|
PR CYSTO W/TX URETERAL STRICTURE
|
Professional
|
Both
|
$1,178.56
|
|
|
Service Code
|
HCPCS 52341
|
| Min. Negotiated Rate |
$222.73 |
| Max. Negotiated Rate |
$715.93 |
| Rate for Payer: Cash Price |
$320.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$318.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$286.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$286.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$302.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$318.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$302.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$318.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$318.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$238.64
|
| Rate for Payer: Healthfirst Commercial |
$318.19
|
| Rate for Payer: Healthfirst Essential Plan |
$715.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$302.28
|
| Rate for Payer: Healthfirst QHP |
$318.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$222.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$318.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$270.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$222.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$318.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$238.64
|
| Rate for Payer: SOMOS Essential |
$238.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$318.19
|
|
|
PR CYSTO W/TX URETEROPELVIC JUNCTION STRICTURE
|
Professional
|
Both
|
$1,276.56
|
|
|
Service Code
|
HCPCS 52342
|
| Min. Negotiated Rate |
$242.70 |
| Max. Negotiated Rate |
$780.12 |
| Rate for Payer: Cash Price |
$349.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$346.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$312.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$312.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$329.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$346.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$329.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$346.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$346.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$260.04
|
| Rate for Payer: Healthfirst Commercial |
$346.72
|
| Rate for Payer: Healthfirst Essential Plan |
$780.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$329.38
|
| Rate for Payer: Healthfirst QHP |
$346.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$242.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$346.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$294.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$242.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$346.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$260.04
|
| Rate for Payer: SOMOS Essential |
$260.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$346.72
|
|
|
PR CYSTO W/URETEROSCOPY W/LITHOTRIPSY
|
Professional
|
Both
|
$1,621.17
|
|
|
Service Code
|
HCPCS 52353
|
| Min. Negotiated Rate |
$306.59 |
| Max. Negotiated Rate |
$985.46 |
| Rate for Payer: Cash Price |
$441.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$437.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$394.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$394.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$416.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$437.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$416.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$437.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$437.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$328.49
|
| Rate for Payer: Healthfirst Commercial |
$437.98
|
| Rate for Payer: Healthfirst Essential Plan |
$985.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$416.08
|
| Rate for Payer: Healthfirst QHP |
$437.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$306.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$437.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$372.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$306.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$437.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$328.49
|
| Rate for Payer: SOMOS Essential |
$328.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$437.98
|
|
|
PR CYSTO W/URETEROSCOPY W/RMVL/MANJ STONES
|
Professional
|
Both
|
$1,463.95
|
|
|
Service Code
|
HCPCS 52352
|
| Min. Negotiated Rate |
$278.14 |
| Max. Negotiated Rate |
$894.01 |
| Rate for Payer: Cash Price |
$399.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$397.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$357.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$357.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$377.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$397.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$377.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$397.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$397.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$298.00
|
| Rate for Payer: Healthfirst Commercial |
$397.34
|
| Rate for Payer: Healthfirst Essential Plan |
$894.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$377.47
|
| Rate for Payer: Healthfirst QHP |
$397.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$278.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$397.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$337.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$278.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$397.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$298.00
|
| Rate for Payer: SOMOS Essential |
$298.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$397.34
|
|
|
PR CYSTO W/URTRL CATHJ BRUSH BX URTR&/RENAL PELVIS
|
Professional
|
Both
|
$689.36
|
|
|
Service Code
|
HCPCS 52007
|
| Min. Negotiated Rate |
$131.82 |
| Max. Negotiated Rate |
$423.70 |
| Rate for Payer: Cash Price |
$189.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$188.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$169.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$169.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$178.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$188.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$178.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$188.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$188.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$141.23
|
| Rate for Payer: Healthfirst Commercial |
$188.31
|
| Rate for Payer: Healthfirst Essential Plan |
$423.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$178.89
|
| Rate for Payer: Healthfirst QHP |
$188.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$131.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$188.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$160.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$131.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$188.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$141.23
|
| Rate for Payer: SOMOS Essential |
$141.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$188.31
|
|
|
PR CYSTO W/URTROSCOPY&/PYELOSCOPY DX
|
Professional
|
Both
|
$1,248.49
|
|
|
Service Code
|
HCPCS 52351
|
| Min. Negotiated Rate |
$238.12 |
| Max. Negotiated Rate |
$765.38 |
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$340.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$306.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$306.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$323.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$340.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$340.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$340.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$255.13
|
| Rate for Payer: Healthfirst Commercial |
$340.17
|
| Rate for Payer: Healthfirst Essential Plan |
$765.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$323.16
|
| Rate for Payer: Healthfirst QHP |
$340.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$238.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$340.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$289.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$238.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$340.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$255.13
|
| Rate for Payer: SOMOS Essential |
$255.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$340.17
|
|
|
PR CYSTO W/URTROSCOPY W/TX INTRA-RENAL STRICTURE
|
Professional
|
Both
|
$1,842.47
|
|
|
Service Code
|
HCPCS 52346
|
| Min. Negotiated Rate |
$349.29 |
| Max. Negotiated Rate |
$1,122.70 |
| Rate for Payer: Cash Price |
$503.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$498.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$449.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$449.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$474.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$498.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$474.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$498.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$498.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$374.24
|
| Rate for Payer: Healthfirst Commercial |
$498.98
|
| Rate for Payer: Healthfirst Essential Plan |
$1,122.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$474.03
|
| Rate for Payer: Healthfirst QHP |
$498.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$349.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$498.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$424.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$349.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$498.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$374.24
|
| Rate for Payer: SOMOS Essential |
$374.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$498.98
|
|
|
PR CYSTO W/URTROSCOPY W/TX URETERAL STRICTURE
|
Professional
|
Both
|
$1,522.68
|
|
|
Service Code
|
HCPCS 52344
|
| Min. Negotiated Rate |
$289.66 |
| Max. Negotiated Rate |
$931.05 |
| Rate for Payer: Cash Price |
$416.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$413.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$372.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$372.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$393.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$413.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$393.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$413.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$413.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$310.35
|
| Rate for Payer: Healthfirst Commercial |
$413.80
|
| Rate for Payer: Healthfirst Essential Plan |
$931.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$393.11
|
| Rate for Payer: Healthfirst QHP |
$413.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$289.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$413.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$351.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$289.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$413.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$310.35
|
| Rate for Payer: SOMOS Essential |
$310.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$413.80
|
|
|
PR CYSTO W/URTROSCOPY W/TX URTROPEL JUNCT STRIX
|
Professional
|
Both
|
$1,628.87
|
|
|
Service Code
|
HCPCS 52345
|
| Min. Negotiated Rate |
$308.77 |
| Max. Negotiated Rate |
$992.48 |
| Rate for Payer: Cash Price |
$444.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$441.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$396.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$396.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$419.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$441.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$419.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$441.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$441.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$330.82
|
| Rate for Payer: Healthfirst Commercial |
$441.10
|
| Rate for Payer: Healthfirst Essential Plan |
$992.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$419.05
|
| Rate for Payer: Healthfirst QHP |
$441.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$308.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$441.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$374.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$308.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$441.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$330.82
|
| Rate for Payer: SOMOS Essential |
$330.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$441.10
|
|
|
PR CYTO/MOLECULAR REPORT
|
Professional
|
Both
|
$130.97
|
|
|
Service Code
|
HCPCS 88291
|
| Min. Negotiated Rate |
$26.45 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.34
|
| Rate for Payer: Healthfirst Commercial |
$37.78
|
| Rate for Payer: Healthfirst Essential Plan |
$85.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.89
|
| Rate for Payer: Healthfirst QHP |
$37.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.34
|
| Rate for Payer: SOMOS Essential |
$28.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.78
|
|
|
PR DACRYOCSTORHINOSTOMY
|
Professional
|
Both
|
$3,369.59
|
|
|
Service Code
|
HCPCS 68720
|
| Min. Negotiated Rate |
$635.95 |
| Max. Negotiated Rate |
$2,044.12 |
| Rate for Payer: Cash Price |
$923.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$908.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$817.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$817.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$863.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$908.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$863.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$908.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$908.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$681.38
|
| Rate for Payer: Healthfirst Commercial |
$908.50
|
| Rate for Payer: Healthfirst Essential Plan |
$2,044.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$863.08
|
| Rate for Payer: Healthfirst QHP |
$908.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$635.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$908.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$772.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$635.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$908.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$681.38
|
| Rate for Payer: SOMOS Essential |
$681.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$908.50
|
|
|
PR DBRDMT EXTENSV ECZMT/INFCT SKIN UP 10% BDY SURF
|
Professional
|
Both
|
$109.10
|
|
|
Service Code
|
HCPCS 11000
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$66.04 |
| Rate for Payer: Cash Price |
$30.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.01
|
| Rate for Payer: Healthfirst Commercial |
$29.35
|
| Rate for Payer: Healthfirst Essential Plan |
$66.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.88
|
| Rate for Payer: Healthfirst QHP |
$29.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.01
|
| Rate for Payer: SOMOS Essential |
$22.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.35
|
|
|
PR DBRDMT EXTNSVE ECZMT/INFCT SKN EA ADDL 10%
|
Professional
|
Both
|
$62.90
|
|
|
Service Code
|
HCPCS 11001
|
| Min. Negotiated Rate |
$11.52 |
| Max. Negotiated Rate |
$37.03 |
| Rate for Payer: Cash Price |
$16.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.35
|
| Rate for Payer: Healthfirst Commercial |
$16.46
|
| Rate for Payer: Healthfirst Essential Plan |
$37.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.64
|
| Rate for Payer: Healthfirst QHP |
$16.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.35
|
| Rate for Payer: SOMOS Essential |
$12.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.46
|
|
|
PR DBRDMT FX&/DISLC SUBQ T/M/F BONE
|
Professional
|
Both
|
$1,818.32
|
|
|
Service Code
|
HCPCS 11012
|
| Min. Negotiated Rate |
$338.91 |
| Max. Negotiated Rate |
$1,089.36 |
| Rate for Payer: Cash Price |
$488.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$484.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$435.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$435.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$459.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$484.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$459.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$484.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$484.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$363.12
|
| Rate for Payer: Healthfirst Commercial |
$484.16
|
| Rate for Payer: Healthfirst Essential Plan |
$1,089.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$459.95
|
| Rate for Payer: Healthfirst QHP |
$484.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$338.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$484.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$411.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$338.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$484.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$363.12
|
| Rate for Payer: SOMOS Essential |
$363.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$484.16
|
|
|
PR DBRDMT SKN SBQ T/M/F NECRO INFCTJ XTRNL GENT&PER
|
Professional
|
Both
|
$2,480.10
|
|
|
Service Code
|
HCPCS 11004
|
| Min. Negotiated Rate |
$459.61 |
| Max. Negotiated Rate |
$1,477.33 |
| Rate for Payer: Cash Price |
$662.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$656.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$590.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$590.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$623.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$656.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$623.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$656.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$656.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$492.44
|
| Rate for Payer: Healthfirst Commercial |
$656.59
|
| Rate for Payer: Healthfirst Essential Plan |
$1,477.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$623.76
|
| Rate for Payer: Healthfirst QHP |
$656.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$459.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$656.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$558.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$459.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$656.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$492.44
|
| Rate for Payer: SOMOS Essential |
$492.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$656.59
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Professional
|
Both
|
$3,456.85
|
|
|
Service Code
|
HCPCS 11005
|
| Min. Negotiated Rate |
$636.36 |
| Max. Negotiated Rate |
$2,045.45 |
| Rate for Payer: Cash Price |
$918.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$909.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$818.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$818.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$863.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$909.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$863.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$909.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$909.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$681.82
|
| Rate for Payer: Healthfirst Commercial |
$909.09
|
| Rate for Payer: Healthfirst Essential Plan |
$2,045.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$863.64
|
| Rate for Payer: Healthfirst QHP |
$909.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$636.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$909.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$772.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$636.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$909.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$681.82
|
| Rate for Payer: SOMOS Essential |
$681.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$909.09
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT PER&ABDL
|
Professional
|
Both
|
$3,090.54
|
|
|
Service Code
|
HCPCS 11006
|
| Min. Negotiated Rate |
$572.91 |
| Max. Negotiated Rate |
$1,841.49 |
| Rate for Payer: Cash Price |
$823.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$818.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$736.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$736.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$777.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$818.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$777.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$818.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$818.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$613.83
|
| Rate for Payer: Healthfirst Commercial |
$818.44
|
| Rate for Payer: Healthfirst Essential Plan |
$1,841.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$777.52
|
| Rate for Payer: Healthfirst QHP |
$818.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$572.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$818.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$695.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$572.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$818.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$613.83
|
| Rate for Payer: SOMOS Essential |
$613.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$818.44
|
|
|
PR DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS
|
Professional
|
Both
|
$1,201.66
|
|
|
Service Code
|
HCPCS 11010
|
| Min. Negotiated Rate |
$225.44 |
| Max. Negotiated Rate |
$724.63 |
| Rate for Payer: Cash Price |
$323.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$322.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$289.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$289.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$305.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$322.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$305.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$322.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$322.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$241.54
|
| Rate for Payer: Healthfirst Commercial |
$322.06
|
| Rate for Payer: Healthfirst Essential Plan |
$724.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$305.96
|
| Rate for Payer: Healthfirst QHP |
$322.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$225.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$322.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$273.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$225.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$322.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$241.54
|
| Rate for Payer: SOMOS Essential |
$241.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$322.06
|
|
|
PR DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC
|
Professional
|
Both
|
$1,295.53
|
|
|
Service Code
|
HCPCS 11011
|
| Min. Negotiated Rate |
$244.24 |
| Max. Negotiated Rate |
$785.05 |
| Rate for Payer: Cash Price |
$349.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$348.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$314.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$314.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$331.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$348.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$331.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$348.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$348.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$261.68
|
| Rate for Payer: Healthfirst Commercial |
$348.91
|
| Rate for Payer: Healthfirst Essential Plan |
$785.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$331.46
|
| Rate for Payer: Healthfirst QHP |
$348.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$244.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$348.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$296.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$244.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$348.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$261.68
|
| Rate for Payer: SOMOS Essential |
$261.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$348.91
|
|
|
PR DCMPRN FACIAL NRV INTRATEMPORAL LAT GANGLION
|
Professional
|
Both
|
$5,186.69
|
|
|
Service Code
|
HCPCS 69720
|
| Min. Negotiated Rate |
$953.76 |
| Max. Negotiated Rate |
$3,065.67 |
| Rate for Payer: Cash Price |
$1,379.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,362.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,226.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,226.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,294.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,362.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,294.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,362.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,362.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,021.89
|
| Rate for Payer: Healthfirst Commercial |
$1,362.52
|
| Rate for Payer: Healthfirst Essential Plan |
$3,065.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,294.39
|
| Rate for Payer: Healthfirst QHP |
$1,362.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$953.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,362.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,158.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$953.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,362.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,021.89
|
| Rate for Payer: SOMOS Essential |
$1,021.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,362.52
|
|
|
PR DCMPRN FASCIOTOMY PELVIC CMPRT DBRDMT MUSCLE UNI
|
Professional
|
Both
|
$4,460.72
|
|
|
Service Code
|
HCPCS 27057
|
| Min. Negotiated Rate |
$836.16 |
| Max. Negotiated Rate |
$2,687.65 |
| Rate for Payer: Cash Price |
$1,200.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,194.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,075.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,075.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,134.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,194.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,134.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,194.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,194.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$895.88
|
| Rate for Payer: Healthfirst Commercial |
$1,194.51
|
| Rate for Payer: Healthfirst Essential Plan |
$2,687.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,134.78
|
| Rate for Payer: Healthfirst QHP |
$1,194.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$836.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,194.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,015.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$836.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,194.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$895.88
|
| Rate for Payer: SOMOS Essential |
$895.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,194.51
|
|
|
PR DCMPRN FASCIOTOMY THIGH&/KNEE MLT COMPARTMENTS
|
Professional
|
Both
|
$2,919.18
|
|
|
Service Code
|
HCPCS 27498
|
| Min. Negotiated Rate |
$552.67 |
| Max. Negotiated Rate |
$1,776.44 |
| Rate for Payer: Cash Price |
$790.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$789.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$710.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$710.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$750.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$789.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$750.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$789.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$789.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$592.15
|
| Rate for Payer: Healthfirst Commercial |
$789.53
|
| Rate for Payer: Healthfirst Essential Plan |
$1,776.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$750.05
|
| Rate for Payer: Healthfirst QHP |
$789.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$552.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$789.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$671.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$552.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$789.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$592.15
|
| Rate for Payer: SOMOS Essential |
$592.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$789.53
|
|
|
PR DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR DBRDMT
|
Professional
|
Both
|
$5,421.29
|
|
|
Service Code
|
HCPCS 25025
|
| Min. Negotiated Rate |
$1,018.65 |
| Max. Negotiated Rate |
$3,274.24 |
| Rate for Payer: Cash Price |
$1,462.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,455.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,309.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,309.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,382.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,455.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,382.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,455.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,455.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,091.41
|
| Rate for Payer: Healthfirst Commercial |
$1,455.22
|
| Rate for Payer: Healthfirst Essential Plan |
$3,274.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,382.46
|
| Rate for Payer: Healthfirst QHP |
$1,455.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,018.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,455.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,236.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,018.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,455.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,091.41
|
| Rate for Payer: SOMOS Essential |
$1,091.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,455.22
|
|
|
PR DCMPRN FASCT F/ARM&/WRST FLXR/XTNSR W/DBRDMT
|
Professional
|
Both
|
$5,776.23
|
|
|
Service Code
|
HCPCS 25023
|
| Min. Negotiated Rate |
$1,075.10 |
| Max. Negotiated Rate |
$3,455.66 |
| Rate for Payer: Cash Price |
$1,558.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,535.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,382.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,382.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,459.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,535.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,459.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,535.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,535.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,151.89
|
| Rate for Payer: Healthfirst Commercial |
$1,535.85
|
| Rate for Payer: Healthfirst Essential Plan |
$3,455.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,459.06
|
| Rate for Payer: Healthfirst QHP |
$1,535.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,075.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,535.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,305.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,075.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,535.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,151.89
|
| Rate for Payer: SOMOS Essential |
$1,151.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,535.85
|
|
|
PR DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR W/O DB
|
Professional
|
Both
|
$3,425.35
|
|
|
Service Code
|
HCPCS 25024
|
| Min. Negotiated Rate |
$648.73 |
| Max. Negotiated Rate |
$2,085.21 |
| Rate for Payer: Cash Price |
$933.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$926.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$834.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$834.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$880.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$926.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$880.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$926.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$926.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$695.07
|
| Rate for Payer: Healthfirst Commercial |
$926.76
|
| Rate for Payer: Healthfirst Essential Plan |
$2,085.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$880.42
|
| Rate for Payer: Healthfirst QHP |
$926.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$648.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$926.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$787.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$648.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$926.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$695.07
|
| Rate for Payer: SOMOS Essential |
$695.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$926.76
|
|
