|
PR LIGATION OF COMMON ILIAC VEIN
|
Professional
|
Both
|
$5,940.24
|
|
|
Service Code
|
HCPCS 37660
|
| Min. Negotiated Rate |
$1,096.82 |
| Max. Negotiated Rate |
$3,525.48 |
| Rate for Payer: Cash Price |
$1,579.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,566.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,410.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,410.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,488.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,566.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,488.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,566.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,566.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,175.16
|
| Rate for Payer: Healthfirst Commercial |
$1,566.88
|
| Rate for Payer: Healthfirst Essential Plan |
$3,525.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,488.54
|
| Rate for Payer: Healthfirst QHP |
$1,566.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,096.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,566.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,331.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,096.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,566.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,175.16
|
| Rate for Payer: SOMOS Essential |
$1,175.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,566.88
|
|
|
PR LIGATION OF FEMORAL VEIN
|
Professional
|
Both
|
$2,049.50
|
|
|
Service Code
|
HCPCS 37650
|
| Min. Negotiated Rate |
$378.36 |
| Max. Negotiated Rate |
$1,216.15 |
| Rate for Payer: Cash Price |
$544.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$540.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$486.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$486.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$513.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$540.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$513.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$540.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$540.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$405.38
|
| Rate for Payer: Healthfirst Commercial |
$540.51
|
| Rate for Payer: Healthfirst Essential Plan |
$1,216.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$513.48
|
| Rate for Payer: Healthfirst QHP |
$540.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$378.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$540.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$459.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$378.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$540.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$405.38
|
| Rate for Payer: SOMOS Essential |
$405.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$540.51
|
|
|
PR LIGATION OF INFERIOR VENA CAVA
|
Professional
|
Both
|
$7,807.14
|
|
|
Service Code
|
HCPCS 37619
|
| Min. Negotiated Rate |
$1,437.83 |
| Max. Negotiated Rate |
$4,621.59 |
| Rate for Payer: Cash Price |
$2,071.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,054.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,848.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,848.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,951.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,054.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,951.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,054.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,054.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,540.53
|
| Rate for Payer: Healthfirst Commercial |
$2,054.04
|
| Rate for Payer: Healthfirst Essential Plan |
$4,621.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,951.34
|
| Rate for Payer: Healthfirst QHP |
$2,054.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,437.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,054.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,745.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,437.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,054.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,540.53
|
| Rate for Payer: SOMOS Essential |
$1,540.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,054.04
|
|
|
PR LIGATION PERITONEAL-VENOUS SHUNT
|
Professional
|
Both
|
$1,950.66
|
|
|
Service Code
|
HCPCS 49428
|
| Min. Negotiated Rate |
$361.75 |
| Max. Negotiated Rate |
$1,162.78 |
| Rate for Payer: Cash Price |
$520.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$516.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$465.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$465.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$490.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$516.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$490.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$516.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$516.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$387.59
|
| Rate for Payer: Healthfirst Commercial |
$516.79
|
| Rate for Payer: Healthfirst Essential Plan |
$1,162.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$490.95
|
| Rate for Payer: Healthfirst QHP |
$516.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$361.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$516.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$439.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$361.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$516.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$387.59
|
| Rate for Payer: SOMOS Essential |
$387.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$516.79
|
|
|
PR LIGATION SALIVARY DUCT INTRAORAL
|
Professional
|
Both
|
$936.64
|
|
|
Service Code
|
HCPCS 42665
|
| Min. Negotiated Rate |
$179.20 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Cash Price |
$257.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$256.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$230.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$230.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$243.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$256.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$243.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$256.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$256.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$192.00
|
| Rate for Payer: Healthfirst Commercial |
$256.00
|
| Rate for Payer: Healthfirst Essential Plan |
$576.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$243.20
|
| Rate for Payer: Healthfirst QHP |
$256.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$179.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$256.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$217.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$179.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$256.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$192.00
|
| Rate for Payer: SOMOS Essential |
$192.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$256.00
|
|
|
PR LIG/BANDING ANGIOACCESS ARTERIOVENOUS FISTULA
|
Professional
|
Both
|
$1,655.36
|
|
|
Service Code
|
HCPCS 37607
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$984.08 |
| Rate for Payer: Cash Price |
$442.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$437.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$393.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$393.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$415.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$437.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$415.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$437.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$437.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$328.03
|
| Rate for Payer: Healthfirst Commercial |
$437.37
|
| Rate for Payer: Healthfirst Essential Plan |
$984.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$415.50
|
| Rate for Payer: Healthfirst QHP |
$437.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$306.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$437.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$371.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$306.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$437.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$328.03
|
| Rate for Payer: SOMOS Essential |
$328.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$437.37
|
|
|
PR LIG&DIV LONG SAPH VEIN SAPHFEM JUNCT/INTERRUPJ
|
Professional
|
Both
|
$1,088.26
|
|
|
Service Code
|
HCPCS 37700
|
| Min. Negotiated Rate |
$201.80 |
| Max. Negotiated Rate |
$648.65 |
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$288.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$259.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$259.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$273.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$288.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$273.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$288.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$288.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$216.22
|
| Rate for Payer: Healthfirst Commercial |
$288.29
|
| Rate for Payer: Healthfirst Essential Plan |
$648.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$273.88
|
| Rate for Payer: Healthfirst QHP |
$288.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$201.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$288.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$245.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$201.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$288.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$216.22
|
| Rate for Payer: SOMOS Essential |
$216.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$288.29
|
|
|
PR LIG INT/COMMON CAROTID ART W/GRADUAL OCCLUSION
|
Professional
|
Both
|
$3,480.23
|
|
|
Service Code
|
HCPCS 37606
|
| Min. Negotiated Rate |
$643.67 |
| Max. Negotiated Rate |
$2,068.94 |
| Rate for Payer: Cash Price |
$925.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$919.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$827.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$827.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$873.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$919.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$873.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$919.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$919.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$689.65
|
| Rate for Payer: Healthfirst Commercial |
$919.53
|
| Rate for Payer: Healthfirst Essential Plan |
$2,068.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$873.55
|
| Rate for Payer: Healthfirst QHP |
$919.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$643.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$919.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$781.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$643.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$919.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$689.65
|
| Rate for Payer: SOMOS Essential |
$689.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$919.53
|
|
|
PR LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG
|
Professional
|
Both
|
$1,127.77
|
|
|
Service Code
|
HCPCS 37785
|
| Min. Negotiated Rate |
$207.07 |
| Max. Negotiated Rate |
$665.57 |
| Rate for Payer: Cash Price |
$303.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$295.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$266.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$266.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$281.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$295.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$281.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$295.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$295.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$221.86
|
| Rate for Payer: Healthfirst Commercial |
$295.81
|
| Rate for Payer: Healthfirst Essential Plan |
$665.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$281.02
|
| Rate for Payer: Healthfirst QHP |
$295.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$207.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$295.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$251.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$207.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$295.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$221.86
|
| Rate for Payer: SOMOS Essential |
$221.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$295.81
|
|
|
PR LIGJ & DIVJ RADICAL STRIP LONG/SHORT SAPHENOUS
|
Professional
|
Both
|
$2,596.30
|
|
|
Service Code
|
HCPCS 37735
|
| Min. Negotiated Rate |
$477.28 |
| Max. Negotiated Rate |
$1,534.12 |
| Rate for Payer: Cash Price |
$689.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$681.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$613.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$613.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$647.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$681.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$647.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$681.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$681.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$511.37
|
| Rate for Payer: Healthfirst Commercial |
$681.83
|
| Rate for Payer: Healthfirst Essential Plan |
$1,534.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$647.74
|
| Rate for Payer: Healthfirst QHP |
$681.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$477.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$681.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$579.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$477.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$681.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$511.37
|
| Rate for Payer: SOMOS Essential |
$511.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$681.83
|
|
|
PR LIGJ DIVJ&STRIP LONG SAPH SAPHFEM JUNCT KNE/BELW
|
Professional
|
Both
|
$2,075.40
|
|
|
Service Code
|
HCPCS 37722
|
| Min. Negotiated Rate |
$376.24 |
| Max. Negotiated Rate |
$1,209.33 |
| Rate for Payer: Cash Price |
$546.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$537.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$483.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$483.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$510.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$537.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$510.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$537.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$537.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$403.11
|
| Rate for Payer: Healthfirst Commercial |
$537.48
|
| Rate for Payer: Healthfirst Essential Plan |
$1,209.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$510.61
|
| Rate for Payer: Healthfirst QHP |
$537.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$376.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$537.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$456.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$376.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$537.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$403.11
|
| Rate for Payer: SOMOS Essential |
$403.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$537.48
|
|
|
PR LIGJ DIVJ & STRIPPING SHORT SAPHENOUS VEIN
|
Professional
|
Both
|
$1,753.08
|
|
|
Service Code
|
HCPCS 37718
|
| Min. Negotiated Rate |
$324.06 |
| Max. Negotiated Rate |
$1,041.62 |
| Rate for Payer: Cash Price |
$465.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$462.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$416.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$416.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$439.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$462.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$439.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$462.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$462.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$347.20
|
| Rate for Payer: Healthfirst Commercial |
$462.94
|
| Rate for Payer: Healthfirst Essential Plan |
$1,041.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$439.79
|
| Rate for Payer: Healthfirst QHP |
$462.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$324.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$462.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$393.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$324.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$462.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$347.20
|
| Rate for Payer: SOMOS Essential |
$347.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$462.94
|
|
|
PR LIGJ & DIV SHORT SAPH VEIN SAPHENOPOP JUNCT SPX
|
Professional
|
Both
|
$1,048.29
|
|
|
Service Code
|
HCPCS 37780
|
| Min. Negotiated Rate |
$194.89 |
| Max. Negotiated Rate |
$626.42 |
| Rate for Payer: Cash Price |
$280.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$278.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$250.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$250.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$264.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$278.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$264.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$278.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$208.81
|
| Rate for Payer: Healthfirst Commercial |
$278.41
|
| Rate for Payer: Healthfirst Essential Plan |
$626.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$264.49
|
| Rate for Payer: Healthfirst QHP |
$278.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$194.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$278.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$236.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$194.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$278.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$208.81
|
| Rate for Payer: SOMOS Essential |
$208.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$278.41
|
|
|
PR LIGMOUS RCNSTJ AGMNTJ KNE INTRA-ARTICULAR XTR
|
Professional
|
Both
|
$5,566.23
|
|
|
Service Code
|
HCPCS 27429
|
| Min. Negotiated Rate |
$1,049.99 |
| Max. Negotiated Rate |
$3,374.98 |
| Rate for Payer: Cash Price |
$1,505.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,499.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,349.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,349.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,424.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,499.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,424.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,499.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,499.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,124.99
|
| Rate for Payer: Healthfirst Commercial |
$1,499.99
|
| Rate for Payer: Healthfirst Essential Plan |
$3,374.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,424.99
|
| Rate for Payer: Healthfirst QHP |
$1,499.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,049.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,499.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,274.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,049.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,499.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,124.99
|
| Rate for Payer: SOMOS Essential |
$1,124.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,499.99
|
|
|
PR LIG PRFRATR VEIN SUBFSCAL OPEN INCL US GID 1 LEG
|
Professional
|
Both
|
$2,401.53
|
|
|
Service Code
|
HCPCS 37761
|
| Min. Negotiated Rate |
$436.59 |
| Max. Negotiated Rate |
$1,403.33 |
| Rate for Payer: Cash Price |
$636.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$623.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$561.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$561.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$592.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$623.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$592.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$623.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$623.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$467.77
|
| Rate for Payer: Healthfirst Commercial |
$623.70
|
| Rate for Payer: Healthfirst Essential Plan |
$1,403.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$592.51
|
| Rate for Payer: Healthfirst QHP |
$623.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$436.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$623.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$530.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$436.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$623.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$467.77
|
| Rate for Payer: SOMOS Essential |
$467.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$623.70
|
|
|
PR LIG PRFRATR VEIN SUBFSCAL RAD INCL SKN GRF 1 LEG
|
Professional
|
Both
|
$2,572.92
|
|
|
Service Code
|
HCPCS 37760
|
| Min. Negotiated Rate |
$472.98 |
| Max. Negotiated Rate |
$1,520.28 |
| Rate for Payer: Cash Price |
$682.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$675.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$608.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$608.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$641.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$675.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$641.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$675.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$675.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$506.76
|
| Rate for Payer: Healthfirst Commercial |
$675.68
|
| Rate for Payer: Healthfirst Essential Plan |
$1,520.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$641.90
|
| Rate for Payer: Healthfirst QHP |
$675.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$472.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$675.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$574.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$472.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$675.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$506.76
|
| Rate for Payer: SOMOS Essential |
$506.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$675.68
|
|
|
PR LIG/STAPLING G-ESOP JUNCT PRE-ESOPHGL PRF8J
|
Professional
|
Both
|
$6,511.93
|
|
|
Service Code
|
HCPCS 43405
|
| Min. Negotiated Rate |
$1,204.29 |
| Max. Negotiated Rate |
$3,870.92 |
| Rate for Payer: Cash Price |
$1,736.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,720.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,548.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,548.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,634.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,720.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,634.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,720.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,720.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,290.31
|
| Rate for Payer: Healthfirst Commercial |
$1,720.41
|
| Rate for Payer: Healthfirst Essential Plan |
$3,870.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,634.39
|
| Rate for Payer: Healthfirst QHP |
$1,720.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,204.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,720.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,462.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,204.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,720.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,290.31
|
| Rate for Payer: SOMOS Essential |
$1,290.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,720.41
|
|
|
PR LIG&TKDN SYSIC-TO-PULM ART SHUNT W/CGEN HEART
|
Professional
|
Both
|
$1,268.72
|
|
|
Service Code
|
HCPCS 33924
|
| Min. Negotiated Rate |
$232.81 |
| Max. Negotiated Rate |
$748.30 |
| Rate for Payer: Cash Price |
$334.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$332.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$299.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$299.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$315.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$332.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$315.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$332.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$332.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$249.44
|
| Rate for Payer: Healthfirst Commercial |
$332.58
|
| Rate for Payer: Healthfirst Essential Plan |
$748.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$315.95
|
| Rate for Payer: Healthfirst QHP |
$332.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$232.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$332.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$282.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$232.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$332.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$249.44
|
| Rate for Payer: SOMOS Essential |
$249.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$332.58
|
|
|
PR LIG/TRNSXJ FALOPIAN TUBE CESAREAN DEL/ABDML SURG
|
Professional
|
Both
|
$330.51
|
|
|
Service Code
|
HCPCS 58611
|
| Min. Negotiated Rate |
$60.56 |
| Max. Negotiated Rate |
$194.67 |
| Rate for Payer: Cash Price |
$87.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$86.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$77.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$82.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$86.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$82.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.89
|
| Rate for Payer: Healthfirst Commercial |
$86.52
|
| Rate for Payer: Healthfirst Essential Plan |
$194.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$82.19
|
| Rate for Payer: Healthfirst QHP |
$86.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$60.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$86.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$73.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$60.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.89
|
| Rate for Payer: SOMOS Essential |
$64.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.52
|
|
|
PR LIG/TRNSXJ FLP TUBE ABDL/VAG APPR UNI/BI
|
Professional
|
Both
|
$1,620.89
|
|
|
Service Code
|
HCPCS 58600
|
| Min. Negotiated Rate |
$302.35 |
| Max. Negotiated Rate |
$971.84 |
| Rate for Payer: Cash Price |
$438.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$431.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$388.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$388.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$431.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$431.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$431.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$323.95
|
| Rate for Payer: Healthfirst Commercial |
$431.93
|
| Rate for Payer: Healthfirst Essential Plan |
$971.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$410.33
|
| Rate for Payer: Healthfirst QHP |
$431.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$302.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$431.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$367.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$302.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$431.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$323.95
|
| Rate for Payer: SOMOS Essential |
$323.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$431.93
|
|
|
PR LIG/TRNSXJ FLP TUBE ABDL/VAG POSTPARTUM SPX
|
Professional
|
Both
|
$1,475.67
|
|
|
Service Code
|
HCPCS 58605
|
| Min. Negotiated Rate |
$274.36 |
| Max. Negotiated Rate |
$881.87 |
| Rate for Payer: Cash Price |
$398.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$391.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$352.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$352.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$372.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$391.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$372.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$391.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$391.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$293.95
|
| Rate for Payer: Healthfirst Commercial |
$391.94
|
| Rate for Payer: Healthfirst Essential Plan |
$881.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$372.34
|
| Rate for Payer: Healthfirst QHP |
$391.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$274.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$391.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$333.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$274.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$391.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$293.95
|
| Rate for Payer: SOMOS Essential |
$293.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$391.94
|
|
|
PR LIMITED PHARYNGECTOMY
|
Professional
|
Both
|
$6,122.34
|
|
|
Service Code
|
HCPCS 42890
|
| Min. Negotiated Rate |
$1,138.65 |
| Max. Negotiated Rate |
$3,659.96 |
| Rate for Payer: Cash Price |
$1,648.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,626.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,463.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,463.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,545.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,626.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,545.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,626.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,626.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,219.99
|
| Rate for Payer: Healthfirst Commercial |
$1,626.65
|
| Rate for Payer: Healthfirst Essential Plan |
$3,659.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,545.32
|
| Rate for Payer: Healthfirst QHP |
$1,626.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,138.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,626.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,382.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,138.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,626.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,219.99
|
| Rate for Payer: SOMOS Essential |
$1,219.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,626.65
|
|
|
PR LIMITED VISUAL FIELD XM UNI/BI I&R
|
Professional
|
Both
|
$139.37
|
|
|
Service Code
|
HCPCS 92081
|
| Min. Negotiated Rate |
$26.58 |
| Max. Negotiated Rate |
$85.43 |
| Rate for Payer: Amida Care Medicaid |
$39.45
|
| Rate for Payer: Cash Price |
$38.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.48
|
| Rate for Payer: Healthfirst Commercial |
$37.97
|
| Rate for Payer: Healthfirst Essential Plan |
$85.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.07
|
| Rate for Payer: Healthfirst QHP |
$37.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.48
|
| Rate for Payer: SOMOS Essential |
$28.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.97
|
|
|
PR LIMITED VISUAL FIELD XM UNI/BI I&R
|
Professional
|
Both
|
$76.06
|
|
|
Service Code
|
HCPCS 92081 TC
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Amida Care Medicaid |
$39.45
|
| Rate for Payer: Cash Price |
$21.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.60
|
| Rate for Payer: Healthfirst Commercial |
$20.80
|
| Rate for Payer: Healthfirst Essential Plan |
$46.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.76
|
| Rate for Payer: Healthfirst QHP |
$20.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.60
|
| Rate for Payer: SOMOS Essential |
$15.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.80
|
|
|
PR LIMITED VISUAL FIELD XM UNI/BI I&R
|
Professional
|
Both
|
$63.32
|
|
|
Service Code
|
HCPCS 92081 26
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$39.45 |
| Rate for Payer: Amida Care Medicaid |
$39.45
|
| Rate for Payer: Cash Price |
$17.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.87
|
| Rate for Payer: Healthfirst Commercial |
$17.16
|
| Rate for Payer: Healthfirst Essential Plan |
$38.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.30
|
| Rate for Payer: Healthfirst QHP |
$17.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$17.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.87
|
| Rate for Payer: SOMOS Essential |
$12.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.16
|
|
