|
PR BLEPHAROTOMY DRAINAGE ABSCESS EYELID
|
Professional
|
Both
|
$481.46
|
|
|
Service Code
|
HCPCS 67700
|
| Min. Negotiated Rate |
$92.48 |
| Max. Negotiated Rate |
$297.25 |
| Rate for Payer: Cash Price |
$132.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$132.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$118.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$118.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$125.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$132.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$125.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$132.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$132.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$99.08
|
| Rate for Payer: Healthfirst Commercial |
$132.11
|
| Rate for Payer: Healthfirst Essential Plan |
$297.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.50
|
| Rate for Payer: Healthfirst QHP |
$132.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$132.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$112.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$92.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$132.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$99.08
|
| Rate for Payer: SOMOS Essential |
$99.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$132.11
|
|
|
PR BLOOD EXCHANGE TRANSFUSION NEWBORN
|
Professional
|
Both
|
$683.87
|
|
|
Service Code
|
HCPCS 36450
|
| Min. Negotiated Rate |
$128.59 |
| Max. Negotiated Rate |
$413.32 |
| Rate for Payer: Cash Price |
$187.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$183.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$165.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$165.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$174.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$183.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$174.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$183.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$183.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$137.78
|
| Rate for Payer: Healthfirst Commercial |
$183.70
|
| Rate for Payer: Healthfirst Essential Plan |
$413.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$174.51
|
| Rate for Payer: Healthfirst QHP |
$183.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$128.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$183.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$156.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$128.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$183.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$137.78
|
| Rate for Payer: SOMOS Essential |
$137.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$183.70
|
|
|
PR BLOOD EXCHANGE TRANSFUSION OTHER THAN NEWBORN
|
Professional
|
Both
|
$560.81
|
|
|
Service Code
|
HCPCS 36455
|
| Min. Negotiated Rate |
$103.03 |
| Max. Negotiated Rate |
$331.18 |
| Rate for Payer: Cash Price |
$147.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$132.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$132.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$139.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$139.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$110.39
|
| Rate for Payer: Healthfirst Commercial |
$147.19
|
| Rate for Payer: Healthfirst Essential Plan |
$331.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$139.83
|
| Rate for Payer: Healthfirst QHP |
$147.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$103.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$125.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$103.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$110.39
|
| Rate for Payer: SOMOS Essential |
$110.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.19
|
|
|
PR BONE GRAFT ANY DONOR AREA MAJOR/LARGE
|
Professional
|
Both
|
$1,201.80
|
|
|
Service Code
|
HCPCS 20902
|
| Min. Negotiated Rate |
$222.82 |
| Max. Negotiated Rate |
$716.20 |
| Rate for Payer: Cash Price |
$322.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$318.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$286.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$286.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$302.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$318.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$302.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$318.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$318.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$238.73
|
| Rate for Payer: Healthfirst Commercial |
$318.31
|
| Rate for Payer: Healthfirst Essential Plan |
$716.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$302.39
|
| Rate for Payer: Healthfirst QHP |
$318.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$222.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$318.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$270.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$222.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$318.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$238.73
|
| Rate for Payer: SOMOS Essential |
$238.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$318.31
|
|
|
PR BONE GRAFT ANY DONOR AREA MINOR/SMALL
|
Professional
|
Both
|
$786.98
|
|
|
Service Code
|
HCPCS 20900
|
| Min. Negotiated Rate |
$146.15 |
| Max. Negotiated Rate |
$469.75 |
| Rate for Payer: Cash Price |
$210.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$208.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$187.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$187.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$198.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$208.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$198.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$208.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$208.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$156.59
|
| Rate for Payer: Healthfirst Commercial |
$208.78
|
| Rate for Payer: Healthfirst Essential Plan |
$469.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$198.34
|
| Rate for Payer: Healthfirst QHP |
$208.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$146.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$208.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$177.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$146.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$208.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$156.59
|
| Rate for Payer: SOMOS Essential |
$156.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$208.78
|
|
|
PR BONE GRAFT MICROVASCULAR ANAST ILIAC CREST
|
Professional
|
Both
|
$11,617.73
|
|
|
Service Code
|
HCPCS 20956
|
| Min. Negotiated Rate |
$2,172.06 |
| Max. Negotiated Rate |
$6,981.61 |
| Rate for Payer: Cash Price |
$3,121.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,102.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,792.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,792.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,947.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,102.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,947.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,102.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,102.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,327.20
|
| Rate for Payer: Healthfirst Commercial |
$3,102.94
|
| Rate for Payer: Healthfirst Essential Plan |
$6,981.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,947.79
|
| Rate for Payer: Healthfirst QHP |
$3,102.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,172.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,102.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,637.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,172.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,102.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,327.20
|
| Rate for Payer: SOMOS Essential |
$2,327.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,102.94
|
|
|
PR BONE GRAFT MICROVASCULAR ANAST METATARSAL
|
Professional
|
Both
|
$12,096.28
|
|
|
Service Code
|
HCPCS 20957
|
| Min. Negotiated Rate |
$2,262.41 |
| Max. Negotiated Rate |
$7,272.02 |
| Rate for Payer: Cash Price |
$3,252.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,232.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,908.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,908.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,070.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,232.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,070.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,232.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,232.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,424.01
|
| Rate for Payer: Healthfirst Commercial |
$3,232.01
|
| Rate for Payer: Healthfirst Essential Plan |
$7,272.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,070.41
|
| Rate for Payer: Healthfirst QHP |
$3,232.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,262.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,232.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,747.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,262.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,232.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,424.01
|
| Rate for Payer: SOMOS Essential |
$2,424.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,232.01
|
|
|
PR BONE GRAFT MICROVASCULAR ANASTOMOSIS FIBULA
|
Professional
|
Both
|
$10,599.40
|
|
|
Service Code
|
HCPCS 20955
|
| Min. Negotiated Rate |
$1,970.43 |
| Max. Negotiated Rate |
$6,333.52 |
| Rate for Payer: Cash Price |
$2,838.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,814.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,533.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,533.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,674.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,814.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,674.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,814.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,814.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,111.18
|
| Rate for Payer: Healthfirst Commercial |
$2,814.90
|
| Rate for Payer: Healthfirst Essential Plan |
$6,333.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,674.16
|
| Rate for Payer: Healthfirst QHP |
$2,814.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,970.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,814.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,392.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,970.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,814.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,111.18
|
| Rate for Payer: SOMOS Essential |
$2,111.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,814.90
|
|
|
PR BONE GRF W/MVASC ANAST OTH/THN ILIAC CREST/METAR
|
Professional
|
Both
|
$11,732.91
|
|
|
Service Code
|
HCPCS 20962
|
| Min. Negotiated Rate |
$2,204.95 |
| Max. Negotiated Rate |
$7,087.34 |
| Rate for Payer: Cash Price |
$3,163.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,149.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,834.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,834.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,992.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,149.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,992.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,149.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,149.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,362.45
|
| Rate for Payer: Healthfirst Commercial |
$3,149.93
|
| Rate for Payer: Healthfirst Essential Plan |
$7,087.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,992.43
|
| Rate for Payer: Healthfirst QHP |
$3,149.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,204.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,149.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,677.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,204.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,149.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,362.45
|
| Rate for Payer: SOMOS Essential |
$2,362.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,149.93
|
|
|
PR BONE MARROW ASPIRATION BONE GRFG SPI SURG ONLY
|
Professional
|
Both
|
$323.12
|
|
|
Service Code
|
HCPCS 20939
|
| Min. Negotiated Rate |
$58.99 |
| Max. Negotiated Rate |
$189.61 |
| Rate for Payer: Cash Price |
$84.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$84.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$75.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$75.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$80.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$84.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$80.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.20
|
| Rate for Payer: Healthfirst Commercial |
$84.27
|
| Rate for Payer: Healthfirst Essential Plan |
$189.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$80.06
|
| Rate for Payer: Healthfirst QHP |
$84.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$84.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$71.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$84.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.20
|
| Rate for Payer: SOMOS Essential |
$63.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.27
|
|
|
PR BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC
|
Professional
|
Both
|
$892.82
|
|
|
Service Code
|
HCPCS 38230
|
| Min. Negotiated Rate |
$165.39 |
| Max. Negotiated Rate |
$531.61 |
| Rate for Payer: Cash Price |
$238.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$236.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$212.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$212.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$224.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$236.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$224.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$236.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$236.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$177.20
|
| Rate for Payer: Healthfirst Commercial |
$236.27
|
| Rate for Payer: Healthfirst Essential Plan |
$531.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$224.46
|
| Rate for Payer: Healthfirst QHP |
$236.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$165.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$236.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$200.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$165.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$236.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$177.20
|
| Rate for Payer: SOMOS Essential |
$177.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$236.27
|
|
|
PR BONE MARROW HARVEST TRANSPLANTATION AUTOLOGOUS
|
Professional
|
Both
|
$820.86
|
|
|
Service Code
|
HCPCS 38232
|
| Min. Negotiated Rate |
$147.73 |
| Max. Negotiated Rate |
$474.84 |
| Rate for Payer: Cash Price |
$216.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$211.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$189.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$189.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$200.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$211.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$200.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$211.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$211.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$158.28
|
| Rate for Payer: Healthfirst Commercial |
$211.04
|
| Rate for Payer: Healthfirst Essential Plan |
$474.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$200.49
|
| Rate for Payer: Healthfirst QHP |
$211.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$147.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$211.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$179.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$147.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$211.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$158.28
|
| Rate for Payer: SOMOS Essential |
$158.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$211.04
|
|
|
PR BPCI ADVANCED IN HOME VISIT
|
Professional
|
Both
|
$197.37
|
|
|
Service Code
|
HCPCS G9987
|
| Min. Negotiated Rate |
$38.79 |
| Max. Negotiated Rate |
$124.67 |
| Rate for Payer: Cash Price |
$56.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$55.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$52.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.56
|
| Rate for Payer: Healthfirst Commercial |
$55.41
|
| Rate for Payer: Healthfirst Essential Plan |
$124.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.64
|
| Rate for Payer: Healthfirst QHP |
$55.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$55.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.56
|
| Rate for Payer: SOMOS Essential |
$41.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.41
|
|
|
PR BPCI HOME VISIT
|
Professional
|
Both
|
$197.37
|
|
|
Service Code
|
HCPCS G9187
|
| Min. Negotiated Rate |
$38.79 |
| Max. Negotiated Rate |
$124.67 |
| Rate for Payer: Cash Price |
$56.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$55.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$52.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.56
|
| Rate for Payer: Healthfirst Commercial |
$55.41
|
| Rate for Payer: Healthfirst Essential Plan |
$124.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.64
|
| Rate for Payer: Healthfirst QHP |
$55.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$55.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.56
|
| Rate for Payer: SOMOS Essential |
$41.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.41
|
|
|
PR BREAST AUGMENTATION WITH IMPLANT
|
Professional
|
Both
|
$2,692.73
|
|
|
Service Code
|
HCPCS 19325
|
| Min. Negotiated Rate |
$508.79 |
| Max. Negotiated Rate |
$1,635.39 |
| Rate for Payer: Cash Price |
$728.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$726.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$654.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$654.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$690.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$726.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$690.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$726.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$545.13
|
| Rate for Payer: Healthfirst Commercial |
$726.84
|
| Rate for Payer: Healthfirst Essential Plan |
$1,635.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$690.50
|
| Rate for Payer: Healthfirst QHP |
$726.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$508.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$726.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$617.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$508.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$545.13
|
| Rate for Payer: SOMOS Essential |
$545.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$726.84
|
|
|
PR BREAST RECONSTRUCTION 1PEDICLED TRAM FLAP ANAST
|
Professional
|
Both
|
$9,471.35
|
|
|
Service Code
|
HCPCS 19368
|
| Min. Negotiated Rate |
$1,771.55 |
| Max. Negotiated Rate |
$5,694.26 |
| Rate for Payer: Cash Price |
$2,542.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,530.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,277.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,277.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,404.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,530.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,404.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,530.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,530.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,898.09
|
| Rate for Payer: Healthfirst Commercial |
$2,530.78
|
| Rate for Payer: Healthfirst Essential Plan |
$5,694.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,404.24
|
| Rate for Payer: Healthfirst QHP |
$2,530.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,771.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,530.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,151.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,771.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,530.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,898.09
|
| Rate for Payer: SOMOS Essential |
$1,898.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,530.78
|
|
|
PR BREAST RECONSTRUCTION BIPEDICLED TRAM FLAP
|
Professional
|
Both
|
$8,801.14
|
|
|
Service Code
|
HCPCS 19369
|
| Min. Negotiated Rate |
$1,646.37 |
| Max. Negotiated Rate |
$5,291.89 |
| Rate for Payer: Cash Price |
$2,363.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,351.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,116.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,116.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,234.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,351.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,234.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,351.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,351.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,763.96
|
| Rate for Payer: Healthfirst Commercial |
$2,351.95
|
| Rate for Payer: Healthfirst Essential Plan |
$5,291.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,234.35
|
| Rate for Payer: Healthfirst QHP |
$2,351.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,646.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,351.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,999.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,646.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,351.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,763.96
|
| Rate for Payer: SOMOS Essential |
$1,763.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,351.95
|
|
|
PR BREAST RECONSTRUCTION SINGLE PEDICLED TRAM FLAP
|
Professional
|
Both
|
$7,728.74
|
|
|
Service Code
|
HCPCS 19367
|
| Min. Negotiated Rate |
$1,450.23 |
| Max. Negotiated Rate |
$4,661.46 |
| Rate for Payer: Cash Price |
$2,078.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,071.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,864.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,864.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,968.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,071.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,968.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,071.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,071.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,553.82
|
| Rate for Payer: Healthfirst Commercial |
$2,071.76
|
| Rate for Payer: Healthfirst Essential Plan |
$4,661.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,968.17
|
| Rate for Payer: Healthfirst QHP |
$2,071.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,450.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,071.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,761.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,450.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,071.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,553.82
|
| Rate for Payer: SOMOS Essential |
$1,553.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,071.76
|
|
|
PR BREAST RECONSTRUCTION W/FREE FLAP
|
Professional
|
Both
|
$11,887.86
|
|
|
Service Code
|
HCPCS 19364
|
| Min. Negotiated Rate |
$2,222.81 |
| Max. Negotiated Rate |
$7,144.74 |
| Rate for Payer: Cash Price |
$3,190.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,175.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,857.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,857.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,016.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,175.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,016.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,175.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,175.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,381.58
|
| Rate for Payer: Healthfirst Commercial |
$3,175.44
|
| Rate for Payer: Healthfirst Essential Plan |
$7,144.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,016.67
|
| Rate for Payer: Healthfirst QHP |
$3,175.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,222.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,175.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,699.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,222.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,175.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,381.58
|
| Rate for Payer: SOMOS Essential |
$2,381.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,175.44
|
|
|
PR BREAST RECONSTRUCTION W/LATISSIMUS DORSI FLAP
|
Professional
|
Both
|
$6,809.85
|
|
|
Service Code
|
HCPCS 19361
|
| Min. Negotiated Rate |
$1,278.65 |
| Max. Negotiated Rate |
$4,109.96 |
| Rate for Payer: Cash Price |
$1,832.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,826.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,643.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,643.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,735.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,826.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,735.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,826.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,826.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,369.99
|
| Rate for Payer: Healthfirst Commercial |
$1,826.65
|
| Rate for Payer: Healthfirst Essential Plan |
$4,109.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,735.32
|
| Rate for Payer: Healthfirst QHP |
$1,826.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,278.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,826.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,552.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,278.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,826.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,369.99
|
| Rate for Payer: SOMOS Essential |
$1,369.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,826.65
|
|
|
PR BREAST REDUCTION
|
Professional
|
Both
|
$4,785.83
|
|
|
Service Code
|
HCPCS 19318
|
| Min. Negotiated Rate |
$899.86 |
| Max. Negotiated Rate |
$2,892.40 |
| Rate for Payer: Cash Price |
$1,288.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,285.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,156.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,156.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,221.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,285.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,221.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,285.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,285.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$964.13
|
| Rate for Payer: Healthfirst Commercial |
$1,285.51
|
| Rate for Payer: Healthfirst Essential Plan |
$2,892.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,221.23
|
| Rate for Payer: Healthfirst QHP |
$1,285.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$899.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,285.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,092.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$899.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,285.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$964.13
|
| Rate for Payer: SOMOS Essential |
$964.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,285.51
|
|
|
PR BREATH HYDROGEN/METHANE TEST
|
Professional
|
Both
|
$321.86
|
|
|
Service Code
|
HCPCS 91065 TC
|
| Min. Negotiated Rate |
$45.81 |
| Max. Negotiated Rate |
$147.24 |
| Rate for Payer: Amida Care Medicaid |
$49.62
|
| Rate for Payer: Cash Price |
$76.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$65.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.08
|
| Rate for Payer: Healthfirst Commercial |
$65.44
|
| Rate for Payer: Healthfirst Essential Plan |
$147.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.17
|
| Rate for Payer: Healthfirst QHP |
$65.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$49.08
|
| Rate for Payer: SOMOS Essential |
$49.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.44
|
|
|
PR BREATH HYDROGEN/METHANE TEST
|
Professional
|
Both
|
$39.27
|
|
|
Service Code
|
HCPCS 91065 26
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$49.62 |
| Rate for Payer: Amida Care Medicaid |
$49.62
|
| Rate for Payer: Cash Price |
$10.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.67
|
| Rate for Payer: Healthfirst Commercial |
$10.23
|
| Rate for Payer: Healthfirst Essential Plan |
$23.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.72
|
| Rate for Payer: Healthfirst QHP |
$10.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.67
|
| Rate for Payer: SOMOS Essential |
$7.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.23
|
|
|
PR BREATH HYDROGEN/METHANE TEST
|
Professional
|
Both
|
$361.13
|
|
|
Service Code
|
HCPCS 91065
|
| Min. Negotiated Rate |
$49.62 |
| Max. Negotiated Rate |
$170.26 |
| Rate for Payer: Amida Care Medicaid |
$49.62
|
| Rate for Payer: Cash Price |
$86.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$75.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$68.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$75.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$71.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.75
|
| Rate for Payer: Healthfirst Commercial |
$75.67
|
| Rate for Payer: Healthfirst Essential Plan |
$170.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$71.89
|
| Rate for Payer: Healthfirst QHP |
$75.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$75.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$64.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$75.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56.75
|
| Rate for Payer: SOMOS Essential |
$56.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.67
|
|
|
PR BREATHING RESPONSE TO HYPOXIA
|
Professional
|
Both
|
$349.97
|
|
|
Service Code
|
HCPCS 94450
|
| Min. Negotiated Rate |
$70.88 |
| Max. Negotiated Rate |
$227.84 |
| Rate for Payer: Cash Price |
$92.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$101.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$91.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$91.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$96.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$101.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$96.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$101.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$101.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.94
|
| Rate for Payer: Healthfirst Commercial |
$101.26
|
| Rate for Payer: Healthfirst Essential Plan |
$227.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$96.20
|
| Rate for Payer: Healthfirst QHP |
$101.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$70.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$101.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$86.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$70.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$101.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$75.94
|
| Rate for Payer: SOMOS Essential |
$75.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$101.26
|
|
