|
PR APPLICATION SHORT LEG CAST BELOW KNEE-TOE
|
Professional
|
Both
|
$250.92
|
|
|
Service Code
|
HCPCS 29405
|
| Min. Negotiated Rate |
$48.29 |
| Max. Negotiated Rate |
$155.21 |
| Rate for Payer: Cash Price |
$69.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$68.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.73
|
| Rate for Payer: Healthfirst Commercial |
$68.98
|
| Rate for Payer: Healthfirst Essential Plan |
$155.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.53
|
| Rate for Payer: Healthfirst QHP |
$68.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$68.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$68.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.73
|
| Rate for Payer: SOMOS Essential |
$51.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.98
|
|
|
PR APPLICATION SHORT LEG CAST WALKING/AMBULATORY
|
Professional
|
Both
|
$229.64
|
|
|
Service Code
|
HCPCS 29425
|
| Min. Negotiated Rate |
$43.99 |
| Max. Negotiated Rate |
$141.41 |
| Rate for Payer: Cash Price |
$62.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.14
|
| Rate for Payer: Healthfirst Commercial |
$62.85
|
| Rate for Payer: Healthfirst Essential Plan |
$141.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.71
|
| Rate for Payer: Healthfirst QHP |
$62.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.14
|
| Rate for Payer: SOMOS Essential |
$47.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.85
|
|
|
PR APPLICATION SHORT LEG SPLINT CALF FOOT
|
Professional
|
Both
|
$212.10
|
|
|
Service Code
|
HCPCS 29515
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$131.78 |
| Rate for Payer: Cash Price |
$58.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$58.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$52.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$58.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.93
|
| Rate for Payer: Healthfirst Commercial |
$58.57
|
| Rate for Payer: Healthfirst Essential Plan |
$131.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$55.64
|
| Rate for Payer: Healthfirst QHP |
$58.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$58.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$49.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$58.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$43.93
|
| Rate for Payer: SOMOS Essential |
$43.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.57
|
|
|
PR APPLICATION UNIPLANE EXTERNAL FIXATION SYSTEM
|
Professional
|
Both
|
$2,626.12
|
|
|
Service Code
|
HCPCS 20690
|
| Min. Negotiated Rate |
$495.63 |
| Max. Negotiated Rate |
$1,593.11 |
| Rate for Payer: Cash Price |
$710.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$708.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$637.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$637.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$672.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$708.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$672.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$708.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$708.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$531.04
|
| Rate for Payer: Healthfirst Commercial |
$708.05
|
| Rate for Payer: Healthfirst Essential Plan |
$1,593.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$672.65
|
| Rate for Payer: Healthfirst QHP |
$708.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$495.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$708.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$601.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$495.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$708.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$531.04
|
| Rate for Payer: SOMOS Essential |
$531.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$708.05
|
|
|
PR APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC
|
Professional
|
Both
|
$3,059.42
|
|
|
Service Code
|
HCPCS 21110
|
| Min. Negotiated Rate |
$567.38 |
| Max. Negotiated Rate |
$1,823.71 |
| Rate for Payer: Cash Price |
$824.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$810.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$729.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$729.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$770.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$810.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$770.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$810.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$810.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$607.90
|
| Rate for Payer: Healthfirst Commercial |
$810.54
|
| Rate for Payer: Healthfirst Essential Plan |
$1,823.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$770.01
|
| Rate for Payer: Healthfirst QHP |
$810.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$567.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$810.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$688.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$567.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$810.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$607.90
|
| Rate for Payer: SOMOS Essential |
$607.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$810.54
|
|
|
PR APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT
|
Professional
|
Both
|
$103.78
|
|
|
Service Code
|
HCPCS 29581
|
| Min. Negotiated Rate |
$19.79 |
| Max. Negotiated Rate |
$63.61 |
| Rate for Payer: Cash Price |
$28.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.20
|
| Rate for Payer: Healthfirst Commercial |
$28.27
|
| Rate for Payer: Healthfirst Essential Plan |
$63.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.86
|
| Rate for Payer: Healthfirst QHP |
$28.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.20
|
| Rate for Payer: SOMOS Essential |
$21.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.27
|
|
|
PR APPL MLTLAYR COMPRES SYS UPARM LWARM HAND&FING
|
Professional
|
Both
|
$62.37
|
|
|
Service Code
|
HCPCS 29584
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$38.14 |
| Rate for Payer: Cash Price |
$16.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.71
|
| Rate for Payer: Healthfirst Commercial |
$16.95
|
| Rate for Payer: Healthfirst Essential Plan |
$38.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.10
|
| Rate for Payer: Healthfirst QHP |
$16.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.71
|
| Rate for Payer: SOMOS Essential |
$12.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.95
|
|
|
PR APPL MODALITY 1+ AREAS CONTRAST BATHS EA 15 MIN
|
Professional
|
Both
|
$59.22
|
|
|
Service Code
|
HCPCS 97034
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.71
|
| Rate for Payer: Healthfirst Commercial |
$15.62
|
| Rate for Payer: Healthfirst Essential Plan |
$35.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.84
|
| Rate for Payer: Healthfirst QHP |
$15.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.71
|
| Rate for Payer: SOMOS Essential |
$11.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.62
|
|
|
PR APPL MODALITY 1+ AREAS ESTIM EA 15 MIN
|
Professional
|
Both
|
$58.49
|
|
|
Service Code
|
HCPCS 97032
|
| Min. Negotiated Rate |
$11.35 |
| Max. Negotiated Rate |
$36.49 |
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.16
|
| Rate for Payer: Healthfirst Commercial |
$16.22
|
| Rate for Payer: Healthfirst Essential Plan |
$36.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.41
|
| Rate for Payer: Healthfirst QHP |
$16.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.16
|
| Rate for Payer: SOMOS Essential |
$12.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.22
|
|
|
PR APPL MODALITY 1+ AREAS HUBBARD TANK EA 15 MIN
|
Professional
|
Both
|
$145.64
|
|
|
Service Code
|
HCPCS 97036
|
| Min. Negotiated Rate |
$28.11 |
| Max. Negotiated Rate |
$90.34 |
| Rate for Payer: Cash Price |
$40.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.11
|
| Rate for Payer: Healthfirst Commercial |
$40.15
|
| Rate for Payer: Healthfirst Essential Plan |
$90.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.14
|
| Rate for Payer: Healthfirst QHP |
$40.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.11
|
| Rate for Payer: SOMOS Essential |
$30.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.15
|
|
|
PR APPL MODALITY 1+ AREAS IONTOPHORESIS EA 15 MIN
|
Professional
|
Both
|
$81.31
|
|
|
Service Code
|
HCPCS 97033
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$48.62 |
| Rate for Payer: Cash Price |
$21.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.21
|
| Rate for Payer: Healthfirst Commercial |
$21.61
|
| Rate for Payer: Healthfirst Essential Plan |
$48.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.53
|
| Rate for Payer: Healthfirst QHP |
$21.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$21.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$18.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16.21
|
| Rate for Payer: SOMOS Essential |
$16.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.61
|
|
|
PR APPL MODALITY 1/> AREAS PARAFFIN BATH
|
Professional
|
Both
|
$24.64
|
|
|
Service Code
|
HCPCS 97018
|
| Min. Negotiated Rate |
$5.14 |
| Max. Negotiated Rate |
$16.52 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.50
|
| Rate for Payer: Healthfirst Commercial |
$7.34
|
| Rate for Payer: Healthfirst Essential Plan |
$16.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.97
|
| Rate for Payer: Healthfirst QHP |
$7.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$7.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$6.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.50
|
| Rate for Payer: SOMOS Essential |
$5.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.34
|
|
|
PR APPL MODALITY 1/> AREAS TRACTION MECHANICAL
|
Professional
|
Both
|
$58.49
|
|
|
Service Code
|
HCPCS 97012
|
| Min. Negotiated Rate |
$11.35 |
| Max. Negotiated Rate |
$36.49 |
| Rate for Payer: Cash Price |
$15.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.16
|
| Rate for Payer: Healthfirst Commercial |
$16.22
|
| Rate for Payer: Healthfirst Essential Plan |
$36.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.41
|
| Rate for Payer: Healthfirst QHP |
$16.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.16
|
| Rate for Payer: SOMOS Essential |
$12.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.22
|
|
|
PR APPL MODALITY 1+ AREAS ULTRASOUND EA 15 MIN
|
Professional
|
Both
|
$59.22
|
|
|
Service Code
|
HCPCS 97035
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.00
|
| Rate for Payer: Healthfirst Commercial |
$16.00
|
| Rate for Payer: Healthfirst Essential Plan |
$36.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.20
|
| Rate for Payer: Healthfirst QHP |
$16.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.00
|
| Rate for Payer: SOMOS Essential |
$12.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.00
|
|
|
PR APPL MODALITY 1/> AREAS ULTRAVIOLET
|
Professional
|
Both
|
$35.77
|
|
|
Service Code
|
HCPCS 97028
|
| Min. Negotiated Rate |
$6.71 |
| Max. Negotiated Rate |
$21.55 |
| Rate for Payer: Cash Price |
$9.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.18
|
| Rate for Payer: Healthfirst Commercial |
$9.58
|
| Rate for Payer: Healthfirst Essential Plan |
$21.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.10
|
| Rate for Payer: Healthfirst QHP |
$9.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.18
|
| Rate for Payer: SOMOS Essential |
$7.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.58
|
|
|
PR APPL MODALITY 1/> AREAS VASOPNEUMATIC DEVICES
|
Professional
|
Both
|
$48.27
|
|
|
Service Code
|
HCPCS 97016
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$30.20 |
| Rate for Payer: Cash Price |
$13.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.06
|
| Rate for Payer: Healthfirst Commercial |
$13.42
|
| Rate for Payer: Healthfirst Essential Plan |
$30.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.75
|
| Rate for Payer: Healthfirst QHP |
$13.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.06
|
| Rate for Payer: SOMOS Essential |
$10.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.42
|
|
|
PR APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION
|
Professional
|
Both
|
$77.21
|
|
|
Service Code
|
HCPCS 96377
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$46.01 |
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.34
|
| Rate for Payer: Healthfirst Commercial |
$20.45
|
| Rate for Payer: Healthfirst Essential Plan |
$46.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.43
|
| Rate for Payer: Healthfirst QHP |
$20.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.34
|
| Rate for Payer: SOMOS Essential |
$15.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.45
|
|
|
PR APPL STRTCTC HEADFRAME STEREOTACTIC RADIOSURGERY
|
Professional
|
Both
|
$726.29
|
|
|
Service Code
|
HCPCS 61800
|
| Min. Negotiated Rate |
$130.42 |
| Max. Negotiated Rate |
$419.22 |
| Rate for Payer: Cash Price |
$190.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$186.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$167.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$177.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$186.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$177.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$186.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$186.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.74
|
| Rate for Payer: Healthfirst Commercial |
$186.32
|
| Rate for Payer: Healthfirst Essential Plan |
$419.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$177.00
|
| Rate for Payer: Healthfirst QHP |
$186.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$130.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$186.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$158.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$130.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$186.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$139.74
|
| Rate for Payer: SOMOS Essential |
$139.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$186.32
|
|
|
PR APP MLTPLN UNI XTRNL FIX STRTCTC ADJMT 1ST&SUBSQ
|
Professional
|
Both
|
$5,103.00
|
|
|
Service Code
|
HCPCS 20696
|
| Min. Negotiated Rate |
$951.64 |
| Max. Negotiated Rate |
$3,058.85 |
| Rate for Payer: Cash Price |
$1,372.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,359.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,223.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,223.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,291.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,359.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,291.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,359.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,359.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,019.62
|
| Rate for Payer: Healthfirst Commercial |
$1,359.49
|
| Rate for Payer: Healthfirst Essential Plan |
$3,058.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,291.52
|
| Rate for Payer: Healthfirst QHP |
$1,359.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$951.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,359.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,155.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$951.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,359.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,019.62
|
| Rate for Payer: SOMOS Essential |
$1,019.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,359.49
|
|
|
PR APP MLTPLN UNI XTRNL FIX STRTCTC ADJMT EXCHANGE
|
Professional
|
Both
|
$7,897.05
|
|
|
Service Code
|
HCPCS 20697
|
| Min. Negotiated Rate |
$1,379.69 |
| Max. Negotiated Rate |
$4,434.70 |
| Rate for Payer: Cash Price |
$2,087.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,970.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,773.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,773.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,872.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,970.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,872.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,970.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,970.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,478.23
|
| Rate for Payer: Healthfirst Commercial |
$1,970.98
|
| Rate for Payer: Healthfirst Essential Plan |
$4,434.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,872.43
|
| Rate for Payer: Healthfirst QHP |
$1,970.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,379.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,970.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,675.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,379.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,970.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,478.23
|
| Rate for Payer: SOMOS Essential |
$1,478.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,970.98
|
|
|
PR APP SKN SUB GRFT T/A/L AREA>=100SCM ADL 100SQCM
|
Professional
|
Both
|
$199.75
|
|
|
Service Code
|
HCPCS 15274
|
| Min. Negotiated Rate |
$35.73 |
| Max. Negotiated Rate |
$114.84 |
| Rate for Payer: Cash Price |
$52.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$51.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$45.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$48.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$48.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.28
|
| Rate for Payer: Healthfirst Commercial |
$51.04
|
| Rate for Payer: Healthfirst Essential Plan |
$114.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$48.49
|
| Rate for Payer: Healthfirst QHP |
$51.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$51.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.28
|
| Rate for Payer: SOMOS Essential |
$38.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.04
|
|
|
PR APP SKN SUBGRFT T/A/L AREA/100SQ CM 1ST 100SQ CM
|
Professional
|
Both
|
$853.41
|
|
|
Service Code
|
HCPCS 15273
|
| Min. Negotiated Rate |
$156.76 |
| Max. Negotiated Rate |
$503.89 |
| Rate for Payer: Cash Price |
$227.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$223.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$201.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$201.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$212.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$223.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$212.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$223.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$223.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$167.96
|
| Rate for Payer: Healthfirst Commercial |
$223.95
|
| Rate for Payer: Healthfirst Essential Plan |
$503.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$212.75
|
| Rate for Payer: Healthfirst QHP |
$223.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$156.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$223.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$190.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$156.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$223.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$167.96
|
| Rate for Payer: SOMOS Essential |
$167.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$223.95
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25
|
Professional
|
Both
|
$355.88
|
|
|
Service Code
|
HCPCS 15271
|
| Min. Negotiated Rate |
$67.27 |
| Max. Negotiated Rate |
$216.22 |
| Rate for Payer: Cash Price |
$96.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$96.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$86.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.08
|
| Rate for Payer: Healthfirst Commercial |
$96.10
|
| Rate for Payer: Healthfirst Essential Plan |
$216.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$91.30
|
| Rate for Payer: Healthfirst QHP |
$96.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$67.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$96.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$81.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$67.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.08
|
| Rate for Payer: SOMOS Essential |
$72.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.10
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM EA ADL 25SC
|
Professional
|
Both
|
$69.51
|
|
|
Service Code
|
HCPCS 15272
|
| Min. Negotiated Rate |
$13.22 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.17
|
| Rate for Payer: Healthfirst Commercial |
$18.89
|
| Rate for Payer: Healthfirst Essential Plan |
$42.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.95
|
| Rate for Payer: Healthfirst QHP |
$18.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.17
|
| Rate for Payer: SOMOS Essential |
$14.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.89
|
|
|
PR AQUEOUS SHUNT EXTRAOC EQUAT PLATE RSVR W/GRAFT
|
Professional
|
Both
|
$4,684.68
|
|
|
Service Code
|
HCPCS 66180
|
| Min. Negotiated Rate |
$889.85 |
| Max. Negotiated Rate |
$2,860.22 |
| Rate for Payer: Cash Price |
$1,291.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,271.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,144.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,144.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,207.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,271.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,207.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,271.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,271.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$953.41
|
| Rate for Payer: Healthfirst Commercial |
$1,271.21
|
| Rate for Payer: Healthfirst Essential Plan |
$2,860.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,207.65
|
| Rate for Payer: Healthfirst QHP |
$1,271.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$889.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,271.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,080.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$889.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,271.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$953.41
|
| Rate for Payer: SOMOS Essential |
$953.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,271.21
|
|
