|
PR CHOLINESTERASE INHIBITOR CHALLENGE TEST
|
Professional
|
Both
|
$116.13
|
|
|
Service Code
|
HCPCS 95857
|
| Min. Negotiated Rate |
$13.48 |
| Max. Negotiated Rate |
$70.22 |
| Rate for Payer: Amida Care Medicaid |
$13.48
|
| Rate for Payer: Cash Price |
$31.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.41
|
| Rate for Payer: Healthfirst Commercial |
$31.21
|
| Rate for Payer: Healthfirst Essential Plan |
$70.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.65
|
| Rate for Payer: Healthfirst QHP |
$31.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.41
|
| Rate for Payer: SOMOS Essential |
$23.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.21
|
|
|
PR CHORIONIC VILLUS SAMPLING
|
Professional
|
Both
|
$607.08
|
|
|
Service Code
|
HCPCS 59015
|
| Min. Negotiated Rate |
$110.96 |
| Max. Negotiated Rate |
$356.65 |
| Rate for Payer: Cash Price |
$161.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$158.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$142.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$142.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$150.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$158.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$150.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$158.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$158.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$118.88
|
| Rate for Payer: Healthfirst Commercial |
$158.51
|
| Rate for Payer: Healthfirst Essential Plan |
$356.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$150.58
|
| Rate for Payer: Healthfirst QHP |
$158.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$110.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$158.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$134.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$110.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$158.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$118.88
|
| Rate for Payer: SOMOS Essential |
$118.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$158.51
|
|
|
PR CHROMOTUBATION OVIDUCT W/MATERIALS
|
Professional
|
Both
|
$417.76
|
|
|
Service Code
|
HCPCS 58350
|
| Min. Negotiated Rate |
$76.94 |
| Max. Negotiated Rate |
$247.30 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$109.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$98.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$98.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$104.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$109.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$104.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.43
|
| Rate for Payer: Healthfirst Commercial |
$109.91
|
| Rate for Payer: Healthfirst Essential Plan |
$247.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$104.41
|
| Rate for Payer: Healthfirst QHP |
$109.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$76.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$109.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$93.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$76.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$109.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.43
|
| Rate for Payer: SOMOS Essential |
$82.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$109.91
|
|
|
PR CHRONIC CARE MGMT SVC PHYS 1ST 30 MIN CAL MONTH
|
Professional
|
Both
|
$305.80
|
|
|
Service Code
|
HCPCS 99491
|
| Min. Negotiated Rate |
$57.89 |
| Max. Negotiated Rate |
$186.07 |
| Rate for Payer: Cash Price |
$83.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$82.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$78.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$82.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$78.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.02
|
| Rate for Payer: Healthfirst Commercial |
$82.70
|
| Rate for Payer: Healthfirst Essential Plan |
$186.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$78.56
|
| Rate for Payer: Healthfirst QHP |
$82.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$82.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$82.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62.02
|
| Rate for Payer: SOMOS Essential |
$62.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.70
|
|
|
PR CHRONIC CARE MGMT SVC PHYS EA ADDL 30 MIN CAL MO
|
Professional
|
Both
|
$204.79
|
|
|
Service Code
|
HCPCS 99437
|
| Min. Negotiated Rate |
$38.12 |
| Max. Negotiated Rate |
$122.53 |
| Rate for Payer: Cash Price |
$56.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.84
|
| Rate for Payer: Healthfirst Commercial |
$54.46
|
| Rate for Payer: Healthfirst Essential Plan |
$122.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.74
|
| Rate for Payer: Healthfirst QHP |
$54.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$54.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$46.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.84
|
| Rate for Payer: SOMOS Essential |
$40.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.46
|
|
|
PR CHRONIC CARE MGMT SVCS STAFF 1ST 20 MIN CAL MO
|
Professional
|
Both
|
$204.79
|
|
|
Service Code
|
HCPCS 99490
|
| Min. Negotiated Rate |
$38.12 |
| Max. Negotiated Rate |
$122.53 |
| Rate for Payer: Cash Price |
$55.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.84
|
| Rate for Payer: Healthfirst Commercial |
$54.46
|
| Rate for Payer: Healthfirst Essential Plan |
$122.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.74
|
| Rate for Payer: Healthfirst QHP |
$54.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$54.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$46.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.84
|
| Rate for Payer: SOMOS Essential |
$40.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.46
|
|
|
PR CHRONIC CARE MGMT SVC STAF EA ADDL 20 MIN CAL MO
|
Professional
|
Both
|
$140.32
|
|
|
Service Code
|
HCPCS 99439
|
| Min. Negotiated Rate |
$26.22 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Cash Price |
$38.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.09
|
| Rate for Payer: Healthfirst Commercial |
$37.46
|
| Rate for Payer: Healthfirst Essential Plan |
$84.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.59
|
| Rate for Payer: Healthfirst QHP |
$37.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.09
|
| Rate for Payer: SOMOS Essential |
$28.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.46
|
|
|
PR CHRONIC PAIN MGMT 30 MINS
|
Professional
|
Both
|
$298.10
|
|
|
Service Code
|
HCPCS G3002
|
| Min. Negotiated Rate |
$58.25 |
| Max. Negotiated Rate |
$187.25 |
| Rate for Payer: Cash Price |
$82.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$83.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$79.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$83.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$79.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.41
|
| Rate for Payer: Healthfirst Commercial |
$83.22
|
| Rate for Payer: Healthfirst Essential Plan |
$187.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$79.06
|
| Rate for Payer: Healthfirst QHP |
$83.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$83.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$83.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62.41
|
| Rate for Payer: SOMOS Essential |
$62.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$83.22
|
|
|
PR CHRONIC PAIN MGMT ADDL 15M
|
Professional
|
Both
|
$103.74
|
|
|
Service Code
|
HCPCS G3003
|
| Min. Negotiated Rate |
$20.03 |
| Max. Negotiated Rate |
$64.39 |
| Rate for Payer: Cash Price |
$28.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.46
|
| Rate for Payer: Healthfirst Commercial |
$28.62
|
| Rate for Payer: Healthfirst Essential Plan |
$64.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.19
|
| Rate for Payer: Healthfirst QHP |
$28.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.46
|
| Rate for Payer: SOMOS Essential |
$21.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.62
|
|
|
PR CILIARY BODY DESTRUCTION CRYOTHERAPY
|
Professional
|
Both
|
$1,696.80
|
|
|
Service Code
|
HCPCS 66720
|
| Min. Negotiated Rate |
$324.88 |
| Max. Negotiated Rate |
$1,044.25 |
| Rate for Payer: Cash Price |
$469.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$464.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$417.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$417.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$440.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$464.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$440.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$464.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$464.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$348.08
|
| Rate for Payer: Healthfirst Commercial |
$464.11
|
| Rate for Payer: Healthfirst Essential Plan |
$1,044.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$440.90
|
| Rate for Payer: Healthfirst QHP |
$464.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$324.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$464.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$394.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$324.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$464.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$348.08
|
| Rate for Payer: SOMOS Essential |
$348.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$464.11
|
|
|
PR CILIARY BODY DESTRUCTION CYCLODIALYSIS
|
Professional
|
Both
|
$1,607.38
|
|
|
Service Code
|
HCPCS 66740
|
| Min. Negotiated Rate |
$307.00 |
| Max. Negotiated Rate |
$986.78 |
| Rate for Payer: Cash Price |
$444.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$438.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$394.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$394.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$416.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$438.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$416.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$438.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$438.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$328.93
|
| Rate for Payer: Healthfirst Commercial |
$438.57
|
| Rate for Payer: Healthfirst Essential Plan |
$986.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$416.64
|
| Rate for Payer: Healthfirst QHP |
$438.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$307.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$438.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$372.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$307.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$438.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$328.93
|
| Rate for Payer: SOMOS Essential |
$328.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$438.57
|
|
|
PR CILIARY BODY DESTRUCTION DIATHERMY
|
Professional
|
Both
|
$1,607.38
|
|
|
Service Code
|
HCPCS 66700
|
| Min. Negotiated Rate |
$307.00 |
| Max. Negotiated Rate |
$986.78 |
| Rate for Payer: Cash Price |
$444.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$438.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$394.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$394.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$416.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$438.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$416.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$438.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$438.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$328.93
|
| Rate for Payer: Healthfirst Commercial |
$438.57
|
| Rate for Payer: Healthfirst Essential Plan |
$986.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$416.64
|
| Rate for Payer: Healthfirst QHP |
$438.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$307.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$438.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$372.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$307.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$438.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$328.93
|
| Rate for Payer: SOMOS Essential |
$328.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$438.57
|
|
|
PR CILIARY BODY DSTRJ CYCLOPHOTOCOAG TRANSSCERAL
|
Professional
|
Both
|
$1,607.38
|
|
|
Service Code
|
HCPCS 66710
|
| Min. Negotiated Rate |
$307.00 |
| Max. Negotiated Rate |
$986.78 |
| Rate for Payer: Cash Price |
$443.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$438.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$394.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$394.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$416.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$438.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$416.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$438.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$438.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$328.93
|
| Rate for Payer: Healthfirst Commercial |
$438.57
|
| Rate for Payer: Healthfirst Essential Plan |
$986.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$416.64
|
| Rate for Payer: Healthfirst QHP |
$438.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$307.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$438.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$372.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$307.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$438.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$328.93
|
| Rate for Payer: SOMOS Essential |
$328.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$438.57
|
|
|
PR CIRCUMCISION AGE >28 DAYS
|
Professional
|
Both
|
$830.03
|
|
|
Service Code
|
HCPCS 54161
|
| Min. Negotiated Rate |
$158.50 |
| Max. Negotiated Rate |
$509.47 |
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$226.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$203.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$203.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$215.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$226.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$215.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$226.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$226.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$169.82
|
| Rate for Payer: Healthfirst Commercial |
$226.43
|
| Rate for Payer: Healthfirst Essential Plan |
$509.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$215.11
|
| Rate for Payer: Healthfirst QHP |
$226.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$158.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$226.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$192.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$158.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$226.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$169.82
|
| Rate for Payer: SOMOS Essential |
$169.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$226.43
|
|
|
PR CIRCUMCISION NEONATE
|
Professional
|
Both
|
$610.26
|
|
|
Service Code
|
HCPCS 54160
|
| Min. Negotiated Rate |
$115.67 |
| Max. Negotiated Rate |
$371.81 |
| Rate for Payer: Cash Price |
$167.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$165.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$148.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$148.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$156.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$165.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$156.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$123.94
|
| Rate for Payer: Healthfirst Commercial |
$165.25
|
| Rate for Payer: Healthfirst Essential Plan |
$371.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.99
|
| Rate for Payer: Healthfirst QHP |
$165.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$115.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$165.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$140.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$115.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$165.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$123.94
|
| Rate for Payer: SOMOS Essential |
$123.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$165.25
|
|
|
PR CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK
|
Professional
|
Both
|
$407.02
|
|
|
Service Code
|
HCPCS 54150
|
| Min. Negotiated Rate |
$76.03 |
| Max. Negotiated Rate |
$244.40 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$108.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$97.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$97.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$103.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$108.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$103.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$108.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$108.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$81.47
|
| Rate for Payer: Healthfirst Commercial |
$108.62
|
| Rate for Payer: Healthfirst Essential Plan |
$244.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$103.19
|
| Rate for Payer: Healthfirst QHP |
$108.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$76.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$108.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$92.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$76.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$108.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$81.47
|
| Rate for Payer: SOMOS Essential |
$81.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$108.62
|
|
|
PR CISTERNAL/LATERAL C1-C2 PUNCTURE W/INJECTION
|
Professional
|
Both
|
$511.18
|
|
|
Service Code
|
HCPCS 61055
|
| Min. Negotiated Rate |
$92.26 |
| Max. Negotiated Rate |
$296.55 |
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$131.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$118.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$118.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$125.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$131.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$125.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$131.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$98.85
|
| Rate for Payer: Healthfirst Commercial |
$131.80
|
| Rate for Payer: Healthfirst Essential Plan |
$296.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.21
|
| Rate for Payer: Healthfirst QHP |
$131.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$131.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$112.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$92.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$131.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$98.85
|
| Rate for Payer: SOMOS Essential |
$98.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$131.80
|
|
|
PR CISTERNAL/LATERAL C1-C2 PUNCTURE W/O INJ SPX
|
Professional
|
Both
|
$328.34
|
|
|
Service Code
|
HCPCS 61050
|
| Min. Negotiated Rate |
$63.28 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Cash Price |
$89.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$90.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$90.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.80
|
| Rate for Payer: Healthfirst Commercial |
$90.40
|
| Rate for Payer: Healthfirst Essential Plan |
$203.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.88
|
| Rate for Payer: Healthfirst QHP |
$90.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$90.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$76.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.80
|
| Rate for Payer: SOMOS Essential |
$67.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.40
|
|
|
PR CJP RCNSTJ CUL-DE-SAC BUCCAL GRF/XTNSV REARRGMT
|
Professional
|
Both
|
$2,649.68
|
|
|
Service Code
|
HCPCS 68326
|
| Min. Negotiated Rate |
$505.37 |
| Max. Negotiated Rate |
$1,624.41 |
| Rate for Payer: Cash Price |
$730.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$721.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$649.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$649.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$685.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$721.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$685.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$721.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$721.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$541.47
|
| Rate for Payer: Healthfirst Commercial |
$721.96
|
| Rate for Payer: Healthfirst Essential Plan |
$1,624.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$685.86
|
| Rate for Payer: Healthfirst QHP |
$721.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$505.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$721.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$613.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$505.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$721.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$541.47
|
| Rate for Payer: SOMOS Essential |
$541.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$721.96
|
|
|
PR CLAVICULECTOMY PARTIAL
|
Professional
|
Both
|
$2,611.35
|
|
|
Service Code
|
HCPCS 23120
|
| Min. Negotiated Rate |
$493.42 |
| Max. Negotiated Rate |
$1,585.98 |
| Rate for Payer: Cash Price |
$709.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$704.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$634.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$634.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$669.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$704.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$669.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$704.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$704.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$528.66
|
| Rate for Payer: Healthfirst Commercial |
$704.88
|
| Rate for Payer: Healthfirst Essential Plan |
$1,585.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$669.64
|
| Rate for Payer: Healthfirst QHP |
$704.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$493.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$704.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$599.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$493.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$704.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$528.66
|
| Rate for Payer: SOMOS Essential |
$528.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$704.88
|
|
|
PR CLAVICULECTOMY TOTAL
|
Professional
|
Both
|
$3,154.13
|
|
|
Service Code
|
HCPCS 23125
|
| Min. Negotiated Rate |
$594.85 |
| Max. Negotiated Rate |
$1,912.01 |
| Rate for Payer: Cash Price |
$853.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$849.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$764.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$764.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$807.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$849.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$807.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$849.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$849.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$637.34
|
| Rate for Payer: Healthfirst Commercial |
$849.78
|
| Rate for Payer: Healthfirst Essential Plan |
$1,912.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$807.29
|
| Rate for Payer: Healthfirst QHP |
$849.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$594.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$849.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$722.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$594.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$849.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$637.34
|
| Rate for Payer: SOMOS Essential |
$637.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$849.78
|
|
|
PR CLITOROPLASTY INTERSEX STATE
|
Professional
|
Both
|
$5,089.39
|
|
|
Service Code
|
HCPCS 56805
|
| Min. Negotiated Rate |
$943.67 |
| Max. Negotiated Rate |
$3,033.22 |
| Rate for Payer: Cash Price |
$1,370.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,348.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,213.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,213.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,280.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,348.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,280.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,348.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,348.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,011.08
|
| Rate for Payer: Healthfirst Commercial |
$1,348.10
|
| Rate for Payer: Healthfirst Essential Plan |
$3,033.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,280.69
|
| Rate for Payer: Healthfirst QHP |
$1,348.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$943.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,348.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,145.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$943.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,348.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,011.08
|
| Rate for Payer: SOMOS Essential |
$1,011.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,348.10
|
|
|
PR CLOSED TREATMENT COCCYGEAL FRACTURE
|
Professional
|
Both
|
$841.96
|
|
|
Service Code
|
HCPCS 27200
|
| Min. Negotiated Rate |
$165.34 |
| Max. Negotiated Rate |
$531.45 |
| Rate for Payer: Cash Price |
$235.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$236.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$212.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$212.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$224.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$236.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$224.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$236.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$236.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$177.15
|
| Rate for Payer: Healthfirst Commercial |
$236.20
|
| Rate for Payer: Healthfirst Essential Plan |
$531.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$224.39
|
| Rate for Payer: Healthfirst QHP |
$236.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$165.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$236.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$200.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$165.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$236.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$177.15
|
| Rate for Payer: SOMOS Essential |
$177.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$236.20
|
|
|
PR CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ
|
Professional
|
Both
|
$2,002.28
|
|
|
Service Code
|
HCPCS 27768
|
| Min. Negotiated Rate |
$381.70 |
| Max. Negotiated Rate |
$1,226.88 |
| Rate for Payer: Cash Price |
$547.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$545.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$490.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$490.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$518.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$545.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$518.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$545.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$545.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$408.96
|
| Rate for Payer: Healthfirst Commercial |
$545.28
|
| Rate for Payer: Healthfirst Essential Plan |
$1,226.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$518.02
|
| Rate for Payer: Healthfirst QHP |
$545.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$381.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$545.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$463.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$381.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$545.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$408.96
|
| Rate for Payer: SOMOS Essential |
$408.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$545.28
|
|
|
PR CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANJ
|
Professional
|
Both
|
$1,297.03
|
|
|
Service Code
|
HCPCS 27767
|
| Min. Negotiated Rate |
$251.04 |
| Max. Negotiated Rate |
$806.92 |
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$358.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$322.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$322.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$340.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$358.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$340.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$358.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$358.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$268.97
|
| Rate for Payer: Healthfirst Commercial |
$358.63
|
| Rate for Payer: Healthfirst Essential Plan |
$806.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$340.70
|
| Rate for Payer: Healthfirst QHP |
$358.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$251.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$358.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$304.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$251.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$358.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$268.97
|
| Rate for Payer: SOMOS Essential |
$268.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$358.63
|
|
