|
PRALIDOXIME CHLORIDE 1 G IV SOLR
|
Facility
|
IP
|
$104.04
|
|
|
Service Code
|
NDC 6097714101
|
| Hospital Charge Code |
6097714101
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$52.02 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.02
|
|
|
PRALIDOXIME CHLORIDE 1 G IV SOLR
|
Facility
|
OP
|
$104.04
|
|
|
Service Code
|
NDC 6097714101
|
| Hospital Charge Code |
6097714101
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$36.41 |
| Max. Negotiated Rate |
$83.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$57.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$52.02
|
| Rate for Payer: Aetna Government |
$52.02
|
| Rate for Payer: Brighton Health Commercial |
$78.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$83.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$70.75
|
| Rate for Payer: EmblemHealth Commercial |
$52.02
|
| Rate for Payer: Group Health Inc Commercial |
$52.02
|
| Rate for Payer: Group Health Inc Medicare |
$36.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$67.63
|
|
|
PR ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/I&R
|
Professional
|
Both
|
$28.91
|
|
|
Service Code
|
HCPCS 95018
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$17.48 |
| Rate for Payer: Amida Care Medicaid |
$3.72
|
| Rate for Payer: Cash Price |
$7.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.83
|
| Rate for Payer: Healthfirst Commercial |
$7.77
|
| Rate for Payer: Healthfirst Essential Plan |
$17.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.38
|
| Rate for Payer: Healthfirst QHP |
$7.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$7.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$6.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.83
|
| Rate for Payer: SOMOS Essential |
$5.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.77
|
|
|
PR ALLG TSTG PERQ & IC VENOMS IMMED REACT W/I&R
|
Professional
|
Both
|
$15.82
|
|
|
Service Code
|
HCPCS 95017
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$9.43 |
| Rate for Payer: Amida Care Medicaid |
$1.85
|
| Rate for Payer: Cash Price |
$4.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.14
|
| Rate for Payer: Healthfirst Commercial |
$4.19
|
| Rate for Payer: Healthfirst Essential Plan |
$9.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.98
|
| Rate for Payer: Healthfirst QHP |
$4.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.14
|
| Rate for Payer: SOMOS Essential |
$3.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.19
|
|
|
PR ALLOGENEIC LYMPHOCYTE INFUSIONS
|
Professional
|
Both
|
$511.00
|
|
|
Service Code
|
HCPCS 38242
|
| Min. Negotiated Rate |
$98.13 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Cash Price |
$140.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$140.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$126.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$133.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$140.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$133.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.14
|
| Rate for Payer: Healthfirst Commercial |
$140.18
|
| Rate for Payer: Healthfirst Essential Plan |
$315.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.17
|
| Rate for Payer: Healthfirst QHP |
$140.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$140.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$119.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$140.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.14
|
| Rate for Payer: SOMOS Essential |
$105.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$140.18
|
|
|
PR ALLOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL
|
Professional
|
Both
|
$514.78
|
|
|
Service Code
|
HCPCS 20931
|
| Min. Negotiated Rate |
$94.61 |
| Max. Negotiated Rate |
$304.09 |
| Rate for Payer: Cash Price |
$135.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$135.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$121.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$121.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$128.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$135.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$128.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$135.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$101.36
|
| Rate for Payer: Healthfirst Commercial |
$135.15
|
| Rate for Payer: Healthfirst Essential Plan |
$304.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$128.39
|
| Rate for Payer: Healthfirst QHP |
$135.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$94.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$135.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$114.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$94.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$135.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$101.36
|
| Rate for Payer: SOMOS Essential |
$101.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$135.15
|
|
|
PR ALVEOLECTOMY W/CURTG OSTEITIS/SEQUESTRECTOMY
|
Professional
|
Both
|
$1,377.71
|
|
|
Service Code
|
HCPCS 41830
|
| Min. Negotiated Rate |
$257.72 |
| Max. Negotiated Rate |
$828.38 |
| Rate for Payer: Cash Price |
$370.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$368.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$331.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$331.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$349.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$368.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$349.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$368.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$368.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$276.13
|
| Rate for Payer: Healthfirst Commercial |
$368.17
|
| Rate for Payer: Healthfirst Essential Plan |
$828.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$349.76
|
| Rate for Payer: Healthfirst QHP |
$368.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$257.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$368.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$312.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$257.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$368.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$276.13
|
| Rate for Payer: SOMOS Essential |
$276.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$368.17
|
|
|
PR ALVEOLOPLASTY EACH QUADRANT SPECIFY
|
Professional
|
Both
|
$1,023.02
|
|
|
Service Code
|
HCPCS 41874
|
| Min. Negotiated Rate |
$202.32 |
| Max. Negotiated Rate |
$650.32 |
| Rate for Payer: Cash Price |
$282.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$289.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$260.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$260.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$274.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$289.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$274.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$289.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$289.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$216.77
|
| Rate for Payer: Healthfirst Commercial |
$289.03
|
| Rate for Payer: Healthfirst Essential Plan |
$650.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$274.58
|
| Rate for Payer: Healthfirst QHP |
$289.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$202.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$289.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$245.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$202.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$289.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$216.77
|
| Rate for Payer: SOMOS Essential |
$216.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$289.03
|
|
|
PR AMBULATORY BP MNTR W/SW 24 HR+ RECORDING ONLY
|
Professional
|
Both
|
$97.62
|
|
|
Service Code
|
HCPCS 93786
|
| Min. Negotiated Rate |
$18.63 |
| Max. Negotiated Rate |
$59.90 |
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.96
|
| Rate for Payer: Healthfirst Commercial |
$26.62
|
| Rate for Payer: Healthfirst Essential Plan |
$59.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.29
|
| Rate for Payer: Healthfirst QHP |
$26.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.96
|
| Rate for Payer: SOMOS Essential |
$19.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.62
|
|
|
PR AMBULATORY BP MNTR W/SW 24 HR+ REC SCAN ALYS I&R
|
Professional
|
Both
|
$192.36
|
|
|
Service Code
|
HCPCS 93784
|
| Min. Negotiated Rate |
$36.82 |
| Max. Negotiated Rate |
$118.35 |
| Rate for Payer: Amida Care Medicaid |
$60.60
|
| Rate for Payer: Cash Price |
$53.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.45
|
| Rate for Payer: Healthfirst Commercial |
$52.60
|
| Rate for Payer: Healthfirst Essential Plan |
$118.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.97
|
| Rate for Payer: Healthfirst QHP |
$52.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.45
|
| Rate for Payer: SOMOS Essential |
$39.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.60
|
|
|
PR AMBULATORY BP MNTR W/SW 24 HR+ REVIEW W/I&R
|
Professional
|
Both
|
$70.46
|
|
|
Service Code
|
HCPCS 93790
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Amida Care Medicaid |
$42.42
|
| Rate for Payer: Cash Price |
$19.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.36
|
| Rate for Payer: Healthfirst Commercial |
$19.14
|
| Rate for Payer: Healthfirst Essential Plan |
$43.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.18
|
| Rate for Payer: Healthfirst QHP |
$19.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.36
|
| Rate for Payer: SOMOS Essential |
$14.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.14
|
|
|
PR AMBULATORY BP MNTR W/SW 24 HR+ SCANNING A/R
|
Professional
|
Both
|
$24.29
|
|
|
Service Code
|
HCPCS 93788
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$15.37 |
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.12
|
| Rate for Payer: Healthfirst Commercial |
$6.83
|
| Rate for Payer: Healthfirst Essential Plan |
$15.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.49
|
| Rate for Payer: Healthfirst QHP |
$6.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$4.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$6.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$5.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$4.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.12
|
| Rate for Payer: SOMOS Essential |
$5.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.83
|
|
|
PR AMNIOCENTESIS DIAGNOSIC
|
Professional
|
Both
|
$370.30
|
|
|
Service Code
|
HCPCS 59000
|
| Min. Negotiated Rate |
$68.06 |
| Max. Negotiated Rate |
$218.77 |
| Rate for Payer: Cash Price |
$99.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$97.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$87.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$92.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$97.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$92.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.92
|
| Rate for Payer: Healthfirst Commercial |
$97.23
|
| Rate for Payer: Healthfirst Essential Plan |
$218.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$92.37
|
| Rate for Payer: Healthfirst QHP |
$97.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$97.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$82.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$97.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.92
|
| Rate for Payer: SOMOS Essential |
$72.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$97.23
|
|
|
PR AMNIOCENTESIS THER AMNIOTIC FLUID RDCTJ US GUID
|
Professional
|
Both
|
$826.14
|
|
|
Service Code
|
HCPCS 59001
|
| Min. Negotiated Rate |
$150.41 |
| Max. Negotiated Rate |
$483.46 |
| Rate for Payer: Cash Price |
$218.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$214.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$193.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$193.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$204.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$214.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$204.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$214.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$214.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$161.15
|
| Rate for Payer: Healthfirst Commercial |
$214.87
|
| Rate for Payer: Healthfirst Essential Plan |
$483.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$204.13
|
| Rate for Payer: Healthfirst QHP |
$214.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$150.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$214.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$182.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$150.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$214.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$161.15
|
| Rate for Payer: SOMOS Essential |
$161.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$214.87
|
|
|
PR AMP ANKLE-MALLI TIBFIB W/PLSTC CLSR&RESCJ NRV
|
Professional
|
Both
|
$2,813.02
|
|
|
Service Code
|
HCPCS 27888
|
| Min. Negotiated Rate |
$476.59 |
| Max. Negotiated Rate |
$1,531.89 |
| Rate for Payer: Cash Price |
$686.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$680.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$612.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$612.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$680.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$646.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$680.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$680.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$510.63
|
| Rate for Payer: Healthfirst Commercial |
$680.84
|
| Rate for Payer: Healthfirst Essential Plan |
$1,531.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$646.80
|
| Rate for Payer: Healthfirst QHP |
$680.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$476.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$680.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$578.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$476.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$680.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$510.63
|
| Rate for Payer: SOMOS Essential |
$510.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$680.84
|
|
|
PR AMP ARM THRU HUMERUS SECONDARY CLSR/SCAR REVJ
|
Professional
|
Both
|
$2,536.84
|
|
|
Service Code
|
HCPCS 24925
|
| Min. Negotiated Rate |
$479.77 |
| Max. Negotiated Rate |
$1,542.13 |
| Rate for Payer: Cash Price |
$687.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$685.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$616.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$616.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$651.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$685.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$651.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$685.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$685.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$514.04
|
| Rate for Payer: Healthfirst Commercial |
$685.39
|
| Rate for Payer: Healthfirst Essential Plan |
$1,542.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$651.12
|
| Rate for Payer: Healthfirst QHP |
$685.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$479.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$685.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$582.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$479.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$685.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$514.04
|
| Rate for Payer: SOMOS Essential |
$514.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$685.39
|
|
|
PR AMP F/ARM THRU RADIUS&ULNA SEC CLOSURE/SCAR RE
|
Professional
|
Both
|
$2,733.01
|
|
|
Service Code
|
HCPCS 25907
|
| Min. Negotiated Rate |
$516.73 |
| Max. Negotiated Rate |
$1,660.90 |
| Rate for Payer: Cash Price |
$741.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$738.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$664.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$664.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$701.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$738.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$701.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$738.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$738.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$553.63
|
| Rate for Payer: Healthfirst Commercial |
$738.18
|
| Rate for Payer: Healthfirst Essential Plan |
$1,660.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$701.27
|
| Rate for Payer: Healthfirst QHP |
$738.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$516.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$738.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$627.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$516.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$738.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$553.63
|
| Rate for Payer: SOMOS Essential |
$553.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$738.18
|
|
|
PR AMP FOREARM THRU RADIUS & ULNA OPEN CIRCULAR
|
Professional
|
Both
|
$3,117.84
|
|
|
Service Code
|
HCPCS 25905
|
| Min. Negotiated Rate |
$587.78 |
| Max. Negotiated Rate |
$1,889.28 |
| Rate for Payer: Cash Price |
$844.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$839.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$755.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$755.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$797.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$839.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$797.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$839.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$839.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$629.76
|
| Rate for Payer: Healthfirst Commercial |
$839.68
|
| Rate for Payer: Healthfirst Essential Plan |
$1,889.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$797.70
|
| Rate for Payer: Healthfirst QHP |
$839.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$587.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$839.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$713.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$587.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$839.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$629.76
|
| Rate for Payer: SOMOS Essential |
$629.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$839.68
|
|
|
PR AMP FOREARM THRU RADIUS&ULNA RE-AMPUTATION
|
Professional
|
Both
|
$3,048.96
|
|
|
Service Code
|
HCPCS 25909
|
| Min. Negotiated Rate |
$575.06 |
| Max. Negotiated Rate |
$1,848.40 |
| Rate for Payer: Cash Price |
$823.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$821.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$739.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$739.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$780.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$821.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$780.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$821.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$821.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$616.13
|
| Rate for Payer: Healthfirst Commercial |
$821.51
|
| Rate for Payer: Healthfirst Essential Plan |
$1,848.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$780.43
|
| Rate for Payer: Healthfirst QHP |
$821.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$575.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$821.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$698.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$575.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$821.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$616.13
|
| Rate for Payer: SOMOS Essential |
$616.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$821.51
|
|
|
PR AMP F/TH 1/2 JT/PHALANX W/NEURECT LOCAL FLAP
|
Professional
|
Both
|
$3,031.70
|
|
|
Service Code
|
HCPCS 26952
|
| Min. Negotiated Rate |
$564.61 |
| Max. Negotiated Rate |
$1,814.81 |
| Rate for Payer: Cash Price |
$817.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$806.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$725.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$725.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$766.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$806.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$766.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$806.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$806.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$604.93
|
| Rate for Payer: Healthfirst Commercial |
$806.58
|
| Rate for Payer: Healthfirst Essential Plan |
$1,814.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$766.25
|
| Rate for Payer: Healthfirst QHP |
$806.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$564.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$806.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$685.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$564.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$806.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$604.93
|
| Rate for Payer: SOMOS Essential |
$604.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$806.58
|
|
|
PR AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR
|
Professional
|
Both
|
$3,102.47
|
|
|
Service Code
|
HCPCS 26951
|
| Min. Negotiated Rate |
$581.40 |
| Max. Negotiated Rate |
$1,868.78 |
| Rate for Payer: Cash Price |
$842.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$830.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$747.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$747.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$789.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$830.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$789.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$830.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$830.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$622.93
|
| Rate for Payer: Healthfirst Commercial |
$830.57
|
| Rate for Payer: Healthfirst Essential Plan |
$1,868.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$789.04
|
| Rate for Payer: Healthfirst QHP |
$830.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$581.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$830.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$705.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$581.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$830.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$622.93
|
| Rate for Payer: SOMOS Essential |
$622.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$830.57
|
|
|
PR AMP LEG THRU TIBFIB W/IMMT FITG TQ W/1ST CST
|
Professional
|
Both
|
$3,798.41
|
|
|
Service Code
|
HCPCS 27881
|
| Min. Negotiated Rate |
$684.49 |
| Max. Negotiated Rate |
$2,200.14 |
| Rate for Payer: Cash Price |
$1,003.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$977.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$880.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$880.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$928.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$977.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$928.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$977.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$977.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$733.38
|
| Rate for Payer: Healthfirst Commercial |
$977.84
|
| Rate for Payer: Healthfirst Essential Plan |
$2,200.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$928.95
|
| Rate for Payer: Healthfirst QHP |
$977.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$684.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$977.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$831.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$684.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$977.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$733.38
|
| Rate for Payer: SOMOS Essential |
$733.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$977.84
|
|
|
PR AMP LEG THRU TIBIA&FIBULA RE-AMPUTATION
|
Professional
|
Both
|
$2,890.69
|
|
|
Service Code
|
HCPCS 27886
|
| Min. Negotiated Rate |
$538.35 |
| Max. Negotiated Rate |
$1,730.41 |
| Rate for Payer: Cash Price |
$774.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$769.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$692.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$692.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$730.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$769.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$730.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$769.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$769.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$576.80
|
| Rate for Payer: Healthfirst Commercial |
$769.07
|
| Rate for Payer: Healthfirst Essential Plan |
$1,730.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$730.62
|
| Rate for Payer: Healthfirst QHP |
$769.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$538.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$769.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$653.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$538.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$769.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$576.80
|
| Rate for Payer: SOMOS Essential |
$576.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$769.07
|
|
|
PR AMP LEG THRU TIBIA&FIBULA SEC CLOSURE/SCAR REV
|
Professional
|
Both
|
$2,580.10
|
|
|
Service Code
|
HCPCS 27884
|
| Min. Negotiated Rate |
$480.96 |
| Max. Negotiated Rate |
$1,545.95 |
| Rate for Payer: Cash Price |
$692.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$687.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$618.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$618.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$652.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$687.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$652.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$687.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$687.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$515.32
|
| Rate for Payer: Healthfirst Commercial |
$687.09
|
| Rate for Payer: Healthfirst Essential Plan |
$1,545.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$652.74
|
| Rate for Payer: Healthfirst QHP |
$687.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$480.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$687.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$584.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$480.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$687.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$515.32
|
| Rate for Payer: SOMOS Essential |
$515.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$687.09
|
|
|
PR AMP MTCRPL W/FINGER/THUMB W/WO INTEROSS TRANSFER
|
Professional
|
Both
|
$3,384.36
|
|
|
Service Code
|
HCPCS 26910
|
| Min. Negotiated Rate |
$629.51 |
| Max. Negotiated Rate |
$2,023.42 |
| Rate for Payer: Cash Price |
$910.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$899.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$809.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$809.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$854.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$899.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$854.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$899.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$899.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$674.48
|
| Rate for Payer: Healthfirst Commercial |
$899.30
|
| Rate for Payer: Healthfirst Essential Plan |
$2,023.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$854.34
|
| Rate for Payer: Healthfirst QHP |
$899.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$629.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$899.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$764.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$629.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$899.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$674.48
|
| Rate for Payer: SOMOS Essential |
$674.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$899.30
|
|
