|
PR ISCHEMIC LIMB XERS TST SPEC ACQUISJ METAB
|
Professional
|
Both
|
$227.78
|
|
|
Service Code
|
HCPCS 95875 26
|
| Min. Negotiated Rate |
$44.02 |
| Max. Negotiated Rate |
$141.48 |
| Rate for Payer: Amida Care Medicaid |
$76.86
|
| Rate for Payer: Cash Price |
$63.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.16
|
| Rate for Payer: Healthfirst Commercial |
$62.88
|
| Rate for Payer: Healthfirst Essential Plan |
$141.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.74
|
| Rate for Payer: Healthfirst QHP |
$62.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$44.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$44.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.16
|
| Rate for Payer: SOMOS Essential |
$47.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.88
|
|
|
PR ISCHEMIC LIMB XERS TST SPEC ACQUISJ METAB
|
Professional
|
Both
|
$344.86
|
|
|
Service Code
|
HCPCS 95875 TC
|
| Min. Negotiated Rate |
$51.24 |
| Max. Negotiated Rate |
$164.70 |
| Rate for Payer: Amida Care Medicaid |
$76.86
|
| Rate for Payer: Cash Price |
$76.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$65.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$69.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.90
|
| Rate for Payer: Healthfirst Commercial |
$73.20
|
| Rate for Payer: Healthfirst Essential Plan |
$164.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.54
|
| Rate for Payer: Healthfirst QHP |
$73.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$73.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.90
|
| Rate for Payer: SOMOS Essential |
$54.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.20
|
|
|
PR ISCHEMIC LIMB XERS TST SPEC ACQUISJ METAB
|
Professional
|
Both
|
$572.64
|
|
|
Service Code
|
HCPCS 95875
|
| Min. Negotiated Rate |
$76.86 |
| Max. Negotiated Rate |
$306.18 |
| Rate for Payer: Amida Care Medicaid |
$76.86
|
| Rate for Payer: Cash Price |
$140.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$136.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$122.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$122.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$129.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$136.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$129.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.06
|
| Rate for Payer: Healthfirst Commercial |
$136.08
|
| Rate for Payer: Healthfirst Essential Plan |
$306.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$129.28
|
| Rate for Payer: Healthfirst QHP |
$136.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$95.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$136.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$115.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$95.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$136.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.06
|
| Rate for Payer: SOMOS Essential |
$102.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$136.08
|
|
|
PRISMASOL BGK 0/2.5 32-2.5 MEQ/L APHERESIS SOLN
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 2457110806
|
| Hospital Charge Code |
2457110806
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
|
|
PRISMASOL BGK 0/2.5 32-2.5 MEQ/L APHERESIS SOLN
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 2457110806
|
| Hospital Charge Code |
2457110806
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: EmblemHealth Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
PR IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL
|
Professional
|
Both
|
$310.24
|
|
|
Service Code
|
HCPCS 93571 26
|
| Min. Negotiated Rate |
$57.13 |
| Max. Negotiated Rate |
$222.65 |
| Rate for Payer: Amida Care Medicaid |
$222.65
|
| Rate for Payer: Cash Price |
$82.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.22
|
| Rate for Payer: Healthfirst Commercial |
$81.62
|
| Rate for Payer: Healthfirst Essential Plan |
$183.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$77.54
|
| Rate for Payer: Healthfirst QHP |
$81.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$81.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$61.22
|
| Rate for Payer: SOMOS Essential |
$61.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.62
|
|
|
PR IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL
|
Professional
|
Both
|
$921.17
|
|
|
Service Code
|
HCPCS 93571 TC
|
| Min. Negotiated Rate |
$222.65 |
| Max. Negotiated Rate |
$222.65 |
| Rate for Payer: Amida Care Medicaid |
$222.65
|
|
|
PR IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL
|
Professional
|
Both
|
$1,231.41
|
|
|
Service Code
|
HCPCS 93571
|
| Min. Negotiated Rate |
$222.65 |
| Max. Negotiated Rate |
$222.65 |
| Rate for Payer: Amida Care Medicaid |
$222.65
|
|
|
PR IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL
|
Professional
|
Both
|
$377.13
|
|
|
Service Code
|
HCPCS 93572 TC
|
| Min. Negotiated Rate |
$132.39 |
| Max. Negotiated Rate |
$132.39 |
| Rate for Payer: Amida Care Medicaid |
$132.39
|
|
|
PR IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL
|
Professional
|
Both
|
$603.23
|
|
|
Service Code
|
HCPCS 93572
|
| Min. Negotiated Rate |
$132.39 |
| Max. Negotiated Rate |
$132.39 |
| Rate for Payer: Amida Care Medicaid |
$132.39
|
|
|
PR IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL
|
Professional
|
Both
|
$226.10
|
|
|
Service Code
|
HCPCS 93572 26
|
| Min. Negotiated Rate |
$41.41 |
| Max. Negotiated Rate |
$133.11 |
| Rate for Payer: Amida Care Medicaid |
$132.39
|
| Rate for Payer: Cash Price |
$60.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$59.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.37
|
| Rate for Payer: Healthfirst Commercial |
$59.16
|
| Rate for Payer: Healthfirst Essential Plan |
$133.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.20
|
| Rate for Payer: Healthfirst QHP |
$59.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.37
|
| Rate for Payer: SOMOS Essential |
$44.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.16
|
|
|
PR IV INFUSION HYDRATION EACH ADDITIONAL HOUR
|
Professional
|
Both
|
$54.25
|
|
|
Service Code
|
HCPCS 96361
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$31.07 |
| Rate for Payer: Cash Price |
$14.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.36
|
| Rate for Payer: Healthfirst Commercial |
$13.81
|
| Rate for Payer: Healthfirst Essential Plan |
$31.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.12
|
| Rate for Payer: Healthfirst QHP |
$13.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.36
|
| Rate for Payer: SOMOS Essential |
$10.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.81
|
|
|
PR IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR
|
Professional
|
Both
|
$137.59
|
|
|
Service Code
|
HCPCS 96360
|
| Min. Negotiated Rate |
$24.91 |
| Max. Negotiated Rate |
$80.08 |
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.69
|
| Rate for Payer: Healthfirst Commercial |
$35.59
|
| Rate for Payer: Healthfirst Essential Plan |
$80.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.81
|
| Rate for Payer: Healthfirst QHP |
$35.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.69
|
| Rate for Payer: SOMOS Essential |
$26.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.59
|
|
|
PR IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR
|
Professional
|
Both
|
$275.87
|
|
|
Service Code
|
HCPCS 96365
|
| Min. Negotiated Rate |
$48.64 |
| Max. Negotiated Rate |
$156.33 |
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$69.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$66.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$69.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$66.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$69.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$69.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.11
|
| Rate for Payer: Healthfirst Commercial |
$69.48
|
| Rate for Payer: Healthfirst Essential Plan |
$156.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$66.01
|
| Rate for Payer: Healthfirst QHP |
$69.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$69.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$59.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$69.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$52.11
|
| Rate for Payer: SOMOS Essential |
$52.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69.48
|
|
|
PR IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR
|
Professional
|
Both
|
$85.65
|
|
|
Service Code
|
HCPCS 96366
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$51.14 |
| Rate for Payer: Cash Price |
$23.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.05
|
| Rate for Payer: Healthfirst Commercial |
$22.73
|
| Rate for Payer: Healthfirst Essential Plan |
$51.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.59
|
| Rate for Payer: Healthfirst QHP |
$22.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.05
|
| Rate for Payer: SOMOS Essential |
$17.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.73
|
|
|
PR IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR
|
Professional
|
Both
|
$121.42
|
|
|
Service Code
|
HCPCS 96367
|
| Min. Negotiated Rate |
$21.86 |
| Max. Negotiated Rate |
$70.27 |
| Rate for Payer: Cash Price |
$32.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.42
|
| Rate for Payer: Healthfirst Commercial |
$31.23
|
| Rate for Payer: Healthfirst Essential Plan |
$70.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.67
|
| Rate for Payer: Healthfirst QHP |
$31.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.42
|
| Rate for Payer: SOMOS Essential |
$23.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.23
|
|
|
PR IV INJECTION TEST VASCULAR FLOW FLAP/GRAFT
|
Professional
|
Both
|
$464.94
|
|
|
Service Code
|
HCPCS 15860
|
| Min. Negotiated Rate |
$86.83 |
| Max. Negotiated Rate |
$279.11 |
| Rate for Payer: Cash Price |
$124.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$124.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$111.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$111.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$117.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$124.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$117.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$93.04
|
| Rate for Payer: Healthfirst Commercial |
$124.05
|
| Rate for Payer: Healthfirst Essential Plan |
$279.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$117.85
|
| Rate for Payer: Healthfirst QHP |
$124.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$86.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$124.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$105.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$86.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$124.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$93.04
|
| Rate for Payer: SOMOS Essential |
$93.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$124.05
|
|
|
PR IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS
|
Professional
|
Both
|
$82.95
|
|
|
Service Code
|
HCPCS 96368
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$48.62 |
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.21
|
| Rate for Payer: Healthfirst Commercial |
$21.61
|
| Rate for Payer: Healthfirst Essential Plan |
$48.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.53
|
| Rate for Payer: Healthfirst QHP |
$21.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$21.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$18.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16.21
|
| Rate for Payer: SOMOS Essential |
$16.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.61
|
|
|
PR JOINT REPLAC MOD HOME VISIT
|
Professional
|
Both
|
$194.64
|
|
|
Service Code
|
HCPCS G9490
|
| Min. Negotiated Rate |
$38.79 |
| Max. Negotiated Rate |
$124.67 |
| Rate for Payer: Cash Price |
$56.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$55.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$52.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.56
|
| Rate for Payer: Healthfirst Commercial |
$55.41
|
| Rate for Payer: Healthfirst Essential Plan |
$124.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.64
|
| Rate for Payer: Healthfirst QHP |
$55.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$55.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.56
|
| Rate for Payer: SOMOS Essential |
$41.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.41
|
|
|
PR KERATOPLASTY ANTERIOR LAMELLAR
|
Professional
|
Both
|
$4,713.98
|
|
|
Service Code
|
HCPCS 65710
|
| Min. Negotiated Rate |
$891.97 |
| Max. Negotiated Rate |
$2,867.04 |
| Rate for Payer: Cash Price |
$1,292.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,274.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,146.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,146.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,210.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,274.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,210.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,274.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,274.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$955.68
|
| Rate for Payer: Healthfirst Commercial |
$1,274.24
|
| Rate for Payer: Healthfirst Essential Plan |
$2,867.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,210.53
|
| Rate for Payer: Healthfirst QHP |
$1,274.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$891.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,274.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,083.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$891.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,274.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$955.68
|
| Rate for Payer: SOMOS Essential |
$955.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,274.24
|
|
|
PR KERATOPLASTY ENDOTHELIAL
|
Professional
|
Both
|
$4,833.99
|
|
|
Service Code
|
HCPCS 65756
|
| Min. Negotiated Rate |
$921.80 |
| Max. Negotiated Rate |
$2,962.93 |
| Rate for Payer: Cash Price |
$1,331.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,316.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,185.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,185.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,251.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,316.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,251.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,316.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,316.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$987.64
|
| Rate for Payer: Healthfirst Commercial |
$1,316.86
|
| Rate for Payer: Healthfirst Essential Plan |
$2,962.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,251.02
|
| Rate for Payer: Healthfirst QHP |
$1,316.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$921.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,316.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,119.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$921.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,316.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$987.64
|
| Rate for Payer: SOMOS Essential |
$987.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,316.86
|
|
|
PR KERATOPLASTY PENETRAING APHAKIA
|
Professional
|
Both
|
$5,190.96
|
|
|
Service Code
|
HCPCS 65750
|
| Min. Negotiated Rate |
$981.39 |
| Max. Negotiated Rate |
$3,154.48 |
| Rate for Payer: Cash Price |
$1,425.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,401.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,261.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,261.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,331.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,401.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,331.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,401.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,401.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,051.49
|
| Rate for Payer: Healthfirst Commercial |
$1,401.99
|
| Rate for Payer: Healthfirst Essential Plan |
$3,154.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,331.89
|
| Rate for Payer: Healthfirst QHP |
$1,401.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$981.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,401.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,191.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$981.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,401.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,051.49
|
| Rate for Payer: SOMOS Essential |
$1,051.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,401.99
|
|
|
PR KERATOPLASTY PENETRATING PSEUDOPHAKIA
|
Professional
|
Both
|
$5,174.33
|
|
|
Service Code
|
HCPCS 65755
|
| Min. Negotiated Rate |
$978.47 |
| Max. Negotiated Rate |
$3,145.07 |
| Rate for Payer: Cash Price |
$1,421.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,397.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,258.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,258.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,327.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,397.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,327.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,397.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,397.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,048.36
|
| Rate for Payer: Healthfirst Commercial |
$1,397.81
|
| Rate for Payer: Healthfirst Essential Plan |
$3,145.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,327.92
|
| Rate for Payer: Healthfirst QHP |
$1,397.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$978.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,397.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,188.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$978.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,397.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,048.36
|
| Rate for Payer: SOMOS Essential |
$1,048.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,397.81
|
|
|
PR KERATOPLASTY PENTRG EXCEPT APHAKIA/PSEUDOPHAKIA
|
Professional
|
Both
|
$5,165.48
|
|
|
Service Code
|
HCPCS 65730
|
| Min. Negotiated Rate |
$977.16 |
| Max. Negotiated Rate |
$3,140.86 |
| Rate for Payer: Cash Price |
$1,418.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,395.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,256.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,256.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,326.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,395.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,326.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,395.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,395.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,046.95
|
| Rate for Payer: Healthfirst Commercial |
$1,395.94
|
| Rate for Payer: Healthfirst Essential Plan |
$3,140.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,326.14
|
| Rate for Payer: Healthfirst QHP |
$1,395.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$977.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,395.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,186.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$977.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,395.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,046.95
|
| Rate for Payer: SOMOS Essential |
$1,046.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,395.94
|
|
|
PR KERATOPROSTHESIS
|
Professional
|
Both
|
$5,783.12
|
|
|
Service Code
|
HCPCS 65770
|
| Min. Negotiated Rate |
$1,096.56 |
| Max. Negotiated Rate |
$3,524.65 |
| Rate for Payer: Cash Price |
$1,588.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,566.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,409.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,409.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,488.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,566.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,488.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,566.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,566.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,174.88
|
| Rate for Payer: Healthfirst Commercial |
$1,566.51
|
| Rate for Payer: Healthfirst Essential Plan |
$3,524.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,488.18
|
| Rate for Payer: Healthfirst QHP |
$1,566.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,096.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,566.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,331.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,096.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,566.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,174.88
|
| Rate for Payer: SOMOS Essential |
$1,174.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,566.51
|
|
