|
PR DONOR HEPATECTOMY LIVING DONOR SEG V VI VII &VI
|
Professional
|
Both
|
$21,119.35
|
|
|
Service Code
|
HCPCS 47142
|
| Min. Negotiated Rate |
$3,929.73 |
| Max. Negotiated Rate |
$12,631.27 |
| Rate for Payer: Cash Price |
$5,654.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,613.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5,052.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,052.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,333.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,613.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,333.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,613.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,613.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4,210.43
|
| Rate for Payer: Healthfirst Commercial |
$5,613.90
|
| Rate for Payer: Healthfirst Essential Plan |
$12,631.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,333.20
|
| Rate for Payer: Healthfirst QHP |
$5,613.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,929.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5,613.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4,771.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3,929.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,613.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,210.43
|
| Rate for Payer: SOMOS Essential |
$4,210.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,613.90
|
|
|
PR DONOR NEPHRECTOMY OPEN LIVING DONOR
|
Professional
|
Both
|
$6,855.35
|
|
|
Service Code
|
HCPCS 50320
|
| Min. Negotiated Rate |
$1,283.99 |
| Max. Negotiated Rate |
$4,127.11 |
| Rate for Payer: Cash Price |
$1,840.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,834.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,650.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,650.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,742.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,834.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,742.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,834.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,834.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,375.70
|
| Rate for Payer: Healthfirst Commercial |
$1,834.27
|
| Rate for Payer: Healthfirst Essential Plan |
$4,127.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,742.56
|
| Rate for Payer: Healthfirst QHP |
$1,834.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,283.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,834.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,559.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,283.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,834.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,375.70
|
| Rate for Payer: SOMOS Essential |
$1,375.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,834.27
|
|
|
PR DOP ECHOCARD COLOR FLOW VELOCITY MAPPING
|
Professional
|
Both
|
$99.33
|
|
|
Service Code
|
HCPCS 93325
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$58.70 |
| Rate for Payer: Amida Care Medicaid |
$33.13
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.57
|
| Rate for Payer: Healthfirst Commercial |
$26.09
|
| Rate for Payer: Healthfirst Essential Plan |
$58.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.79
|
| Rate for Payer: Healthfirst QHP |
$26.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.57
|
| Rate for Payer: SOMOS Essential |
$19.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.09
|
|
|
PR DOP ECHOCARD COLOR FLOW VELOCITY MAPPING
|
Professional
|
Both
|
$87.68
|
|
|
Service Code
|
HCPCS 93325 TC
|
| Min. Negotiated Rate |
$16.03 |
| Max. Negotiated Rate |
$51.52 |
| Rate for Payer: Amida Care Medicaid |
$33.13
|
| Rate for Payer: Cash Price |
$23.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.18
|
| Rate for Payer: Healthfirst Commercial |
$22.90
|
| Rate for Payer: Healthfirst Essential Plan |
$51.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.75
|
| Rate for Payer: Healthfirst QHP |
$22.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.18
|
| Rate for Payer: SOMOS Essential |
$17.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.90
|
|
|
PR DOP ECHOCARD COLOR FLOW VELOCITY MAPPING
|
Professional
|
Both
|
$11.66
|
|
|
Service Code
|
HCPCS 93325 26
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$33.13 |
| Rate for Payer: Amida Care Medicaid |
$33.13
|
| Rate for Payer: Cash Price |
$3.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.39
|
| Rate for Payer: Healthfirst Commercial |
$3.19
|
| Rate for Payer: Healthfirst Essential Plan |
$7.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.03
|
| Rate for Payer: Healthfirst QHP |
$3.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.39
|
| Rate for Payer: SOMOS Essential |
$2.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.19
|
|
|
PR DOP ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD
|
Professional
|
Both
|
$28.70
|
|
|
Service Code
|
HCPCS 93321 26
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$34.02 |
| Rate for Payer: Amida Care Medicaid |
$34.02
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.80
|
| Rate for Payer: Healthfirst Commercial |
$7.73
|
| Rate for Payer: Healthfirst Essential Plan |
$17.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.34
|
| Rate for Payer: Healthfirst QHP |
$7.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$7.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$6.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.80
|
| Rate for Payer: SOMOS Essential |
$5.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.73
|
|
|
PR DOP ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD
|
Professional
|
Both
|
$106.33
|
|
|
Service Code
|
HCPCS 93321
|
| Min. Negotiated Rate |
$19.81 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Amida Care Medicaid |
$34.02
|
| Rate for Payer: Cash Price |
$29.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.23
|
| Rate for Payer: Healthfirst Commercial |
$28.30
|
| Rate for Payer: Healthfirst Essential Plan |
$63.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.89
|
| Rate for Payer: Healthfirst QHP |
$28.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.23
|
| Rate for Payer: SOMOS Essential |
$21.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.30
|
|
|
PR DOP ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD
|
Professional
|
Both
|
$77.63
|
|
|
Service Code
|
HCPCS 93321 TC
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$46.28 |
| Rate for Payer: Amida Care Medicaid |
$34.02
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.43
|
| Rate for Payer: Healthfirst Commercial |
$20.57
|
| Rate for Payer: Healthfirst Essential Plan |
$46.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.54
|
| Rate for Payer: Healthfirst QHP |
$20.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.43
|
| Rate for Payer: SOMOS Essential |
$15.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.57
|
|
|
PR DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY
|
Professional
|
Both
|
$143.61
|
|
|
Service Code
|
HCPCS 93320 TC
|
| Min. Negotiated Rate |
$26.79 |
| Max. Negotiated Rate |
$86.11 |
| Rate for Payer: Amida Care Medicaid |
$68.35
|
| Rate for Payer: Cash Price |
$39.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.70
|
| Rate for Payer: Healthfirst Commercial |
$38.27
|
| Rate for Payer: Healthfirst Essential Plan |
$86.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.36
|
| Rate for Payer: Healthfirst QHP |
$38.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.70
|
| Rate for Payer: SOMOS Essential |
$28.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.27
|
|
|
PR DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY
|
Professional
|
Both
|
$69.02
|
|
|
Service Code
|
HCPCS 93320 26
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$68.35 |
| Rate for Payer: Amida Care Medicaid |
$68.35
|
| Rate for Payer: Cash Price |
$18.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.06
|
| Rate for Payer: Healthfirst Commercial |
$18.75
|
| Rate for Payer: Healthfirst Essential Plan |
$42.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.81
|
| Rate for Payer: Healthfirst QHP |
$18.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.06
|
| Rate for Payer: SOMOS Essential |
$14.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.75
|
|
|
PR DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY
|
Professional
|
Both
|
$212.63
|
|
|
Service Code
|
HCPCS 93320
|
| Min. Negotiated Rate |
$39.91 |
| Max. Negotiated Rate |
$128.29 |
| Rate for Payer: Amida Care Medicaid |
$68.35
|
| Rate for Payer: Cash Price |
$58.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$57.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$51.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$54.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$57.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$54.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.77
|
| Rate for Payer: Healthfirst Commercial |
$57.02
|
| Rate for Payer: Healthfirst Essential Plan |
$128.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$54.17
|
| Rate for Payer: Healthfirst QHP |
$57.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$57.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.77
|
| Rate for Payer: SOMOS Essential |
$42.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57.02
|
|
|
PR DRAINAGE ABSCESS/HEMATOMA NASAL INT APPROACH
|
Professional
|
Both
|
$525.88
|
|
|
Service Code
|
HCPCS 30000
|
| Min. Negotiated Rate |
$99.82 |
| Max. Negotiated Rate |
$320.85 |
| Rate for Payer: Cash Price |
$142.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$142.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$128.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$128.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$135.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$142.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$135.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$106.95
|
| Rate for Payer: Healthfirst Commercial |
$142.60
|
| Rate for Payer: Healthfirst Essential Plan |
$320.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$135.47
|
| Rate for Payer: Healthfirst QHP |
$142.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$99.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$142.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$121.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$99.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$142.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$106.95
|
| Rate for Payer: SOMOS Essential |
$106.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$142.60
|
|
|
PR DRAINAGE ABSCESS/HEMATOMA NASAL SEPTUM
|
Professional
|
Both
|
$530.18
|
|
|
Service Code
|
HCPCS 30020
|
| Min. Negotiated Rate |
$99.93 |
| Max. Negotiated Rate |
$321.21 |
| Rate for Payer: Cash Price |
$144.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$142.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$128.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$128.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$135.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$142.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$135.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$107.07
|
| Rate for Payer: Healthfirst Commercial |
$142.76
|
| Rate for Payer: Healthfirst Essential Plan |
$321.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$135.62
|
| Rate for Payer: Healthfirst QHP |
$142.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$99.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$142.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$121.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$99.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$142.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$107.07
|
| Rate for Payer: SOMOS Essential |
$107.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$142.76
|
|
|
PR DRAINAGE ABSCESS PALATE UVULA
|
Professional
|
Both
|
$471.07
|
|
|
Service Code
|
HCPCS 42000
|
| Min. Negotiated Rate |
$89.19 |
| Max. Negotiated Rate |
$286.69 |
| Rate for Payer: Cash Price |
$128.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$114.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$114.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$121.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$121.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.56
|
| Rate for Payer: Healthfirst Commercial |
$127.42
|
| Rate for Payer: Healthfirst Essential Plan |
$286.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$121.05
|
| Rate for Payer: Healthfirst QHP |
$127.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$89.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$127.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$108.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$89.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$95.56
|
| Rate for Payer: SOMOS Essential |
$95.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.42
|
|
|
PR DRAINAGE ABSCESS PAROTID COMPLICATED
|
Professional
|
Both
|
$1,822.14
|
|
|
Service Code
|
HCPCS 42305
|
| Min. Negotiated Rate |
$352.77 |
| Max. Negotiated Rate |
$1,133.91 |
| Rate for Payer: Cash Price |
$509.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$503.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$453.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$453.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$478.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$503.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$478.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$503.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$503.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$377.97
|
| Rate for Payer: Healthfirst Commercial |
$503.96
|
| Rate for Payer: Healthfirst Essential Plan |
$1,133.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$478.76
|
| Rate for Payer: Healthfirst QHP |
$503.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$352.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$503.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$428.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$352.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$503.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$377.97
|
| Rate for Payer: SOMOS Essential |
$377.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$503.96
|
|
|
PR DRAINAGE ABSCESS PAROTID SIMPLE
|
Professional
|
Both
|
$678.09
|
|
|
Service Code
|
HCPCS 42300
|
| Min. Negotiated Rate |
$127.52 |
| Max. Negotiated Rate |
$409.88 |
| Rate for Payer: Cash Price |
$184.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$163.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$163.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$173.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$173.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$182.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$136.63
|
| Rate for Payer: Healthfirst Commercial |
$182.17
|
| Rate for Payer: Healthfirst Essential Plan |
$409.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$173.06
|
| Rate for Payer: Healthfirst QHP |
$182.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$127.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$182.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$154.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$127.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$136.63
|
| Rate for Payer: SOMOS Essential |
$136.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.17
|
|
|
PR DRAINAGE ABSCESS SUBMAXILLARY INTRAORAL
|
Professional
|
Both
|
$777.28
|
|
|
Service Code
|
HCPCS 42320
|
| Min. Negotiated Rate |
$146.38 |
| Max. Negotiated Rate |
$470.52 |
| Rate for Payer: Cash Price |
$210.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$209.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$188.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$198.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$209.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$198.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$156.84
|
| Rate for Payer: Healthfirst Commercial |
$209.12
|
| Rate for Payer: Healthfirst Essential Plan |
$470.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$198.66
|
| Rate for Payer: Healthfirst QHP |
$209.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$146.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$209.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$177.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$146.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$209.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$156.84
|
| Rate for Payer: SOMOS Essential |
$156.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$209.12
|
|
|
PR DRAINAGE DEEP PERIURETHRAL ABSCESS
|
Professional
|
Both
|
$1,651.93
|
|
|
Service Code
|
HCPCS 53040
|
| Min. Negotiated Rate |
$315.92 |
| Max. Negotiated Rate |
$1,015.47 |
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$451.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$406.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$406.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$428.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$451.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$428.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$451.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$451.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$338.49
|
| Rate for Payer: Healthfirst Commercial |
$451.32
|
| Rate for Payer: Healthfirst Essential Plan |
$1,015.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$428.75
|
| Rate for Payer: Healthfirst QHP |
$451.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$315.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$451.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$383.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$315.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$451.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$338.49
|
| Rate for Payer: SOMOS Essential |
$338.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$451.32
|
|
|
PR DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS
|
Professional
|
Both
|
$625.59
|
|
|
Service Code
|
HCPCS 69020
|
| Min. Negotiated Rate |
$116.90 |
| Max. Negotiated Rate |
$375.75 |
| Rate for Payer: Cash Price |
$169.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$167.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$150.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$150.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$158.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$167.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$158.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$167.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$167.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$125.25
|
| Rate for Payer: Healthfirst Commercial |
$167.00
|
| Rate for Payer: Healthfirst Essential Plan |
$375.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$158.65
|
| Rate for Payer: Healthfirst QHP |
$167.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$116.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$167.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$141.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$116.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$167.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$125.25
|
| Rate for Payer: SOMOS Essential |
$125.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$167.00
|
|
|
PR DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX
|
Professional
|
Both
|
$690.45
|
|
|
Service Code
|
HCPCS 69005
|
| Min. Negotiated Rate |
$131.84 |
| Max. Negotiated Rate |
$423.79 |
| Rate for Payer: Cash Price |
$190.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$188.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$169.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$169.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$178.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$188.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$178.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$188.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$188.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$141.26
|
| Rate for Payer: Healthfirst Commercial |
$188.35
|
| Rate for Payer: Healthfirst Essential Plan |
$423.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$178.93
|
| Rate for Payer: Healthfirst QHP |
$188.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$131.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$188.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$160.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$131.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$188.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$141.26
|
| Rate for Payer: SOMOS Essential |
$141.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$188.35
|
|
|
PR DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE
|
Professional
|
Both
|
$539.88
|
|
|
Service Code
|
HCPCS 69000
|
| Min. Negotiated Rate |
$102.21 |
| Max. Negotiated Rate |
$328.52 |
| Rate for Payer: Cash Price |
$148.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$146.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$131.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$131.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$138.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$146.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$138.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$146.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$146.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$109.51
|
| Rate for Payer: Healthfirst Commercial |
$146.01
|
| Rate for Payer: Healthfirst Essential Plan |
$328.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$138.71
|
| Rate for Payer: Healthfirst QHP |
$146.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$102.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$146.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$124.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$102.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$146.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$109.51
|
| Rate for Payer: SOMOS Essential |
$109.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$146.01
|
|
|
PR DRAINAGE FINGER ABSCESS COMPLICATED
|
Professional
|
Both
|
$816.80
|
|
|
Service Code
|
HCPCS 26011
|
| Min. Negotiated Rate |
$154.25 |
| Max. Negotiated Rate |
$495.79 |
| Rate for Payer: Cash Price |
$220.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$220.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$198.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$198.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$209.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$220.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$209.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$220.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$220.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.26
|
| Rate for Payer: Healthfirst Commercial |
$220.35
|
| Rate for Payer: Healthfirst Essential Plan |
$495.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.33
|
| Rate for Payer: Healthfirst QHP |
$220.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$154.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$220.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$187.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$154.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$220.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$165.26
|
| Rate for Payer: SOMOS Essential |
$165.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$220.35
|
|
|
PR DRAINAGE FINGER ABSCESS SIMPLE
|
Professional
|
Both
|
$616.60
|
|
|
Service Code
|
HCPCS 26010
|
| Min. Negotiated Rate |
$116.75 |
| Max. Negotiated Rate |
$375.28 |
| Rate for Payer: Cash Price |
$168.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$166.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$150.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$150.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$158.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$166.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$158.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$166.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$166.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$125.09
|
| Rate for Payer: Healthfirst Commercial |
$166.79
|
| Rate for Payer: Healthfirst Essential Plan |
$375.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$158.45
|
| Rate for Payer: Healthfirst QHP |
$166.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$116.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$166.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$141.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$116.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$166.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$125.09
|
| Rate for Payer: SOMOS Essential |
$125.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$166.79
|
|
|
PR DRAINAGE OF PALMAR BURSA MULTIPLE BURSA
|
Professional
|
Both
|
$2,175.32
|
|
|
Service Code
|
HCPCS 26030
|
| Min. Negotiated Rate |
$412.89 |
| Max. Negotiated Rate |
$1,327.16 |
| Rate for Payer: Cash Price |
$591.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$589.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$530.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$530.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$560.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$589.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$560.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$589.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$589.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$442.39
|
| Rate for Payer: Healthfirst Commercial |
$589.85
|
| Rate for Payer: Healthfirst Essential Plan |
$1,327.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$560.36
|
| Rate for Payer: Healthfirst QHP |
$589.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$412.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$589.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$501.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$412.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$589.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$442.39
|
| Rate for Payer: SOMOS Essential |
$442.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$589.85
|
|
|
PR DRAINAGE OF PALMAR BURSA SINGLE BURSA
|
Professional
|
Both
|
$1,859.17
|
|
|
Service Code
|
HCPCS 26025
|
| Min. Negotiated Rate |
$351.57 |
| Max. Negotiated Rate |
$1,130.04 |
| Rate for Payer: Cash Price |
$505.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$502.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$452.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$452.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$477.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$502.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$477.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$502.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$502.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$376.68
|
| Rate for Payer: Healthfirst Commercial |
$502.24
|
| Rate for Payer: Healthfirst Essential Plan |
$1,130.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$477.13
|
| Rate for Payer: Healthfirst QHP |
$502.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$351.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$502.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$426.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$351.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$502.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$376.68
|
| Rate for Payer: SOMOS Essential |
$376.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$502.24
|
|
