|
PR CLTX TARSAL DISLC OTH/THN TALOTARSAL W/ANES
|
Professional
|
Both
|
$1,212.40
|
|
|
Service Code
|
HCPCS 28545
|
| Min. Negotiated Rate |
$232.90 |
| Max. Negotiated Rate |
$748.60 |
| Rate for Payer: Cash Price |
$332.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$332.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$299.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$299.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$316.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$332.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$316.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$332.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$332.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$249.53
|
| Rate for Payer: Healthfirst Commercial |
$332.71
|
| Rate for Payer: Healthfirst Essential Plan |
$748.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$316.07
|
| Rate for Payer: Healthfirst QHP |
$332.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$232.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$332.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$282.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$232.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$332.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$249.53
|
| Rate for Payer: SOMOS Essential |
$249.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$332.71
|
|
|
PR CLTX TARSAL DISLC OTH/THN TALOTARSAL W/O ANES
|
Professional
|
Both
|
$743.30
|
|
|
Service Code
|
HCPCS 28540
|
| Min. Negotiated Rate |
$144.78 |
| Max. Negotiated Rate |
$465.37 |
| Rate for Payer: Cash Price |
$207.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$206.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$186.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$186.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$196.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$206.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$196.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$206.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$206.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$155.12
|
| Rate for Payer: Healthfirst Commercial |
$206.83
|
| Rate for Payer: Healthfirst Essential Plan |
$465.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.49
|
| Rate for Payer: Healthfirst QHP |
$206.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$144.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$206.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$175.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$144.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$206.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$155.12
|
| Rate for Payer: SOMOS Essential |
$155.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$206.83
|
|
|
PR CLTX TIBIAL FX PROXIMAL W/O MANIPULATION
|
Professional
|
Both
|
$1,296.58
|
|
|
Service Code
|
HCPCS 27530
|
| Min. Negotiated Rate |
$249.16 |
| Max. Negotiated Rate |
$800.87 |
| Rate for Payer: Cash Price |
$356.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$355.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$320.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$320.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$338.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$355.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$338.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$355.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$266.95
|
| Rate for Payer: Healthfirst Commercial |
$355.94
|
| Rate for Payer: Healthfirst Essential Plan |
$800.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$338.14
|
| Rate for Payer: Healthfirst QHP |
$355.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$249.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$355.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$302.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$249.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$355.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$266.95
|
| Rate for Payer: SOMOS Essential |
$266.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$355.94
|
|
|
PR CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ
|
Professional
|
Both
|
$2,579.22
|
|
|
Service Code
|
HCPCS 27532
|
| Min. Negotiated Rate |
$489.43 |
| Max. Negotiated Rate |
$1,573.18 |
| Rate for Payer: Cash Price |
$701.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$699.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$629.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$629.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$664.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$699.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$664.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$699.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$699.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$524.39
|
| Rate for Payer: Healthfirst Commercial |
$699.19
|
| Rate for Payer: Healthfirst Essential Plan |
$1,573.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$664.23
|
| Rate for Payer: Healthfirst QHP |
$699.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$489.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$699.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$594.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$489.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$699.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$524.39
|
| Rate for Payer: SOMOS Essential |
$524.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$699.19
|
|
|
PR CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ
|
Professional
|
Both
|
$2,196.67
|
|
|
Service Code
|
HCPCS 27752
|
| Min. Negotiated Rate |
$414.28 |
| Max. Negotiated Rate |
$1,331.62 |
| Rate for Payer: Cash Price |
$595.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$591.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$532.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$532.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$562.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$591.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$562.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$591.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$591.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$443.87
|
| Rate for Payer: Healthfirst Commercial |
$591.83
|
| Rate for Payer: Healthfirst Essential Plan |
$1,331.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$562.24
|
| Rate for Payer: Healthfirst QHP |
$591.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$414.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$591.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$503.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$414.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$591.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$443.87
|
| Rate for Payer: SOMOS Essential |
$443.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$591.83
|
|
|
PR CLTX TIBIAL SHAFT FX W/O MANIPULATION
|
Professional
|
Both
|
$1,448.06
|
|
|
Service Code
|
HCPCS 27750
|
| Min. Negotiated Rate |
$276.77 |
| Max. Negotiated Rate |
$889.61 |
| Rate for Payer: Cash Price |
$397.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$395.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$355.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$355.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$375.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$395.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$375.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$395.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$395.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$296.54
|
| Rate for Payer: Healthfirst Commercial |
$395.38
|
| Rate for Payer: Healthfirst Essential Plan |
$889.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$375.61
|
| Rate for Payer: Healthfirst QHP |
$395.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$276.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$395.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$336.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$276.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$395.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$296.54
|
| Rate for Payer: SOMOS Essential |
$296.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$395.38
|
|
|
PR CLTX TRANS-SCAPHOPRILUNAR TYP FX DISLC W/MANJ
|
Professional
|
Both
|
$2,371.36
|
|
|
Service Code
|
HCPCS 25680
|
| Min. Negotiated Rate |
$451.24 |
| Max. Negotiated Rate |
$1,450.42 |
| Rate for Payer: Cash Price |
$645.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$644.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$580.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$580.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$612.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$644.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$612.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$644.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$644.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$483.47
|
| Rate for Payer: Healthfirst Commercial |
$644.63
|
| Rate for Payer: Healthfirst Essential Plan |
$1,450.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$612.40
|
| Rate for Payer: Healthfirst QHP |
$644.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$451.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$644.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$547.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$451.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$644.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$483.47
|
| Rate for Payer: SOMOS Essential |
$483.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$644.63
|
|
|
PR CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION
|
Professional
|
Both
|
$1,972.04
|
|
|
Service Code
|
HCPCS 27818
|
| Min. Negotiated Rate |
$374.45 |
| Max. Negotiated Rate |
$1,203.59 |
| Rate for Payer: Cash Price |
$537.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$534.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$481.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$481.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$508.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$534.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$508.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$534.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$534.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$401.20
|
| Rate for Payer: Healthfirst Commercial |
$534.93
|
| Rate for Payer: Healthfirst Essential Plan |
$1,203.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$508.18
|
| Rate for Payer: Healthfirst QHP |
$534.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$374.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$534.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$454.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$374.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$534.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$401.20
|
| Rate for Payer: SOMOS Essential |
$401.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$534.93
|
|
|
PR CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION
|
Professional
|
Both
|
$1,315.16
|
|
|
Service Code
|
HCPCS 27816
|
| Min. Negotiated Rate |
$252.97 |
| Max. Negotiated Rate |
$813.11 |
| Rate for Payer: Cash Price |
$362.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$361.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$325.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$325.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$343.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$361.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$343.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$361.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$361.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$271.04
|
| Rate for Payer: Healthfirst Commercial |
$361.38
|
| Rate for Payer: Healthfirst Essential Plan |
$813.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$343.31
|
| Rate for Payer: Healthfirst QHP |
$361.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$252.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$361.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$307.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$252.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$361.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$271.04
|
| Rate for Payer: SOMOS Essential |
$271.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$361.38
|
|
|
PR CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING
|
Professional
|
Both
|
$1,325.87
|
|
|
Service Code
|
HCPCS 22310
|
| Min. Negotiated Rate |
$251.28 |
| Max. Negotiated Rate |
$807.68 |
| Rate for Payer: Cash Price |
$360.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$358.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$323.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$323.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$341.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$358.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$341.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$358.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$358.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$269.23
|
| Rate for Payer: Healthfirst Commercial |
$358.97
|
| Rate for Payer: Healthfirst Essential Plan |
$807.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$341.02
|
| Rate for Payer: Healthfirst QHP |
$358.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$251.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$358.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$305.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$251.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$358.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$269.23
|
| Rate for Payer: SOMOS Essential |
$269.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$358.97
|
|
|
PR CLTX VRT FX&/DISLC CSTING/BRACING MANJ/TRCJ
|
Professional
|
Both
|
$3,463.04
|
|
|
Service Code
|
HCPCS 22315
|
| Min. Negotiated Rate |
$661.83 |
| Max. Negotiated Rate |
$2,127.31 |
| Rate for Payer: Cash Price |
$943.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$945.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$850.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$850.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$898.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$945.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$898.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$945.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$945.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$709.10
|
| Rate for Payer: Healthfirst Commercial |
$945.47
|
| Rate for Payer: Healthfirst Essential Plan |
$2,127.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$898.20
|
| Rate for Payer: Healthfirst QHP |
$945.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$661.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$945.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$803.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$661.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$945.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$709.10
|
| Rate for Payer: SOMOS Essential |
$709.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$945.47
|
|
|
PR CMBND ANTERPOST COLPORRAPHY W/CYSTO
|
Professional
|
Both
|
$3,384.26
|
|
|
Service Code
|
HCPCS 57260
|
| Min. Negotiated Rate |
$630.68 |
| Max. Negotiated Rate |
$2,027.18 |
| Rate for Payer: Cash Price |
$913.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$900.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$810.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$810.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$855.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$900.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$855.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$900.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$900.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$675.73
|
| Rate for Payer: Healthfirst Commercial |
$900.97
|
| Rate for Payer: Healthfirst Essential Plan |
$2,027.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$855.92
|
| Rate for Payer: Healthfirst QHP |
$900.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$630.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$900.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$765.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$630.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$900.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$675.73
|
| Rate for Payer: SOMOS Essential |
$675.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$900.97
|
|
|
PR CMBND ANTERPOST COLPORRAPHY W/CYSTO W/NTRCL RPR
|
Professional
|
Both
|
$3,795.82
|
|
|
Service Code
|
HCPCS 57265
|
| Min. Negotiated Rate |
$705.26 |
| Max. Negotiated Rate |
$2,266.92 |
| Rate for Payer: Cash Price |
$1,021.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,007.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$906.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$906.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$957.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,007.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$957.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,007.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,007.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$755.64
|
| Rate for Payer: Healthfirst Commercial |
$1,007.52
|
| Rate for Payer: Healthfirst Essential Plan |
$2,266.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$957.14
|
| Rate for Payer: Healthfirst QHP |
$1,007.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$705.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,007.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$856.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$705.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,007.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$755.64
|
| Rate for Payer: SOMOS Essential |
$755.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,007.52
|
|
|
PR CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI
|
Professional
|
Both
|
$132.16
|
|
|
Service Code
|
HCPCS 92132
|
| Min. Negotiated Rate |
$17.36 |
| Max. Negotiated Rate |
$75.92 |
| Rate for Payer: Amida Care Medicaid |
$17.36
|
| Rate for Payer: Cash Price |
$36.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.30
|
| Rate for Payer: Healthfirst Commercial |
$33.74
|
| Rate for Payer: Healthfirst Essential Plan |
$75.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.05
|
| Rate for Payer: Healthfirst QHP |
$33.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.30
|
| Rate for Payer: SOMOS Essential |
$25.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.74
|
|
|
PR CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI
|
Professional
|
Both
|
$67.41
|
|
|
Service Code
|
HCPCS 92132 TC
|
| Min. Negotiated Rate |
$11.84 |
| Max. Negotiated Rate |
$38.07 |
| Rate for Payer: Amida Care Medicaid |
$17.36
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.69
|
| Rate for Payer: Healthfirst Commercial |
$16.92
|
| Rate for Payer: Healthfirst Essential Plan |
$38.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.07
|
| Rate for Payer: Healthfirst QHP |
$16.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.69
|
| Rate for Payer: SOMOS Essential |
$12.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.92
|
|
|
PR CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI
|
Professional
|
Both
|
$64.75
|
|
|
Service Code
|
HCPCS 92132 26
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$37.84 |
| Rate for Payer: Amida Care Medicaid |
$17.36
|
| Rate for Payer: Cash Price |
$17.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.62
|
| Rate for Payer: Healthfirst Commercial |
$16.82
|
| Rate for Payer: Healthfirst Essential Plan |
$37.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.98
|
| Rate for Payer: Healthfirst QHP |
$16.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.62
|
| Rate for Payer: SOMOS Essential |
$12.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.82
|
|
|
PR CNTRST NJX ASSMT ABSC/CST VIA DRG CATH/TUBE SPX
|
Professional
|
Both
|
$154.46
|
|
|
Service Code
|
HCPCS 49424
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$91.35 |
| Rate for Payer: Cash Price |
$41.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.45
|
| Rate for Payer: Healthfirst Commercial |
$40.60
|
| Rate for Payer: Healthfirst Essential Plan |
$91.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.57
|
| Rate for Payer: Healthfirst QHP |
$40.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.45
|
| Rate for Payer: SOMOS Essential |
$30.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.60
|
|
|
PR CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT
|
Professional
|
Both
|
$146.34
|
|
|
Service Code
|
HCPCS 36598
|
| Min. Negotiated Rate |
$26.96 |
| Max. Negotiated Rate |
$86.67 |
| Rate for Payer: Cash Price |
$39.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.89
|
| Rate for Payer: Healthfirst Commercial |
$38.52
|
| Rate for Payer: Healthfirst Essential Plan |
$86.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.59
|
| Rate for Payer: Healthfirst QHP |
$38.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.89
|
| Rate for Payer: SOMOS Essential |
$28.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.52
|
|
|
PR COCCYGECTOMY PRIMARY
|
Professional
|
Both
|
$2,302.27
|
|
|
Service Code
|
HCPCS 27080
|
| Min. Negotiated Rate |
$428.50 |
| Max. Negotiated Rate |
$1,377.34 |
| Rate for Payer: Cash Price |
$616.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$612.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$550.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$550.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$581.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$612.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$581.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$612.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$612.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$459.11
|
| Rate for Payer: Healthfirst Commercial |
$612.15
|
| Rate for Payer: Healthfirst Essential Plan |
$1,377.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$581.54
|
| Rate for Payer: Healthfirst QHP |
$612.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$428.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$612.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$520.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$428.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$612.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$459.11
|
| Rate for Payer: SOMOS Essential |
$459.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$612.15
|
|
|
PR COCHLEAR DEVICE IMPLANTATION W/WO MASTOIDECTOMY
|
Professional
|
Both
|
$5,260.47
|
|
|
Service Code
|
HCPCS 69930
|
| Min. Negotiated Rate |
$975.66 |
| Max. Negotiated Rate |
$3,136.05 |
| Rate for Payer: Cash Price |
$1,418.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,393.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,254.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,254.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,324.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,393.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,324.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,393.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,393.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,045.35
|
| Rate for Payer: Healthfirst Commercial |
$1,393.80
|
| Rate for Payer: Healthfirst Essential Plan |
$3,136.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,324.11
|
| Rate for Payer: Healthfirst QHP |
$1,393.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$975.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,393.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,184.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$975.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,393.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,045.35
|
| Rate for Payer: SOMOS Essential |
$1,045.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,393.80
|
|
|
PR CO DIFFUSING CAPACITY
|
Professional
|
Both
|
$206.85
|
|
|
Service Code
|
HCPCS 94729 TC
|
| Min. Negotiated Rate |
$24.87 |
| Max. Negotiated Rate |
$124.54 |
| Rate for Payer: Amida Care Medicaid |
$24.87
|
| Rate for Payer: Cash Price |
$56.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$55.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$52.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.51
|
| Rate for Payer: Healthfirst Commercial |
$55.35
|
| Rate for Payer: Healthfirst Essential Plan |
$124.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.58
|
| Rate for Payer: Healthfirst QHP |
$55.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$55.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.51
|
| Rate for Payer: SOMOS Essential |
$41.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.35
|
|
|
PR CO DIFFUSING CAPACITY
|
Professional
|
Both
|
$35.18
|
|
|
Service Code
|
HCPCS 94729 26
|
| Min. Negotiated Rate |
$6.64 |
| Max. Negotiated Rate |
$24.87 |
| Rate for Payer: Amida Care Medicaid |
$24.87
|
| Rate for Payer: Cash Price |
$9.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.12
|
| Rate for Payer: Healthfirst Commercial |
$9.49
|
| Rate for Payer: Healthfirst Essential Plan |
$21.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.02
|
| Rate for Payer: Healthfirst QHP |
$9.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.12
|
| Rate for Payer: SOMOS Essential |
$7.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.49
|
|
|
PR CO DIFFUSING CAPACITY
|
Professional
|
Both
|
$242.03
|
|
|
Service Code
|
HCPCS 94729
|
| Min. Negotiated Rate |
$24.87 |
| Max. Negotiated Rate |
$145.89 |
| Rate for Payer: Amida Care Medicaid |
$24.87
|
| Rate for Payer: Cash Price |
$66.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$64.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$61.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.63
|
| Rate for Payer: Healthfirst Commercial |
$64.84
|
| Rate for Payer: Healthfirst Essential Plan |
$145.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.60
|
| Rate for Payer: Healthfirst QHP |
$64.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$64.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.63
|
| Rate for Payer: SOMOS Essential |
$48.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.84
|
|
|
PR COLCT TOT ABDL W/O PRCTECT W/CONTINENT ILEOST
|
Professional
|
Both
|
$9,701.76
|
|
|
Service Code
|
HCPCS 44151
|
| Min. Negotiated Rate |
$1,788.64 |
| Max. Negotiated Rate |
$5,749.20 |
| Rate for Payer: Cash Price |
$2,581.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,555.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,299.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,299.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,427.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,555.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,427.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,555.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,555.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,916.40
|
| Rate for Payer: Healthfirst Commercial |
$2,555.20
|
| Rate for Payer: Healthfirst Essential Plan |
$5,749.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,427.44
|
| Rate for Payer: Healthfirst QHP |
$2,555.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,788.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,555.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,171.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,788.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,555.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,916.40
|
| Rate for Payer: SOMOS Essential |
$1,916.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,555.20
|
|
|
PR COLCT TOT ABDL W/O PRCTECT W/ILEOST/ILEOPXTS
|
Professional
|
Both
|
$8,218.21
|
|
|
Service Code
|
HCPCS 44150
|
| Min. Negotiated Rate |
$1,524.58 |
| Max. Negotiated Rate |
$4,900.43 |
| Rate for Payer: Cash Price |
$2,195.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,177.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,960.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,960.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,069.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,177.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,069.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,177.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,177.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,633.48
|
| Rate for Payer: Healthfirst Commercial |
$2,177.97
|
| Rate for Payer: Healthfirst Essential Plan |
$4,900.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,069.07
|
| Rate for Payer: Healthfirst QHP |
$2,177.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,524.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,177.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,851.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,524.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,177.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,633.48
|
| Rate for Payer: SOMOS Essential |
$1,633.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,177.97
|
|
