|
PR DCMPRN FASCT F/ARM&WRST FLXR/XTNSR W/O DBRDMT
|
Professional
|
Both
|
$3,273.31
|
|
|
Service Code
|
HCPCS 25020
|
| Min. Negotiated Rate |
$603.73 |
| Max. Negotiated Rate |
$1,940.56 |
| Rate for Payer: Cash Price |
$881.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$862.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$776.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$776.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$819.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$862.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$819.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$862.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$862.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$646.85
|
| Rate for Payer: Healthfirst Commercial |
$862.47
|
| Rate for Payer: Healthfirst Essential Plan |
$1,940.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$819.35
|
| Rate for Payer: Healthfirst QHP |
$862.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$603.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$862.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$733.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$603.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$862.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$646.85
|
| Rate for Payer: SOMOS Essential |
$646.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$862.47
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT COMPARTMENTS ONLY
|
Professional
|
Both
|
$1,776.32
|
|
|
Service Code
|
HCPCS 27600
|
| Min. Negotiated Rate |
$332.75 |
| Max. Negotiated Rate |
$1,069.54 |
| Rate for Payer: Cash Price |
$476.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$475.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$427.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$427.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$451.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$475.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$451.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$475.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$475.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$356.51
|
| Rate for Payer: Healthfirst Commercial |
$475.35
|
| Rate for Payer: Healthfirst Essential Plan |
$1,069.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$451.58
|
| Rate for Payer: Healthfirst QHP |
$475.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$332.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$475.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$404.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$332.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$475.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$356.51
|
| Rate for Payer: SOMOS Essential |
$356.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$475.35
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT&PST CMPRT
|
Professional
|
Both
|
$2,135.95
|
|
|
Service Code
|
HCPCS 27602
|
| Min. Negotiated Rate |
$395.72 |
| Max. Negotiated Rate |
$1,271.97 |
| Rate for Payer: Cash Price |
$569.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$565.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$508.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$508.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$537.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$565.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$537.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$565.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$565.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$423.99
|
| Rate for Payer: Healthfirst Commercial |
$565.32
|
| Rate for Payer: Healthfirst Essential Plan |
$1,271.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$537.05
|
| Rate for Payer: Healthfirst QHP |
$565.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$395.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$565.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$480.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$395.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$565.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$423.99
|
| Rate for Payer: SOMOS Essential |
$423.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$565.32
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT&PST W/DBRDMT MUS
|
Professional
|
Both
|
$3,596.92
|
|
|
Service Code
|
HCPCS 27894
|
| Min. Negotiated Rate |
$681.67 |
| Max. Negotiated Rate |
$2,191.07 |
| Rate for Payer: Cash Price |
$970.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$973.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$876.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$876.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$925.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$973.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$925.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$973.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$973.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$730.36
|
| Rate for Payer: Healthfirst Commercial |
$973.81
|
| Rate for Payer: Healthfirst Essential Plan |
$2,191.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$925.12
|
| Rate for Payer: Healthfirst QHP |
$973.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$681.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$973.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$827.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$681.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$973.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$730.36
|
| Rate for Payer: SOMOS Essential |
$730.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$973.81
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT W/DBRDMT MUSC&/NERVE
|
Professional
|
Both
|
$2,365.62
|
|
|
Service Code
|
HCPCS 27892
|
| Min. Negotiated Rate |
$449.92 |
| Max. Negotiated Rate |
$1,446.16 |
| Rate for Payer: Cash Price |
$639.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$642.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$578.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$578.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$610.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$642.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$610.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$642.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$642.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$482.06
|
| Rate for Payer: Healthfirst Commercial |
$642.74
|
| Rate for Payer: Healthfirst Essential Plan |
$1,446.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$610.60
|
| Rate for Payer: Healthfirst QHP |
$642.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$449.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$642.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$546.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$449.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$642.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$482.06
|
| Rate for Payer: SOMOS Essential |
$482.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$642.74
|
|
|
PR DCMPRN FASCT LEG POST COMPARTMENT ONLY
|
Professional
|
Both
|
$1,947.58
|
|
|
Service Code
|
HCPCS 27601
|
| Min. Negotiated Rate |
$363.57 |
| Max. Negotiated Rate |
$1,168.61 |
| Rate for Payer: Cash Price |
$528.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$519.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$467.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$467.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$493.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$519.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$493.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$519.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$519.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$389.54
|
| Rate for Payer: Healthfirst Commercial |
$519.38
|
| Rate for Payer: Healthfirst Essential Plan |
$1,168.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$493.41
|
| Rate for Payer: Healthfirst QHP |
$519.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$363.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$519.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$441.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$363.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$519.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$389.54
|
| Rate for Payer: SOMOS Essential |
$389.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$519.38
|
|
|
PR DCMPRN FASCT LEG PST W/DBRDMT MUSC&/NRV
|
Professional
|
Both
|
$2,726.89
|
|
|
Service Code
|
HCPCS 27893
|
| Min. Negotiated Rate |
$515.84 |
| Max. Negotiated Rate |
$1,658.07 |
| Rate for Payer: Cash Price |
$739.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$736.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$663.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$663.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$700.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$736.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$700.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$736.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$736.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$552.69
|
| Rate for Payer: Healthfirst Commercial |
$736.92
|
| Rate for Payer: Healthfirst Essential Plan |
$1,658.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$700.07
|
| Rate for Payer: Healthfirst QHP |
$736.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$515.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$736.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$626.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$515.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$736.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$552.69
|
| Rate for Payer: SOMOS Essential |
$552.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$736.92
|
|
|
PR DCMPRN FASCT THIGH&/KNEE DBRDMT MUSCLE&/NERVE
|
Professional
|
Both
|
$2,579.85
|
|
|
Service Code
|
HCPCS 27497
|
| Min. Negotiated Rate |
$487.61 |
| Max. Negotiated Rate |
$1,567.31 |
| Rate for Payer: Cash Price |
$699.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$696.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$626.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$626.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$661.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$696.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$661.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$696.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$696.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$522.43
|
| Rate for Payer: Healthfirst Commercial |
$696.58
|
| Rate for Payer: Healthfirst Essential Plan |
$1,567.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$661.75
|
| Rate for Payer: Healthfirst QHP |
$696.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$487.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$696.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$592.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$487.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$696.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$522.43
|
| Rate for Payer: SOMOS Essential |
$522.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$696.58
|
|
|
PR DCMPRN FASCT THIGH&/KNEE MLT DBRDMT NV MUSC&NRVE
|
Professional
|
Both
|
$3,121.06
|
|
|
Service Code
|
HCPCS 27499
|
| Min. Negotiated Rate |
$588.16 |
| Max. Negotiated Rate |
$1,890.52 |
| Rate for Payer: Cash Price |
$844.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$840.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$756.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$756.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$798.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$840.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$798.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$840.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$840.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$630.17
|
| Rate for Payer: Healthfirst Commercial |
$840.23
|
| Rate for Payer: Healthfirst Essential Plan |
$1,890.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$798.22
|
| Rate for Payer: Healthfirst QHP |
$840.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$588.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$840.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$714.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$588.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$840.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$630.17
|
| Rate for Payer: SOMOS Essential |
$630.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$840.23
|
|
|
PR DCMPRN NRV INTRATEMPORAL MEDIAL GENICULATE
|
Professional
|
Both
|
$8,077.58
|
|
|
Service Code
|
HCPCS 69725
|
| Min. Negotiated Rate |
$1,500.78 |
| Max. Negotiated Rate |
$4,823.93 |
| Rate for Payer: Cash Price |
$2,178.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,143.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,929.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,929.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,036.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,143.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,036.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,143.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,143.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,607.98
|
| Rate for Payer: Healthfirst Commercial |
$2,143.97
|
| Rate for Payer: Healthfirst Essential Plan |
$4,823.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,036.77
|
| Rate for Payer: Healthfirst QHP |
$2,143.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,500.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,143.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,822.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,500.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,143.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,607.98
|
| Rate for Payer: SOMOS Essential |
$1,607.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,143.97
|
|
|
PR DCMPRN PERQ NUCLEUS PULPOSUS 1/> LEVELS LUMBAR
|
Professional
|
Both
|
$2,363.38
|
|
|
Service Code
|
HCPCS 62287
|
| Min. Negotiated Rate |
$480.42 |
| Max. Negotiated Rate |
$1,544.20 |
| Rate for Payer: Cash Price |
$693.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$686.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$617.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$651.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$686.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$651.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$686.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$686.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$514.73
|
| Rate for Payer: Healthfirst Commercial |
$686.31
|
| Rate for Payer: Healthfirst Essential Plan |
$1,544.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$651.99
|
| Rate for Payer: Healthfirst QHP |
$686.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$480.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$686.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$583.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$480.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$686.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$514.73
|
| Rate for Payer: SOMOS Essential |
$514.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$686.31
|
|
|
PR DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$967.37
|
|
|
Service Code
|
HCPCS 11044
|
| Min. Negotiated Rate |
$180.63 |
| Max. Negotiated Rate |
$580.61 |
| Rate for Payer: Cash Price |
$261.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$258.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$232.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$232.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$245.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$258.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$245.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$258.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$258.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$193.54
|
| Rate for Payer: Healthfirst Commercial |
$258.05
|
| Rate for Payer: Healthfirst Essential Plan |
$580.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$245.15
|
| Rate for Payer: Healthfirst QHP |
$258.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$180.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$258.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$219.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$180.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$258.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$193.54
|
| Rate for Payer: SOMOS Essential |
$193.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$258.05
|
|
|
PR DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM
|
Professional
|
Both
|
$424.73
|
|
|
Service Code
|
HCPCS 11047
|
| Min. Negotiated Rate |
$78.66 |
| Max. Negotiated Rate |
$252.83 |
| Rate for Payer: Cash Price |
$113.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$112.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$101.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$101.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$106.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$112.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$106.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$84.28
|
| Rate for Payer: Healthfirst Commercial |
$112.37
|
| Rate for Payer: Healthfirst Essential Plan |
$252.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$106.75
|
| Rate for Payer: Healthfirst QHP |
$112.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$112.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$95.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$112.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$84.28
|
| Rate for Payer: SOMOS Essential |
$84.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$112.37
|
|
|
PR DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX
|
Professional
|
Both
|
$589.96
|
|
|
Service Code
|
HCPCS 69222
|
| Min. Negotiated Rate |
$111.17 |
| Max. Negotiated Rate |
$357.32 |
| Rate for Payer: Cash Price |
$161.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$158.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$142.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$142.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$150.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$158.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$150.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$158.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$158.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$119.11
|
| Rate for Payer: Healthfirst Commercial |
$158.81
|
| Rate for Payer: Healthfirst Essential Plan |
$357.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$150.87
|
| Rate for Payer: Healthfirst QHP |
$158.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$111.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$158.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$134.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$111.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$158.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$119.11
|
| Rate for Payer: SOMOS Essential |
$119.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$158.81
|
|
|
PR DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE
|
Professional
|
Both
|
$220.15
|
|
|
Service Code
|
HCPCS 69220
|
| Min. Negotiated Rate |
$41.94 |
| Max. Negotiated Rate |
$134.82 |
| Rate for Payer: Cash Price |
$59.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$59.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.94
|
| Rate for Payer: Healthfirst Commercial |
$59.92
|
| Rate for Payer: Healthfirst Essential Plan |
$134.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.92
|
| Rate for Payer: Healthfirst QHP |
$59.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.94
|
| Rate for Payer: SOMOS Essential |
$44.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.92
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA 1ST 20 SQ CM/<
|
Professional
|
Both
|
$656.04
|
|
|
Service Code
|
HCPCS 11043
|
| Min. Negotiated Rate |
$124.04 |
| Max. Negotiated Rate |
$398.70 |
| Rate for Payer: Cash Price |
$177.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$177.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$159.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$159.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$168.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$177.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$168.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$132.90
|
| Rate for Payer: Healthfirst Commercial |
$177.20
|
| Rate for Payer: Healthfirst Essential Plan |
$398.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$168.34
|
| Rate for Payer: Healthfirst QHP |
$177.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$124.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$177.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$150.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$124.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$177.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$132.90
|
| Rate for Payer: SOMOS Essential |
$132.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$177.20
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Professional
|
Both
|
$238.49
|
|
|
Service Code
|
HCPCS 11046
|
| Min. Negotiated Rate |
$43.76 |
| Max. Negotiated Rate |
$140.67 |
| Rate for Payer: Cash Price |
$63.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.89
|
| Rate for Payer: Healthfirst Commercial |
$62.52
|
| Rate for Payer: Healthfirst Essential Plan |
$140.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.39
|
| Rate for Payer: Healthfirst QHP |
$62.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$46.89
|
| Rate for Payer: SOMOS Essential |
$46.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.52
|
|
|
PR DEBRIDEMENT NAIL ANY METHOD 1-5
|
Professional
|
Both
|
$61.08
|
|
|
Service Code
|
HCPCS 11720
|
| Min. Negotiated Rate |
$11.19 |
| Max. Negotiated Rate |
$35.95 |
| Rate for Payer: Cash Price |
$15.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.98
|
| Rate for Payer: Healthfirst Commercial |
$15.98
|
| Rate for Payer: Healthfirst Essential Plan |
$35.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.18
|
| Rate for Payer: Healthfirst QHP |
$15.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.98
|
| Rate for Payer: SOMOS Essential |
$11.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.98
|
|
|
PR DEBRIDEMENT NAIL ANY METHOD 6/>
|
Professional
|
Both
|
$95.83
|
|
|
Service Code
|
HCPCS 11721
|
| Min. Negotiated Rate |
$18.28 |
| Max. Negotiated Rate |
$58.77 |
| Rate for Payer: Cash Price |
$26.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.59
|
| Rate for Payer: Healthfirst Commercial |
$26.12
|
| Rate for Payer: Healthfirst Essential Plan |
$58.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.81
|
| Rate for Payer: Healthfirst QHP |
$26.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.59
|
| Rate for Payer: SOMOS Essential |
$19.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.12
|
|
|
PR DEBRIDEMENT OPEN WOUND FIRST 20 SQ CM/<
|
Professional
|
Both
|
$144.48
|
|
|
Service Code
|
HCPCS 97597
|
| Min. Negotiated Rate |
$26.98 |
| Max. Negotiated Rate |
$86.72 |
| Rate for Payer: Cash Price |
$39.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.91
|
| Rate for Payer: Healthfirst Commercial |
$38.54
|
| Rate for Payer: Healthfirst Essential Plan |
$86.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.61
|
| Rate for Payer: Healthfirst QHP |
$38.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.91
|
| Rate for Payer: SOMOS Essential |
$28.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.54
|
|
|
PR DEBRIDEMENT OPN WND EA ADDL 20 SQ CM/PRT THEREOF
|
Professional
|
Both
|
$103.50
|
|
|
Service Code
|
HCPCS 97598
|
| Min. Negotiated Rate |
$18.84 |
| Max. Negotiated Rate |
$60.55 |
| Rate for Payer: Cash Price |
$27.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.18
|
| Rate for Payer: Healthfirst Commercial |
$26.91
|
| Rate for Payer: Healthfirst Essential Plan |
$60.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.56
|
| Rate for Payer: Healthfirst QHP |
$26.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.18
|
| Rate for Payer: SOMOS Essential |
$20.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.91
|
|
|
PR DEBRIDEMENT PRMLG HYPERKERATOTIC LES W/PDT
|
Professional
|
Both
|
$1,198.33
|
|
|
Service Code
|
HCPCS 96574
|
| Min. Negotiated Rate |
$133.85 |
| Max. Negotiated Rate |
$698.69 |
| Rate for Payer: Amida Care Medicaid |
$133.85
|
| Rate for Payer: Cash Price |
$324.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$310.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$295.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$310.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$295.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$310.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$310.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$232.90
|
| Rate for Payer: Healthfirst Commercial |
$310.53
|
| Rate for Payer: Healthfirst Essential Plan |
$698.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$295.00
|
| Rate for Payer: Healthfirst QHP |
$310.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$217.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$310.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$263.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$217.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$310.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$232.90
|
| Rate for Payer: SOMOS Essential |
$232.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.53
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$251.34
|
|
|
Service Code
|
HCPCS 11042
|
| Min. Negotiated Rate |
$48.45 |
| Max. Negotiated Rate |
$155.75 |
| Rate for Payer: Cash Price |
$69.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$69.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$69.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$69.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$69.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.91
|
| Rate for Payer: Healthfirst Commercial |
$69.22
|
| Rate for Payer: Healthfirst Essential Plan |
$155.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.76
|
| Rate for Payer: Healthfirst QHP |
$69.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$69.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$69.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.91
|
| Rate for Payer: SOMOS Essential |
$51.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69.22
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM
|
Professional
|
Both
|
$108.96
|
|
|
Service Code
|
HCPCS 11045
|
| Min. Negotiated Rate |
$19.70 |
| Max. Negotiated Rate |
$63.34 |
| Rate for Payer: Cash Price |
$29.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.11
|
| Rate for Payer: Healthfirst Commercial |
$28.15
|
| Rate for Payer: Healthfirst Essential Plan |
$63.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.74
|
| Rate for Payer: Healthfirst QHP |
$28.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.11
|
| Rate for Payer: SOMOS Essential |
$21.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.15
|
|
|
PR DECALCIFY TISSUE
|
Professional
|
Both
|
$85.86
|
|
|
Service Code
|
HCPCS 88311
|
| Min. Negotiated Rate |
$16.16 |
| Max. Negotiated Rate |
$51.95 |
| Rate for Payer: Cash Price |
$23.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$23.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.32
|
| Rate for Payer: Healthfirst Commercial |
$23.09
|
| Rate for Payer: Healthfirst Essential Plan |
$51.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.94
|
| Rate for Payer: Healthfirst QHP |
$23.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.32
|
| Rate for Payer: SOMOS Essential |
$17.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.09
|
|
