for Payer: SOMOS Essential |
$111.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$148.53
|
|
|
PR ACTIGRAPHY TESTING RECORDING ANALYSIS I&R
|
Professional
|
Both
|
$418.18
|
|
|
Service Code
|
HCPCS 95803 TC
|
| Min. Negotiated Rate |
$72.98 |
| Max. Negotiated Rate |
$234.59 |
| Rate for Payer: Cash Price |
$111.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$104.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$93.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$93.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$99.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$104.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$99.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$78.19
|
| Rate for Payer: Healthfirst Commercial |
$104.26
|
| Rate for Payer: Healthfirst Essential Plan |
$234.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$99.05
|
| Rate for Payer: Healthfirst QHP |
$104.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$104.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$88.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$104.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$78.19
|
| Rate for Payer: SOMOS Essential |
$78.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$104.26
|
|
|
PR ACTIGRAPHY TESTING RECORDING ANALYSIS I&R
|
Professional
|
Both
|
$165.62
|
|
|
Service Code
|
HCPCS 95803 26
|
| Min. Negotiated Rate |
$30.99 |
| Max. Negotiated Rate |
$99.61 |
| Rate for Payer: Cash Price |
$44.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$44.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.20
|
| Rate for Payer: Healthfirst Commercial |
$44.27
|
| Rate for Payer: Healthfirst Essential Plan |
$99.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.06
|
| Rate for Payer: Healthfirst QHP |
$44.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.20
|
| Rate for Payer: SOMOS Essential |
$33.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.27
|
|
|
PR ACTINOTHERAPY ULTRAVIOLET LIGHT
|
Professional
|
Both
|
$106.23
|
|
|
Service Code
|
HCPCS 96900
|
| Min. Negotiated Rate |
$20.54 |
| Max. Negotiated Rate |
$66.02 |
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.00
|
| Rate for Payer: Healthfirst Commercial |
$29.34
|
| Rate for Payer: Healthfirst Essential Plan |
$66.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.87
|
| Rate for Payer: Healthfirst QHP |
$29.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.00
|
| Rate for Payer: SOMOS Essential |
$22.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.34
|
|
|
PR ACUP 1/> NDLS W/ELEC STIMJ EA 15 MIN W/RE-INSJ
|
Professional
|
Both
|
$115.78
|
|
|
Service Code
|
HCPCS 97814
|
| Min. Negotiated Rate |
$18.61 |
| Max. Negotiated Rate |
$59.80 |
| Rate for Payer: Cash Price |
$31.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.93
|
| Rate for Payer: Healthfirst Commercial |
$26.58
|
| Rate for Payer: Healthfirst Essential Plan |
$59.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.25
|
| Rate for Payer: Healthfirst QHP |
$26.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.93
|
| Rate for Payer: SOMOS Essential |
$19.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.58
|
|
|
PR ACUPUNCTURE 1/> NDLES W/O ELEC STIMJ INIT 15 MIN
|
Professional
|
Both
|
$124.92
|
|
|
Service Code
|
HCPCS 97810
|
| Min. Negotiated Rate |
$24.05 |
| Max. Negotiated Rate |
$77.29 |
| Rate for Payer: Cash Price |
$34.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.76
|
| Rate for Payer: Healthfirst Commercial |
$34.35
|
| Rate for Payer: Healthfirst Essential Plan |
$77.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.63
|
| Rate for Payer: Healthfirst QHP |
$34.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.76
|
| Rate for Payer: SOMOS Essential |
$25.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.35
|
|
|
PR ACUPUNCTURE 1/> NDLS W/ELEC STIMJ 1ST 15 MIN
|
Professional
|
Both
|
$135.49
|
|
|
Service Code
|
HCPCS 97813
|
| Min. Negotiated Rate |
$28.81 |
| Max. Negotiated Rate |
$92.61 |
| Rate for Payer: Cash Price |
$36.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.87
|
| Rate for Payer: Healthfirst Commercial |
$41.16
|
| Rate for Payer: Healthfirst Essential Plan |
$92.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.10
|
| Rate for Payer: Healthfirst QHP |
$41.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.87
|
| Rate for Payer: SOMOS Essential |
$30.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.16
|
|
|
PR ACUPUNCTURE 1/> NDLS W/O ELEC STIMJ EA 15 MIN
|
Professional
|
Both
|
$106.65
|
|
|
Service Code
|
HCPCS 97811
|
| Min. Negotiated Rate |
$18.37 |
| Max. Negotiated Rate |
$59.04 |
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.68
|
| Rate for Payer: Healthfirst Commercial |
$26.24
|
| Rate for Payer: Healthfirst Essential Plan |
$59.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.93
|
| Rate for Payer: Healthfirst QHP |
$26.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.68
|
| Rate for Payer: SOMOS Essential |
$19.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.24
|
|
|
PR ACUTE NURSING FACILITY CARE
|
Professional
|
Both
|
$759.75
|
|
|
Service Code
|
HCPCS G9685
|
| Min. Negotiated Rate |
$143.40 |
| Max. Negotiated Rate |
$460.91 |
| Rate for Payer: Cash Price |
$206.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$204.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$184.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$184.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$194.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$204.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$194.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$204.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$204.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$153.64
|
| Rate for Payer: Healthfirst Commercial |
$204.85
|
| Rate for Payer: Healthfirst Essential Plan |
$460.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$194.61
|
| Rate for Payer: Healthfirst QHP |
$204.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$143.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$204.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$174.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$143.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$204.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$153.64
|
| Rate for Payer: SOMOS Essential |
$153.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$204.85
|
|
|
PR ADDING WALKER PREVIOUSLY APPLIED CAST
|
Professional
|
Both
|
$112.53
|
|
|
Service Code
|
HCPCS 29440
|
| Min. Negotiated Rate |
$21.45 |
| Max. Negotiated Rate |
$68.96 |
| Rate for Payer: Cash Price |
$31.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.99
|
| Rate for Payer: Healthfirst Commercial |
$30.65
|
| Rate for Payer: Healthfirst Essential Plan |
$68.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.12
|
| Rate for Payer: Healthfirst QHP |
$30.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$30.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.99
|
| Rate for Payer: SOMOS Essential |
$22.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.65
|
|
|
PR ADENOIDECTOMY PRIMARY <AGE 12
|
Professional
|
Both
|
$919.03
|
|
|
Service Code
|
HCPCS 42830
|
| Min. Negotiated Rate |
$175.60 |
| Max. Negotiated Rate |
$564.43 |
| Rate for Payer: Cash Price |
$252.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$250.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$225.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$225.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$238.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$250.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$238.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$250.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$188.15
|
| Rate for Payer: Healthfirst Commercial |
$250.86
|
| Rate for Payer: Healthfirst Essential Plan |
$564.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$238.32
|
| Rate for Payer: Healthfirst QHP |
$250.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$175.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$250.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$213.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$175.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$250.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$188.15
|
| Rate for Payer: SOMOS Essential |
$188.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$250.86
|
|
|
PR ADENOIDECTOMY PRIMARY AGE 12/>
|
Professional
|
Both
|
$1,001.88
|
|
|
Service Code
|
HCPCS 42831
|
| Min. Negotiated Rate |
$190.49 |
| Max. Negotiated Rate |
$612.29 |
| Rate for Payer: Cash Price |
$273.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$272.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$244.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$244.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$258.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$272.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$258.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$272.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$272.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$204.10
|
| Rate for Payer: Healthfirst Commercial |
$272.13
|
| Rate for Payer: Healthfirst Essential Plan |
$612.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$258.52
|
| Rate for Payer: Healthfirst QHP |
$272.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$190.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$272.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$231.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$190.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$272.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$204.10
|
| Rate for Payer: SOMOS Essential |
$204.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$272.13
|
|
|
PR ADENOIDECTOMY SECONDARY AGE 12/>
|
Professional
|
Both
|
$1,061.73
|
|
|
Service Code
|
HCPCS 42836
|
| Min. Negotiated Rate |
$202.52 |
| Max. Negotiated Rate |
$650.97 |
| Rate for Payer: Cash Price |
$290.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$289.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$260.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$260.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$274.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$289.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$274.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$289.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$289.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$216.99
|
| Rate for Payer: Healthfirst Commercial |
$289.32
|
| Rate for Payer: Healthfirst Essential Plan |
$650.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$274.85
|
| Rate for Payer: Healthfirst QHP |
$289.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$202.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$289.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$245.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$202.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$289.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$216.99
|
| Rate for Payer: SOMOS Essential |
$216.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$289.32
|
|
|
PR ADENOIDECTOMY SECONDARY<AGE 12
|
Professional
|
Both
|
$861.04
|
|
|
Service Code
|
HCPCS 42835
|
| Min. Negotiated Rate |
$163.83 |
| Max. Negotiated Rate |
$526.59 |
| Rate for Payer: Cash Price |
$235.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$234.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$210.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$210.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$222.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$234.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$222.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$234.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$234.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$175.53
|
| Rate for Payer: Healthfirst Commercial |
$234.04
|
| Rate for Payer: Healthfirst Essential Plan |
$526.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$222.34
|
| Rate for Payer: Healthfirst QHP |
$234.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$163.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$234.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$198.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$163.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$234.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$175.53
|
| Rate for Payer: SOMOS Essential |
$175.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$234.04
|
|
|
PR ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<
|
Professional
|
Both
|
$2,184.11
|
|
|
Service Code
|
HCPCS 14000
|
| Min. Negotiated Rate |
$416.39 |
| Max. Negotiated Rate |
$1,338.39 |
| Rate for Payer: Cash Price |
$595.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$594.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$535.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$535.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$565.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$594.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$565.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$594.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$594.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$446.13
|
| Rate for Payer: Healthfirst Commercial |
$594.84
|
| Rate for Payer: Healthfirst Essential Plan |
$1,338.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$565.10
|
| Rate for Payer: Healthfirst QHP |
$594.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$416.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$594.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$505.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$416.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$594.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$446.13
|
| Rate for Payer: SOMOS Essential |
$446.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$594.84
|
|
|
PR ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM
|
Professional
|
Both
|
$2,844.14
|
|
|
Service Code
|
HCPCS 14001
|
| Min. Negotiated Rate |
$538.26 |
| Max. Negotiated Rate |
$1,730.12 |
| Rate for Payer: Cash Price |
$772.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$768.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$692.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$692.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$730.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$768.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$730.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$768.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$768.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$576.71
|
| Rate for Payer: Healthfirst Commercial |
$768.94
|
| Rate for Payer: Healthfirst Essential Plan |
$1,730.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$730.49
|
| Rate for Payer: Healthfirst QHP |
$768.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$538.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$768.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$653.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$538.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$768.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$576.71
|
| Rate for Payer: SOMOS Essential |
$576.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$768.94
|
|
|
PR ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM
|
Professional
|
Both
|
$3,737.72
|
|
|
Service Code
|
HCPCS 14301
|
| Min. Negotiated Rate |
$707.74 |
| Max. Negotiated Rate |
$2,274.86 |
| Rate for Payer: Cash Price |
$1,015.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,011.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$909.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$909.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$960.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,011.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$960.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,011.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,011.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$758.29
|
| Rate for Payer: Healthfirst Commercial |
$1,011.05
|
| Rate for Payer: Healthfirst Essential Plan |
$2,274.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$960.50
|
| Rate for Payer: Healthfirst QHP |
$1,011.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$707.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,011.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$859.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$707.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,011.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$758.29
|
| Rate for Payer: SOMOS Essential |
$758.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,011.05
|
|
