|
PR INSJ TUN VAD REQ 2 CATH 2 SITS W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$1,479.77
|
|
|
Service Code
|
HCPCS 36565
|
| Min. Negotiated Rate |
$274.95 |
| Max. Negotiated Rate |
$883.78 |
| Rate for Payer: Cash Price |
$395.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$392.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$353.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$353.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$373.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$392.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$373.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$392.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$392.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$294.59
|
| Rate for Payer: Healthfirst Commercial |
$392.79
|
| Rate for Payer: Healthfirst Essential Plan |
$883.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$373.15
|
| Rate for Payer: Healthfirst QHP |
$392.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$274.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$392.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$333.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$274.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$392.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$294.59
|
| Rate for Payer: SOMOS Essential |
$294.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$392.79
|
|
|
PR INSJ TUN VAD REQ 2 CATH 2 SITS W/SUBQ PORT
|
Professional
|
Both
|
$1,544.20
|
|
|
Service Code
|
HCPCS 36566
|
| Min. Negotiated Rate |
$286.38 |
| Max. Negotiated Rate |
$920.52 |
| Rate for Payer: Cash Price |
$412.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$409.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$368.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$368.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$388.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$409.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$388.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$409.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$409.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$306.84
|
| Rate for Payer: Healthfirst Commercial |
$409.12
|
| Rate for Payer: Healthfirst Essential Plan |
$920.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$388.66
|
| Rate for Payer: Healthfirst QHP |
$409.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$286.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$409.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$347.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$286.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$409.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$306.84
|
| Rate for Payer: SOMOS Essential |
$306.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$409.12
|
|
|
PR INSJ VENTR ASSIST DEV IMPLTABLE ICORP 1 VNTRC
|
Professional
|
Both
|
$8,591.10
|
|
|
Service Code
|
HCPCS 33979
|
| Min. Negotiated Rate |
$1,575.01 |
| Max. Negotiated Rate |
$5,062.55 |
| Rate for Payer: Cash Price |
$2,277.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,250.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,025.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,025.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,137.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,250.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,137.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,250.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,250.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,687.52
|
| Rate for Payer: Healthfirst Commercial |
$2,250.02
|
| Rate for Payer: Healthfirst Essential Plan |
$5,062.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,137.52
|
| Rate for Payer: Healthfirst QHP |
$2,250.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,575.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,250.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,912.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,575.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,250.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,687.52
|
| Rate for Payer: SOMOS Essential |
$1,687.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,250.02
|
|
|
PR INSJ VENTRIC ASSIST DEV XTRCORP BIVENTRICULAR
|
Professional
|
Both
|
$6,958.07
|
|
|
Service Code
|
HCPCS 33976
|
| Min. Negotiated Rate |
$1,274.05 |
| Max. Negotiated Rate |
$4,095.16 |
| Rate for Payer: Cash Price |
$1,840.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,820.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,638.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,638.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,729.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,820.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,729.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,820.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,820.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,365.05
|
| Rate for Payer: Healthfirst Commercial |
$1,820.07
|
| Rate for Payer: Healthfirst Essential Plan |
$4,095.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,729.07
|
| Rate for Payer: Healthfirst QHP |
$1,820.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,274.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,820.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,547.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,274.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,820.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,365.05
|
| Rate for Payer: SOMOS Essential |
$1,365.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,820.07
|
|
|
PR INSJ VENTRIC ASSIST DEV XTRCORP SINGLE VENTRICLE
|
Professional
|
Both
|
$5,719.04
|
|
|
Service Code
|
HCPCS 33975
|
| Min. Negotiated Rate |
$1,061.48 |
| Max. Negotiated Rate |
$3,411.90 |
| Rate for Payer: Cash Price |
$1,529.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,516.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,364.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,364.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,440.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,516.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,440.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,516.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,516.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,137.30
|
| Rate for Payer: Healthfirst Commercial |
$1,516.40
|
| Rate for Payer: Healthfirst Essential Plan |
$3,411.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,440.58
|
| Rate for Payer: Healthfirst QHP |
$1,516.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,061.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,516.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,288.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,061.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,516.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,137.30
|
| Rate for Payer: SOMOS Essential |
$1,137.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,516.40
|
|
|
PR INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL
|
Professional
|
Both
|
$2,008.09
|
|
|
Service Code
|
HCPCS 33206
|
| Min. Negotiated Rate |
$369.93 |
| Max. Negotiated Rate |
$1,189.06 |
| Rate for Payer: Cash Price |
$532.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$528.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$475.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$475.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$502.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$528.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$502.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$528.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$528.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$396.35
|
| Rate for Payer: Healthfirst Commercial |
$528.47
|
| Rate for Payer: Healthfirst Essential Plan |
$1,189.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$502.05
|
| Rate for Payer: Healthfirst QHP |
$528.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$369.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$528.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$449.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$369.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$528.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$396.35
|
| Rate for Payer: SOMOS Essential |
$396.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$528.47
|
|
|
PR INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT
|
Professional
|
Both
|
$2,291.35
|
|
|
Service Code
|
HCPCS 33208
|
| Min. Negotiated Rate |
$420.42 |
| Max. Negotiated Rate |
$1,351.35 |
| Rate for Payer: Cash Price |
$606.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$600.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$540.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$540.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$570.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$600.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$570.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$600.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$600.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$450.45
|
| Rate for Payer: Healthfirst Commercial |
$600.60
|
| Rate for Payer: Healthfirst Essential Plan |
$1,351.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$570.57
|
| Rate for Payer: Healthfirst QHP |
$600.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$420.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$600.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$510.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$420.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$600.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$450.45
|
| Rate for Payer: SOMOS Essential |
$450.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$600.60
|
|
|
PR INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR
|
Professional
|
Both
|
$2,112.99
|
|
|
Service Code
|
HCPCS 33207
|
| Min. Negotiated Rate |
$389.67 |
| Max. Negotiated Rate |
$1,252.51 |
| Rate for Payer: Cash Price |
$560.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$556.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$501.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$501.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$528.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$556.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$528.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$556.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$556.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$417.50
|
| Rate for Payer: Healthfirst Commercial |
$556.67
|
| Rate for Payer: Healthfirst Essential Plan |
$1,252.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$528.84
|
| Rate for Payer: Healthfirst QHP |
$556.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$389.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$556.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$473.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$389.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$556.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$417.50
|
| Rate for Payer: SOMOS Essential |
$417.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$556.67
|
|
|
PR INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS
|
Professional
|
Both
|
$1,485.86
|
|
|
Service Code
|
HCPCS 33213
|
| Min. Negotiated Rate |
$274.84 |
| Max. Negotiated Rate |
$883.42 |
| Rate for Payer: Cash Price |
$397.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$392.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$353.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$353.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$373.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$392.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$373.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$392.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$392.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$294.47
|
| Rate for Payer: Healthfirst Commercial |
$392.63
|
| Rate for Payer: Healthfirst Essential Plan |
$883.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$373.00
|
| Rate for Payer: Healthfirst QHP |
$392.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$274.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$392.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$333.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$274.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$392.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$294.47
|
| Rate for Payer: SOMOS Essential |
$294.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$392.63
|
|
|
PR INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS
|
Professional
|
Both
|
$1,583.96
|
|
|
Service Code
|
HCPCS 33221
|
| Min. Negotiated Rate |
$290.79 |
| Max. Negotiated Rate |
$934.67 |
| Rate for Payer: Cash Price |
$419.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$415.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$373.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$373.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$394.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$415.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$394.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$415.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$415.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$311.56
|
| Rate for Payer: Healthfirst Commercial |
$415.41
|
| Rate for Payer: Healthfirst Essential Plan |
$934.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$394.64
|
| Rate for Payer: Healthfirst QHP |
$415.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$290.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$415.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$353.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$290.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$415.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$311.56
|
| Rate for Payer: SOMOS Essential |
$311.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$415.41
|
|
|
PR INS PM PLS GEN W/EXIST SINGLE LEAD
|
Professional
|
Both
|
$1,421.11
|
|
|
Service Code
|
HCPCS 33212
|
| Min. Negotiated Rate |
$264.59 |
| Max. Negotiated Rate |
$850.46 |
| Rate for Payer: Cash Price |
$379.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$377.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$340.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$340.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$359.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$377.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$359.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$377.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$377.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$283.49
|
| Rate for Payer: Healthfirst Commercial |
$377.98
|
| Rate for Payer: Healthfirst Essential Plan |
$850.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$359.08
|
| Rate for Payer: Healthfirst QHP |
$377.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$264.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$377.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$321.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$264.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$377.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$283.49
|
| Rate for Payer: SOMOS Essential |
$283.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$377.98
|
|
|
PR INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD
|
Professional
|
Both
|
$2,481.78
|
|
|
Service Code
|
HCPCS 33270
|
| Min. Negotiated Rate |
$455.14 |
| Max. Negotiated Rate |
$1,462.95 |
| Rate for Payer: Cash Price |
$656.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$650.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$585.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$585.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$617.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$650.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$617.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$650.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$650.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$487.65
|
| Rate for Payer: Healthfirst Commercial |
$650.20
|
| Rate for Payer: Healthfirst Essential Plan |
$1,462.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$617.69
|
| Rate for Payer: Healthfirst QHP |
$650.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$455.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$650.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$552.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$455.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$650.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$487.65
|
| Rate for Payer: SOMOS Essential |
$487.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$650.20
|
|
|
PR INS/RPLC PERPH SAC/GSTRC NPG/RCVR PCKT CRTJ&CONN
|
Professional
|
Both
|
$688.70
|
|
|
Service Code
|
HCPCS 64590
|
| Min. Negotiated Rate |
$236.84 |
| Max. Negotiated Rate |
$761.29 |
| Rate for Payer: Cash Price |
$341.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$338.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$304.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$304.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$321.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$338.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$321.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$338.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$338.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$253.76
|
| Rate for Payer: Healthfirst Commercial |
$338.35
|
| Rate for Payer: Healthfirst Essential Plan |
$761.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$321.43
|
| Rate for Payer: Healthfirst QHP |
$338.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$236.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$338.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$287.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$236.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$338.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$253.76
|
| Rate for Payer: SOMOS Essential |
$253.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$338.35
|
|
|
PR INSTLJ CH TUBE/CATH AGENT FBRNLYSIS SBSQ DAY
|
Professional
|
Both
|
$249.69
|
|
|
Service Code
|
HCPCS 32562
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$149.13 |
| Rate for Payer: Cash Price |
$67.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$66.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$66.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.71
|
| Rate for Payer: Healthfirst Commercial |
$66.28
|
| Rate for Payer: Healthfirst Essential Plan |
$149.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.97
|
| Rate for Payer: Healthfirst QHP |
$66.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$66.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$56.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$66.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$49.71
|
| Rate for Payer: SOMOS Essential |
$49.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.28
|
|
|
PR INSTLJ THER AGENT RENAL PELVIS&/URETER VIA TUB
|
Professional
|
Both
|
$404.74
|
|
|
Service Code
|
HCPCS 50391
|
| Min. Negotiated Rate |
$76.51 |
| Max. Negotiated Rate |
$245.93 |
| Rate for Payer: Cash Price |
$110.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$109.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$98.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$98.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$103.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$109.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$103.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$81.97
|
| Rate for Payer: Healthfirst Commercial |
$109.30
|
| Rate for Payer: Healthfirst Essential Plan |
$245.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$103.83
|
| Rate for Payer: Healthfirst QHP |
$109.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$76.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$109.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$92.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$76.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$109.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$81.97
|
| Rate for Payer: SOMOS Essential |
$81.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$109.30
|
|
|
PR INSTLJ VIA CHEST TUBE/CATH AGENT FOR PLEURODESIS
|
Professional
|
Both
|
$321.93
|
|
|
Service Code
|
HCPCS 32560
|
| Min. Negotiated Rate |
$59.86 |
| Max. Negotiated Rate |
$192.40 |
| Rate for Payer: Cash Price |
$86.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$76.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$81.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$81.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.13
|
| Rate for Payer: Healthfirst Commercial |
$85.51
|
| Rate for Payer: Healthfirst Essential Plan |
$192.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$81.23
|
| Rate for Payer: Healthfirst QHP |
$85.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$85.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$72.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.13
|
| Rate for Payer: SOMOS Essential |
$64.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.51
|
|
|
PR INSTLJ VIA CH TUBE/CATH AGENT FBRNLYSIS 1ST DAY
|
Professional
|
Both
|
$282.42
|
|
|
Service Code
|
HCPCS 32561
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$168.41 |
| Rate for Payer: Cash Price |
$75.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$74.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$74.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$71.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.14
|
| Rate for Payer: Healthfirst Commercial |
$74.85
|
| Rate for Payer: Healthfirst Essential Plan |
$168.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$71.11
|
| Rate for Payer: Healthfirst QHP |
$74.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$74.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56.14
|
| Rate for Payer: SOMOS Essential |
$56.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.85
|
|
|
PR INT ANAST PANCREATIC CYST GI TRACT DIRECT
|
Professional
|
Both
|
$4,985.89
|
|
|
Service Code
|
HCPCS 48520
|
| Min. Negotiated Rate |
$920.54 |
| Max. Negotiated Rate |
$2,958.89 |
| Rate for Payer: Cash Price |
$1,326.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,315.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,183.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,183.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,249.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,315.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,249.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,315.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,315.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$986.29
|
| Rate for Payer: Healthfirst Commercial |
$1,315.06
|
| Rate for Payer: Healthfirst Essential Plan |
$2,958.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,249.31
|
| Rate for Payer: Healthfirst QHP |
$1,315.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$920.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,315.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,117.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$920.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,315.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$986.29
|
| Rate for Payer: SOMOS Essential |
$986.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,315.06
|
|
|
PR INT ANAST PANCREATIC CYST GI TRACT ROUX-EN-Y
|
Professional
|
Both
|
$5,923.09
|
|
|
Service Code
|
HCPCS 48540
|
| Min. Negotiated Rate |
$1,094.06 |
| Max. Negotiated Rate |
$3,516.61 |
| Rate for Payer: Cash Price |
$1,574.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,562.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,406.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,406.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,484.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,562.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,484.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,562.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,562.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,172.20
|
| Rate for Payer: Healthfirst Commercial |
$1,562.94
|
| Rate for Payer: Healthfirst Essential Plan |
$3,516.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,484.79
|
| Rate for Payer: Healthfirst QHP |
$1,562.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,094.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,562.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,328.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,094.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,562.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,172.20
|
| Rate for Payer: SOMOS Essential |
$1,172.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,562.94
|
|
|
PR INTENS BEHAVE THER CARDIO DX
|
Professional
|
Both
|
$94.61
|
|
|
Service Code
|
HCPCS G0446
|
| Min. Negotiated Rate |
$23.26 |
| Max. Negotiated Rate |
$74.77 |
| Rate for Payer: Cash Price |
$25.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.92
|
| Rate for Payer: Healthfirst Commercial |
$33.23
|
| Rate for Payer: Healthfirst Essential Plan |
$74.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.57
|
| Rate for Payer: Healthfirst QHP |
$33.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.92
|
| Rate for Payer: SOMOS Essential |
$24.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.23
|
|
|
PR INTENS CARDIAC REHAB NO EXER
|
Professional
|
Both
|
$485.91
|
|
|
Service Code
|
HCPCS G0423
|
| Min. Negotiated Rate |
$101.81 |
| Max. Negotiated Rate |
$327.26 |
| Rate for Payer: Cash Price |
$145.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$145.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$130.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$130.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$138.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$145.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$138.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$145.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$145.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$109.09
|
| Rate for Payer: Healthfirst Commercial |
$145.45
|
| Rate for Payer: Healthfirst Essential Plan |
$327.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$138.18
|
| Rate for Payer: Healthfirst QHP |
$145.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$101.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$145.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$123.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$101.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$145.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$109.09
|
| Rate for Payer: SOMOS Essential |
$109.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$145.45
|
|
|
PR INTENS CARDIAC REHAB W/EXERC
|
Professional
|
Both
|
$485.91
|
|
|
Service Code
|
HCPCS G0422
|
| Min. Negotiated Rate |
$101.81 |
| Max. Negotiated Rate |
$327.26 |
| Rate for Payer: Cash Price |
$145.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$145.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$130.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$130.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$138.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$145.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$138.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$145.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$145.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$109.09
|
| Rate for Payer: Healthfirst Commercial |
$145.45
|
| Rate for Payer: Healthfirst Essential Plan |
$327.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$138.18
|
| Rate for Payer: Healthfirst QHP |
$145.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$101.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$145.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$123.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$101.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$145.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$109.09
|
| Rate for Payer: SOMOS Essential |
$109.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$145.45
|
|
|
PR INTERCALARY ALLOGRAFT COMPLETE
|
Professional
|
Both
|
$3,316.71
|
|
|
Service Code
|
HCPCS 20934
|
| Min. Negotiated Rate |
$615.36 |
| Max. Negotiated Rate |
$1,977.95 |
| Rate for Payer: Cash Price |
$885.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$879.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$791.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$791.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$835.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$879.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$835.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$879.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$879.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$659.32
|
| Rate for Payer: Healthfirst Commercial |
$879.09
|
| Rate for Payer: Healthfirst Essential Plan |
$1,977.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$835.14
|
| Rate for Payer: Healthfirst QHP |
$879.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$615.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$879.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$747.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$615.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$879.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$659.32
|
| Rate for Payer: SOMOS Essential |
$659.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$879.09
|
|
|
PR INTERDENTAL WIRING OTHER THAN FRACTURE
|
Professional
|
Both
|
$2,518.53
|
|
|
Service Code
|
HCPCS 21497
|
| Min. Negotiated Rate |
$474.85 |
| Max. Negotiated Rate |
$1,526.31 |
| Rate for Payer: Cash Price |
$682.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$678.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$610.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$610.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$644.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$678.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$644.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$678.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$678.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$508.77
|
| Rate for Payer: Healthfirst Commercial |
$678.36
|
| Rate for Payer: Healthfirst Essential Plan |
$1,526.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$644.44
|
| Rate for Payer: Healthfirst QHP |
$678.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$474.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$678.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$576.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$474.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$678.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$508.77
|
| Rate for Payer: SOMOS Essential |
$508.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$678.36
|
|
|
PR INTERMEDIATE VISUAL FIELD XM UNI/BI I&R
|
Professional
|
Both
|
$195.02
|
|
|
Service Code
|
HCPCS 92082
|
| Min. Negotiated Rate |
$37.14 |
| Max. Negotiated Rate |
$119.39 |
| Rate for Payer: Amida Care Medicaid |
$51.44
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.80
|
| Rate for Payer: Healthfirst Commercial |
$53.06
|
| Rate for Payer: Healthfirst Essential Plan |
$119.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.41
|
| Rate for Payer: Healthfirst QHP |
$53.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.80
|
| Rate for Payer: SOMOS Essential |
$39.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.06
|
|
