|
PR DECALCIFY TISSUE
|
Professional
|
Both
|
$37.24
|
|
|
Service Code
|
HCPCS 88311 TC
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$22.34 |
| Rate for Payer: Cash Price |
$10.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.45
|
| Rate for Payer: Healthfirst Commercial |
$9.93
|
| Rate for Payer: Healthfirst Essential Plan |
$22.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.43
|
| Rate for Payer: Healthfirst QHP |
$9.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.45
|
| Rate for Payer: SOMOS Essential |
$7.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.93
|
|
|
PR DECALCIFY TISSUE
|
Professional
|
Both
|
$48.62
|
|
|
Service Code
|
HCPCS 88311 26
|
| Min. Negotiated Rate |
$9.21 |
| Max. Negotiated Rate |
$29.61 |
| Rate for Payer: Cash Price |
$12.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.87
|
| Rate for Payer: Healthfirst Commercial |
$13.16
|
| Rate for Payer: Healthfirst Essential Plan |
$29.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.50
|
| Rate for Payer: Healthfirst QHP |
$13.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.87
|
| Rate for Payer: SOMOS Essential |
$9.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.16
|
|
|
PR DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH
|
Professional
|
Both
|
$144.90
|
|
|
Service Code
|
HCPCS 36593
|
| Min. Negotiated Rate |
$28.58 |
| Max. Negotiated Rate |
$91.87 |
| Rate for Payer: Cash Price |
$41.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.62
|
| Rate for Payer: Healthfirst Commercial |
$40.83
|
| Rate for Payer: Healthfirst Essential Plan |
$91.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.79
|
| Rate for Payer: Healthfirst QHP |
$40.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.62
|
| Rate for Payer: SOMOS Essential |
$30.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.83
|
|
|
PR DECOMPRESSION FASCIOTOMY PELVIC COMPARTMENT UNI
|
Professional
|
Both
|
$3,960.85
|
|
|
Service Code
|
HCPCS 27027
|
| Min. Negotiated Rate |
$734.40 |
| Max. Negotiated Rate |
$2,360.59 |
| Rate for Payer: Cash Price |
$1,057.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,049.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$944.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$944.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$996.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,049.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$996.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,049.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,049.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$786.86
|
| Rate for Payer: Healthfirst Commercial |
$1,049.15
|
| Rate for Payer: Healthfirst Essential Plan |
$2,360.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$996.69
|
| Rate for Payer: Healthfirst QHP |
$1,049.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$734.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,049.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$891.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$734.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,049.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$786.86
|
| Rate for Payer: SOMOS Essential |
$786.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,049.15
|
|
|
PR DECOMPRESSION FASCIOTOMY THIGH&/KNEE 1 COMPONENT
|
Professional
|
Both
|
$2,434.81
|
|
|
Service Code
|
HCPCS 27496
|
| Min. Negotiated Rate |
$463.29 |
| Max. Negotiated Rate |
$1,489.14 |
| Rate for Payer: Cash Price |
$663.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$661.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$595.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$595.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$628.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$661.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$628.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$661.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$661.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$496.38
|
| Rate for Payer: Healthfirst Commercial |
$661.84
|
| Rate for Payer: Healthfirst Essential Plan |
$1,489.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$628.75
|
| Rate for Payer: Healthfirst QHP |
$661.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$463.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$661.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$562.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$463.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$661.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$496.38
|
| Rate for Payer: SOMOS Essential |
$496.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$661.84
|
|
|
PR DECOMPRESSION FASCT F/ARM W/BRACH ART EXPL
|
Professional
|
Both
|
$4,091.75
|
|
|
Service Code
|
HCPCS 24495
|
| Min. Negotiated Rate |
$754.62 |
| Max. Negotiated Rate |
$2,425.57 |
| Rate for Payer: Cash Price |
$1,098.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,078.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$970.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$970.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,024.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,078.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,024.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,078.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,078.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$808.52
|
| Rate for Payer: Healthfirst Commercial |
$1,078.03
|
| Rate for Payer: Healthfirst Essential Plan |
$2,425.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,024.13
|
| Rate for Payer: Healthfirst QHP |
$1,078.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$754.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,078.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$916.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$754.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,078.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$808.52
|
| Rate for Payer: SOMOS Essential |
$808.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,078.03
|
|
|
PR DECOMPRESSION FINGERS&/HAND INJECTION INJURY
|
Professional
|
Both
|
$3,817.35
|
|
|
Service Code
|
HCPCS 26035
|
| Min. Negotiated Rate |
$720.57 |
| Max. Negotiated Rate |
$2,316.11 |
| Rate for Payer: Cash Price |
$1,033.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,029.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$926.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$926.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$977.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,029.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$977.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,029.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,029.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$772.03
|
| Rate for Payer: Healthfirst Commercial |
$1,029.38
|
| Rate for Payer: Healthfirst Essential Plan |
$2,316.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$977.91
|
| Rate for Payer: Healthfirst QHP |
$1,029.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$720.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,029.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$874.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$720.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,029.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$772.03
|
| Rate for Payer: SOMOS Essential |
$772.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,029.38
|
|
|
PR DECOMPRESSION INTERNAL AUDITORY CANAL
|
Professional
|
Both
|
$8,130.29
|
|
|
Service Code
|
HCPCS 69960
|
| Min. Negotiated Rate |
$1,512.84 |
| Max. Negotiated Rate |
$4,862.70 |
| Rate for Payer: Cash Price |
$2,192.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,161.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,945.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,945.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,053.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,161.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,053.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,161.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,161.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,620.90
|
| Rate for Payer: Healthfirst Commercial |
$2,161.20
|
| Rate for Payer: Healthfirst Essential Plan |
$4,862.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,053.14
|
| Rate for Payer: Healthfirst QHP |
$2,161.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,512.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,161.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,837.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,512.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,161.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,620.90
|
| Rate for Payer: SOMOS Essential |
$1,620.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,161.20
|
|
|
PR DECOMPRESSION ORBIT ONLY TRANSCRANIAL APPROACH
|
Professional
|
Both
|
$8,653.02
|
|
|
Service Code
|
HCPCS 61330
|
| Min. Negotiated Rate |
$1,583.74 |
| Max. Negotiated Rate |
$5,090.58 |
| Rate for Payer: Cash Price |
$2,284.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,262.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,036.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,036.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,149.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,262.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,149.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,262.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,262.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,696.86
|
| Rate for Payer: Healthfirst Commercial |
$2,262.48
|
| Rate for Payer: Healthfirst Essential Plan |
$5,090.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,149.36
|
| Rate for Payer: Healthfirst QHP |
$2,262.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,583.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,262.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,923.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,583.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,262.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,696.86
|
| Rate for Payer: SOMOS Essential |
$1,696.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,262.48
|
|
|
PR DECOMPRESSION PLANTAR DIGITAL NERVE
|
Professional
|
Both
|
$1,128.96
|
|
|
Service Code
|
HCPCS 64726
|
| Min. Negotiated Rate |
$217.55 |
| Max. Negotiated Rate |
$699.25 |
| Rate for Payer: Cash Price |
$309.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$310.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$295.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$310.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$295.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$310.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$310.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$233.09
|
| Rate for Payer: Healthfirst Commercial |
$310.78
|
| Rate for Payer: Healthfirst Essential Plan |
$699.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$295.24
|
| Rate for Payer: Healthfirst QHP |
$310.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$217.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$310.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$264.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$217.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$310.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$233.09
|
| Rate for Payer: SOMOS Essential |
$233.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.78
|
|
|
PR DECOMPRESSION UNSPECIFIED NERVE
|
Professional
|
Both
|
$1,621.94
|
|
|
Service Code
|
HCPCS 64722
|
| Min. Negotiated Rate |
$312.24 |
| Max. Negotiated Rate |
$1,003.63 |
| Rate for Payer: Cash Price |
$447.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$446.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$401.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$401.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$423.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$446.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$423.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$446.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$446.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$334.55
|
| Rate for Payer: Healthfirst Commercial |
$446.06
|
| Rate for Payer: Healthfirst Essential Plan |
$1,003.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$423.76
|
| Rate for Payer: Healthfirst QHP |
$446.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$312.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$446.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$379.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$312.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$446.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$334.55
|
| Rate for Payer: SOMOS Essential |
$334.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$446.06
|
|
|
PR DECOMPRESSIVE FASCIOTOMY HAND
|
Professional
|
Both
|
$2,489.13
|
|
|
Service Code
|
HCPCS 26037
|
| Min. Negotiated Rate |
$471.51 |
| Max. Negotiated Rate |
$1,515.58 |
| Rate for Payer: Cash Price |
$673.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$673.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$606.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$606.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$639.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$673.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$639.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$673.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$673.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$505.19
|
| Rate for Payer: Healthfirst Commercial |
$673.59
|
| Rate for Payer: Healthfirst Essential Plan |
$1,515.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$639.91
|
| Rate for Payer: Healthfirst QHP |
$673.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$471.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$673.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$572.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$471.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$673.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$505.19
|
| Rate for Payer: SOMOS Essential |
$505.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$673.59
|
|
|
PR DECORTICATION & PARIETAL PLEURECTOMY
|
Professional
|
Both
|
$7,145.22
|
|
|
Service Code
|
HCPCS 32320
|
| Min. Negotiated Rate |
$1,319.89 |
| Max. Negotiated Rate |
$4,242.51 |
| Rate for Payer: Cash Price |
$1,902.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,885.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,697.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,697.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,791.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,885.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,791.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,885.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,885.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,414.17
|
| Rate for Payer: Healthfirst Commercial |
$1,885.56
|
| Rate for Payer: Healthfirst Essential Plan |
$4,242.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,791.28
|
| Rate for Payer: Healthfirst QHP |
$1,885.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,319.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,885.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,602.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,319.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,885.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,414.17
|
| Rate for Payer: SOMOS Essential |
$1,414.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,885.56
|
|
|
PR DECORTICATION PULMONARY PARTIAL SEPARATE PROC
|
Professional
|
Both
|
$4,433.49
|
|
|
Service Code
|
HCPCS 32225
|
| Min. Negotiated Rate |
$819.79 |
| Max. Negotiated Rate |
$2,635.04 |
| Rate for Payer: Cash Price |
$1,179.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,171.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,054.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,054.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,112.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,171.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,112.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,171.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,171.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$878.35
|
| Rate for Payer: Healthfirst Commercial |
$1,171.13
|
| Rate for Payer: Healthfirst Essential Plan |
$2,635.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,112.57
|
| Rate for Payer: Healthfirst QHP |
$1,171.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$819.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,171.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$995.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$819.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,171.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$878.35
|
| Rate for Payer: SOMOS Essential |
$878.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,171.13
|
|
|
PR DECORTICATION PULMONARY TOTAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$7,101.19
|
|
|
Service Code
|
HCPCS 32220
|
| Min. Negotiated Rate |
$1,316.32 |
| Max. Negotiated Rate |
$4,231.03 |
| Rate for Payer: Cash Price |
$1,896.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,880.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,692.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,692.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,786.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,880.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,786.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,880.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,880.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,410.35
|
| Rate for Payer: Healthfirst Commercial |
$1,880.46
|
| Rate for Payer: Healthfirst Essential Plan |
$4,231.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,786.44
|
| Rate for Payer: Healthfirst QHP |
$1,880.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,316.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,880.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,598.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,316.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,880.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,410.35
|
| Rate for Payer: SOMOS Essential |
$1,410.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,880.46
|
|
|
PR DELAYED CREATION EXIT SITE EMBEDDED CATHETER
|
Professional
|
Both
|
$834.65
|
|
|
Service Code
|
HCPCS 49436
|
| Min. Negotiated Rate |
$155.72 |
| Max. Negotiated Rate |
$500.51 |
| Rate for Payer: Cash Price |
$224.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$222.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$200.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$200.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$211.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$222.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$211.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$222.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$222.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$166.84
|
| Rate for Payer: Healthfirst Commercial |
$222.45
|
| Rate for Payer: Healthfirst Essential Plan |
$500.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$211.33
|
| Rate for Payer: Healthfirst QHP |
$222.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$155.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$222.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$189.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$155.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$222.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$166.84
|
| Rate for Payer: SOMOS Essential |
$166.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$222.45
|
|
|
PR DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS
|
Professional
|
Both
|
$1,470.81
|
|
|
Service Code
|
HCPCS 15630
|
| Min. Negotiated Rate |
$281.02 |
| Max. Negotiated Rate |
$903.28 |
| Rate for Payer: Cash Price |
$402.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$401.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$361.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$361.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$381.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$401.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$381.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$401.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$401.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$301.10
|
| Rate for Payer: Healthfirst Commercial |
$401.46
|
| Rate for Payer: Healthfirst Essential Plan |
$903.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$381.39
|
| Rate for Payer: Healthfirst QHP |
$401.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$281.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$401.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$341.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$281.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$401.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$301.10
|
| Rate for Payer: SOMOS Essential |
$301.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$401.46
|
|
|
PR DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F
|
Professional
|
Both
|
$1,410.36
|
|
|
Service Code
|
HCPCS 15620
|
| Min. Negotiated Rate |
$269.09 |
| Max. Negotiated Rate |
$864.95 |
| Rate for Payer: Cash Price |
$384.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$384.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$345.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$345.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$365.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$384.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$365.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$384.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$384.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$288.31
|
| Rate for Payer: Healthfirst Commercial |
$384.42
|
| Rate for Payer: Healthfirst Essential Plan |
$864.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$365.20
|
| Rate for Payer: Healthfirst QHP |
$384.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$269.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$384.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$326.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$269.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$384.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$288.31
|
| Rate for Payer: SOMOS Essential |
$288.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$384.42
|
|
|
PR DELAY FLAP/SECTIONING FLAP SCALP ARMS/LEGS
|
Professional
|
Both
|
$1,061.48
|
|
|
Service Code
|
HCPCS 15610
|
| Min. Negotiated Rate |
$203.38 |
| Max. Negotiated Rate |
$653.72 |
| Rate for Payer: Cash Price |
$290.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$290.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$261.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$261.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$276.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$290.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$276.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$290.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$290.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$217.91
|
| Rate for Payer: Healthfirst Commercial |
$290.54
|
| Rate for Payer: Healthfirst Essential Plan |
$653.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$276.01
|
| Rate for Payer: Healthfirst QHP |
$290.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$203.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$290.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$246.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$203.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$290.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$217.91
|
| Rate for Payer: SOMOS Essential |
$217.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$290.54
|
|
|
PR DELAY FLAP/SECTIONING FLAP TRUNK
|
Professional
|
Both
|
$920.92
|
|
|
Service Code
|
HCPCS 15600
|
| Min. Negotiated Rate |
$174.96 |
| Max. Negotiated Rate |
$562.37 |
| Rate for Payer: Cash Price |
$252.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$249.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$224.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$224.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$237.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$249.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$237.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$249.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$249.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$187.46
|
| Rate for Payer: Healthfirst Commercial |
$249.94
|
| Rate for Payer: Healthfirst Essential Plan |
$562.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$237.44
|
| Rate for Payer: Healthfirst QHP |
$249.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$174.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$249.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$212.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$174.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$249.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$187.46
|
| Rate for Payer: SOMOS Essential |
$187.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$249.94
|
|
|
PR DELIGATION URETER
|
Professional
|
Both
|
$3,716.69
|
|
|
Service Code
|
HCPCS 50940
|
| Min. Negotiated Rate |
$706.33 |
| Max. Negotiated Rate |
$2,270.34 |
| Rate for Payer: Cash Price |
$1,014.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,009.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$908.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$908.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$958.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,009.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$958.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,009.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,009.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$756.78
|
| Rate for Payer: Healthfirst Commercial |
$1,009.04
|
| Rate for Payer: Healthfirst Essential Plan |
$2,270.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$958.59
|
| Rate for Payer: Healthfirst QHP |
$1,009.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$706.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,009.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$857.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$706.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,009.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$756.78
|
| Rate for Payer: SOMOS Essential |
$756.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,009.04
|
|
|
PR DELIVERY/BIRTHING ROOM RESUSCITATION
|
Professional
|
Both
|
$571.34
|
|
|
Service Code
|
HCPCS 99465
|
| Min. Negotiated Rate |
$59.95 |
| Max. Negotiated Rate |
$347.49 |
| Rate for Payer: Amida Care Medicaid |
$59.95
|
| Rate for Payer: Cash Price |
$157.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$154.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$139.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$139.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$146.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$154.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$146.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$115.83
|
| Rate for Payer: Healthfirst Commercial |
$154.44
|
| Rate for Payer: Healthfirst Essential Plan |
$347.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$146.72
|
| Rate for Payer: Healthfirst QHP |
$154.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$108.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$154.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$131.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$108.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$154.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$115.83
|
| Rate for Payer: SOMOS Essential |
$115.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$154.44
|
|
|
PR DELIVERY COMP IMRT
|
Professional
|
Both
|
$1,545.18
|
|
|
Service Code
|
HCPCS G6016
|
| Min. Negotiated Rate |
$282.47 |
| Max. Negotiated Rate |
$907.94 |
| Rate for Payer: Cash Price |
$417.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$403.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$363.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$363.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$383.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$403.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$383.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$403.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$403.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$302.65
|
| Rate for Payer: Healthfirst Commercial |
$403.53
|
| Rate for Payer: Healthfirst Essential Plan |
$907.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$383.35
|
| Rate for Payer: Healthfirst QHP |
$403.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$282.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$403.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$343.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$282.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$403.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$302.65
|
| Rate for Payer: SOMOS Essential |
$302.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$403.53
|
|
|
PR DELIVERY PLACENTA SEPARATE PROCEDURE
|
Professional
|
Both
|
$420.81
|
|
|
Service Code
|
HCPCS 59414
|
| Min. Negotiated Rate |
$77.31 |
| Max. Negotiated Rate |
$248.49 |
| Rate for Payer: Cash Price |
$111.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$110.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$99.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$99.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$104.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$110.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$104.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.83
|
| Rate for Payer: Healthfirst Commercial |
$110.44
|
| Rate for Payer: Healthfirst Essential Plan |
$248.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$104.92
|
| Rate for Payer: Healthfirst QHP |
$110.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$77.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$110.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$93.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$77.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$110.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.83
|
| Rate for Payer: SOMOS Essential |
$82.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$110.44
|
|
|
PR DEMO&/EVAL OF PT UTILIZ AERSL GEN/NEB/INHLR/IP
|
Professional
|
Both
|
$74.62
|
|
|
Service Code
|
HCPCS 94664
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$48.20 |
| Rate for Payer: Amida Care Medicaid |
$8.21
|
| Rate for Payer: Cash Price |
$21.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.07
|
| Rate for Payer: Healthfirst Commercial |
$21.42
|
| Rate for Payer: Healthfirst Essential Plan |
$48.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.35
|
| Rate for Payer: Healthfirst QHP |
$21.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$21.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$18.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16.07
|
| Rate for Payer: SOMOS Essential |
$16.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.42
|
|
