|
PR LITHOLAPAXY COMP/LG > 2.5 CM
|
Professional
|
Both
|
$1,956.75
|
|
|
Service Code
|
HCPCS 52318
|
| Min. Negotiated Rate |
$370.91 |
| Max. Negotiated Rate |
$1,192.21 |
| Rate for Payer: Cash Price |
$533.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$529.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$476.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$476.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$503.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$529.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$503.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$529.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$529.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$397.40
|
| Rate for Payer: Healthfirst Commercial |
$529.87
|
| Rate for Payer: Healthfirst Essential Plan |
$1,192.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$503.38
|
| Rate for Payer: Healthfirst QHP |
$529.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$370.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$529.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$450.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$370.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$529.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$397.40
|
| Rate for Payer: SOMOS Essential |
$397.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$529.87
|
|
|
PR LITHOLAPAXY SMPL/SM <2.5 CM
|
Professional
|
Both
|
$1,431.75
|
|
|
Service Code
|
HCPCS 52317
|
| Min. Negotiated Rate |
$272.01 |
| Max. Negotiated Rate |
$874.30 |
| Rate for Payer: Cash Price |
$389.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$388.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$349.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$349.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$369.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$388.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$369.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$388.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$388.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$291.44
|
| Rate for Payer: Healthfirst Commercial |
$388.58
|
| Rate for Payer: Healthfirst Essential Plan |
$874.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$369.15
|
| Rate for Payer: Healthfirst QHP |
$388.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$272.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$388.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$330.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$272.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$388.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$291.44
|
| Rate for Payer: SOMOS Essential |
$291.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$388.58
|
|
|
PR LITHOTRIPSY XTRCORP SHOCK WAVE
|
Professional
|
Both
|
$2,393.65
|
|
|
Service Code
|
HCPCS 50590
|
| Min. Negotiated Rate |
$457.67 |
| Max. Negotiated Rate |
$1,471.10 |
| Rate for Payer: Cash Price |
$658.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$653.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$588.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$588.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$621.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$653.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$621.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$653.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$653.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$490.37
|
| Rate for Payer: Healthfirst Commercial |
$653.82
|
| Rate for Payer: Healthfirst Essential Plan |
$1,471.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$621.13
|
| Rate for Payer: Healthfirst QHP |
$653.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$457.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$653.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$555.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$457.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$653.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$490.37
|
| Rate for Payer: SOMOS Essential |
$490.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$653.82
|
|
|
PR LITT LES ICR MLT TRAJECTORIES MLT/CPLX LESIONS
|
Professional
|
Both
|
$4,462.47
|
|
|
Service Code
|
HCPCS 61737
|
| Min. Negotiated Rate |
$1,277.63 |
| Max. Negotiated Rate |
$4,106.68 |
| Rate for Payer: Cash Price |
$1,846.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,825.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,642.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,642.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,733.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,825.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,733.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,825.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,825.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,368.89
|
| Rate for Payer: Healthfirst Commercial |
$1,825.19
|
| Rate for Payer: Healthfirst Essential Plan |
$4,106.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,733.93
|
| Rate for Payer: Healthfirst QHP |
$1,825.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,277.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,825.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,551.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,277.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,825.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,368.89
|
| Rate for Payer: SOMOS Essential |
$1,368.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,825.19
|
|
|
PR LITT LES ICR SINGLE TRAJECTORY 1 SIMPLE LESION
|
Professional
|
Both
|
$3,713.92
|
|
|
Service Code
|
HCPCS 61736
|
| Min. Negotiated Rate |
$1,075.63 |
| Max. Negotiated Rate |
$3,457.37 |
| Rate for Payer: Cash Price |
$1,520.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,536.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,382.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,382.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,459.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,536.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,459.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,536.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,536.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,152.46
|
| Rate for Payer: Healthfirst Commercial |
$1,536.61
|
| Rate for Payer: Healthfirst Essential Plan |
$3,457.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,459.78
|
| Rate for Payer: Healthfirst QHP |
$1,536.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,075.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,536.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,306.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,075.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,536.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,152.46
|
| Rate for Payer: SOMOS Essential |
$1,152.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,536.61
|
|
|
PR LIVER ELASTOGRAPHY W/O IMAG W/I&R
|
Professional
|
Both
|
$41.97
|
|
|
Service Code
|
HCPCS 91200 26
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$25.54 |
| Rate for Payer: Amida Care Medicaid |
$23.61
|
| Rate for Payer: Cash Price |
$11.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.51
|
| Rate for Payer: Healthfirst Commercial |
$11.35
|
| Rate for Payer: Healthfirst Essential Plan |
$25.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.78
|
| Rate for Payer: Healthfirst QHP |
$11.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$11.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.51
|
| Rate for Payer: SOMOS Essential |
$8.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.35
|
|
|
PR LIVER ELASTOGRAPHY W/O IMAG W/I&R
|
Professional
|
Both
|
$87.54
|
|
|
Service Code
|
HCPCS 91200 TC
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$52.92 |
| Rate for Payer: Amida Care Medicaid |
$23.61
|
| Rate for Payer: Cash Price |
$24.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$23.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.64
|
| Rate for Payer: Healthfirst Commercial |
$23.52
|
| Rate for Payer: Healthfirst Essential Plan |
$52.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.34
|
| Rate for Payer: Healthfirst QHP |
$23.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.64
|
| Rate for Payer: SOMOS Essential |
$17.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.52
|
|
|
PR LIVER ELASTOGRAPHY W/O IMAG W/I&R
|
Professional
|
Both
|
$129.54
|
|
|
Service Code
|
HCPCS 91200
|
| Min. Negotiated Rate |
$23.61 |
| Max. Negotiated Rate |
$78.46 |
| Rate for Payer: Amida Care Medicaid |
$23.61
|
| Rate for Payer: Cash Price |
$35.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.15
|
| Rate for Payer: Healthfirst Commercial |
$34.87
|
| Rate for Payer: Healthfirst Essential Plan |
$78.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.13
|
| Rate for Payer: Healthfirst QHP |
$34.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.15
|
| Rate for Payer: SOMOS Essential |
$26.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.87
|
|
|
PR LMTD LMPHADEC STAGING SPX PEL&PARA-AORTIC
|
Professional
|
Both
|
$3,070.80
|
|
|
Service Code
|
HCPCS 38562
|
| Min. Negotiated Rate |
$581.05 |
| Max. Negotiated Rate |
$1,867.66 |
| Rate for Payer: Cash Price |
$833.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$830.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$747.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$747.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$788.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$830.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$788.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$830.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$830.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$622.55
|
| Rate for Payer: Healthfirst Commercial |
$830.07
|
| Rate for Payer: Healthfirst Essential Plan |
$1,867.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$788.57
|
| Rate for Payer: Healthfirst QHP |
$830.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$581.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$830.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$705.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$581.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$830.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$622.55
|
| Rate for Payer: SOMOS Essential |
$622.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$830.07
|
|
|
PR LMTD LMPHADEC STAGING SPX RPR AORTIC&/SPLENIC
|
Professional
|
Both
|
$3,119.31
|
|
|
Service Code
|
HCPCS 38564
|
| Min. Negotiated Rate |
$582.32 |
| Max. Negotiated Rate |
$1,871.73 |
| Rate for Payer: Cash Price |
$834.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$831.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$748.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$748.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$790.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$831.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$790.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$831.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$831.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$623.91
|
| Rate for Payer: Healthfirst Commercial |
$831.88
|
| Rate for Payer: Healthfirst Essential Plan |
$1,871.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$790.29
|
| Rate for Payer: Healthfirst QHP |
$831.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$582.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$831.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$707.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$582.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$831.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$623.91
|
| Rate for Payer: SOMOS Essential |
$623.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$831.88
|
|
|
PR LMTD OPH XM&EVAL GENERAL ANES W/WO MNPJ GLOBE
|
Professional
|
Both
|
$284.27
|
|
|
Service Code
|
HCPCS 92019
|
| Min. Negotiated Rate |
$32.53 |
| Max. Negotiated Rate |
$179.24 |
| Rate for Payer: Amida Care Medicaid |
$32.53
|
| Rate for Payer: Cash Price |
$80.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$79.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.74
|
| Rate for Payer: Healthfirst Commercial |
$79.66
|
| Rate for Payer: Healthfirst Essential Plan |
$179.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$75.68
|
| Rate for Payer: Healthfirst QHP |
$79.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$79.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$67.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$59.74
|
| Rate for Payer: SOMOS Essential |
$59.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.66
|
|
|
PR LNGTH/SHRT FLXR/XTNSR TDN F/ARM&/WRIST 1 EA TDN
|
Professional
|
Both
|
$2,499.74
|
|
|
Service Code
|
HCPCS 25280
|
| Min. Negotiated Rate |
$475.01 |
| Max. Negotiated Rate |
$1,526.83 |
| Rate for Payer: Cash Price |
$680.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$678.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$610.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$610.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$644.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$678.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$644.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$678.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$678.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$508.94
|
| Rate for Payer: Healthfirst Commercial |
$678.59
|
| Rate for Payer: Healthfirst Essential Plan |
$1,526.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$644.66
|
| Rate for Payer: Healthfirst QHP |
$678.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$475.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$678.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$576.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$475.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$678.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$508.94
|
| Rate for Payer: SOMOS Essential |
$508.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$678.59
|
|
|
PR LNGTH/SHRT TDN LEG/ANKLE MLT TDN SAME INC EA
|
Professional
|
Both
|
$2,278.78
|
|
|
Service Code
|
HCPCS 27686
|
| Min. Negotiated Rate |
$435.81 |
| Max. Negotiated Rate |
$1,400.83 |
| Rate for Payer: Cash Price |
$628.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$622.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$560.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$560.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$591.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$622.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$591.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$622.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$622.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$466.94
|
| Rate for Payer: Healthfirst Commercial |
$622.59
|
| Rate for Payer: Healthfirst Essential Plan |
$1,400.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$591.46
|
| Rate for Payer: Healthfirst QHP |
$622.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$435.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$622.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$529.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$435.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$622.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$466.94
|
| Rate for Payer: SOMOS Essential |
$466.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$622.59
|
|
|
PR LNGTH/SHRT TENDON LEG/ANKLE 1 TENDON SPX
|
Professional
|
Both
|
$2,002.74
|
|
|
Service Code
|
HCPCS 27685
|
| Min. Negotiated Rate |
$381.34 |
| Max. Negotiated Rate |
$1,225.73 |
| Rate for Payer: Cash Price |
$548.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$544.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$490.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$490.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$517.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$544.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$517.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$544.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$544.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$408.58
|
| Rate for Payer: Healthfirst Commercial |
$544.77
|
| Rate for Payer: Healthfirst Essential Plan |
$1,225.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$517.53
|
| Rate for Payer: Healthfirst QHP |
$544.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$381.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$544.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$463.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$381.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$544.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$408.58
|
| Rate for Payer: SOMOS Essential |
$408.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$544.77
|
|
|
PR LOUDNESS BALANCE BINAURAL/MONAURAL
|
Professional
|
Both
|
$206.85
|
|
|
Service Code
|
HCPCS 92562
|
| Min. Negotiated Rate |
$40.65 |
| Max. Negotiated Rate |
$130.66 |
| Rate for Payer: Cash Price |
$57.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$58.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$52.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$58.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.55
|
| Rate for Payer: Healthfirst Commercial |
$58.07
|
| Rate for Payer: Healthfirst Essential Plan |
$130.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$55.17
|
| Rate for Payer: Healthfirst QHP |
$58.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$58.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$49.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$58.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$43.55
|
| Rate for Payer: SOMOS Essential |
$43.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.07
|
|
|
PR LOW FREQUENCY NON-THERMAL ULTRASOUND PER DAY
|
Professional
|
Both
|
$70.07
|
|
|
Service Code
|
HCPCS 97610
|
| Min. Negotiated Rate |
$13.34 |
| Max. Negotiated Rate |
$42.88 |
| Rate for Payer: Cash Price |
$19.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.29
|
| Rate for Payer: Healthfirst Commercial |
$19.06
|
| Rate for Payer: Healthfirst Essential Plan |
$42.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.11
|
| Rate for Payer: Healthfirst QHP |
$19.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.29
|
| Rate for Payer: SOMOS Essential |
$14.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.06
|
|
|
PR LOW INTENSITY US STIMJ BONE HEALING NONINVASIVE
|
Professional
|
Both
|
$139.51
|
|
|
Service Code
|
HCPCS 20979
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$78.75 |
| Rate for Payer: Cash Price |
$36.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.25
|
| Rate for Payer: Healthfirst Commercial |
$35.00
|
| Rate for Payer: Healthfirst Essential Plan |
$78.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.25
|
| Rate for Payer: Healthfirst QHP |
$35.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.25
|
| Rate for Payer: SOMOS Essential |
$26.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.00
|
|
|
PR LUNG TRANSPLANT 1 W/CARDIOPULMONARY BYPASS
|
Professional
|
Both
|
$15,601.78
|
|
|
Service Code
|
HCPCS 32852
|
| Min. Negotiated Rate |
$2,872.33 |
| Max. Negotiated Rate |
$9,232.49 |
| Rate for Payer: Cash Price |
$4,139.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,103.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,693.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,693.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,898.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,103.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,898.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,103.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,103.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,077.50
|
| Rate for Payer: Healthfirst Commercial |
$4,103.33
|
| Rate for Payer: Healthfirst Essential Plan |
$9,232.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,898.16
|
| Rate for Payer: Healthfirst QHP |
$4,103.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,872.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,103.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,487.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,872.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,103.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,077.50
|
| Rate for Payer: SOMOS Essential |
$3,077.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,103.33
|
|
|
PR LUNG TRANSPLANT 1 W/O CARDIOPULMONARY BYPASS
|
Professional
|
Both
|
$14,544.57
|
|
|
Service Code
|
HCPCS 32851
|
| Min. Negotiated Rate |
$2,680.69 |
| Max. Negotiated Rate |
$8,616.51 |
| Rate for Payer: Cash Price |
$3,865.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,829.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,446.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,446.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,638.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,829.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,638.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,829.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,829.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,872.17
|
| Rate for Payer: Healthfirst Commercial |
$3,829.56
|
| Rate for Payer: Healthfirst Essential Plan |
$8,616.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,638.08
|
| Rate for Payer: Healthfirst QHP |
$3,829.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,680.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,829.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,255.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,680.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,829.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,872.17
|
| Rate for Payer: SOMOS Essential |
$2,872.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,829.56
|
|
|
PR LUNG TRANSPLANT 2 W/CARDIOPULMONARY BYPASS
|
Professional
|
Both
|
$21,506.45
|
|
|
Service Code
|
HCPCS 32854
|
| Min. Negotiated Rate |
$3,963.93 |
| Max. Negotiated Rate |
$12,741.19 |
| Rate for Payer: Cash Price |
$5,715.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,662.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5,096.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,096.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,379.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,662.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,379.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,662.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,662.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4,247.06
|
| Rate for Payer: Healthfirst Commercial |
$5,662.75
|
| Rate for Payer: Healthfirst Essential Plan |
$12,741.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,379.61
|
| Rate for Payer: Healthfirst QHP |
$5,662.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,963.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5,662.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4,813.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3,963.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,662.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,247.06
|
| Rate for Payer: SOMOS Essential |
$4,247.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,662.75
|
|
|
PR LUNG TRANSPLANT 2 W/O CARDIOPULMONARY BYPASS
|
Professional
|
Both
|
$20,313.83
|
|
|
Service Code
|
HCPCS 32853
|
| Min. Negotiated Rate |
$3,750.38 |
| Max. Negotiated Rate |
$12,054.80 |
| Rate for Payer: Cash Price |
$5,400.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,357.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,821.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,821.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,089.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,357.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,089.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,357.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,357.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4,018.27
|
| Rate for Payer: Healthfirst Commercial |
$5,357.69
|
| Rate for Payer: Healthfirst Essential Plan |
$12,054.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,089.81
|
| Rate for Payer: Healthfirst QHP |
$5,357.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,750.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5,357.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4,554.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3,750.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,357.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,018.27
|
| Rate for Payer: SOMOS Essential |
$4,018.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,357.69
|
|
|
PR LVR ALTRNSPLJ ORTHOTOPIC PRTL/WHL DON ANY AGE
|
Professional
|
Both
|
$24,286.33
|
|
|
Service Code
|
HCPCS 47135
|
| Min. Negotiated Rate |
$4,507.98 |
| Max. Negotiated Rate |
$14,489.93 |
| Rate for Payer: Cash Price |
$6,481.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,439.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5,795.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,795.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,117.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,439.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,117.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,439.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,439.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4,829.98
|
| Rate for Payer: Healthfirst Commercial |
$6,439.97
|
| Rate for Payer: Healthfirst Essential Plan |
$14,489.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6,117.97
|
| Rate for Payer: Healthfirst QHP |
$6,439.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$4,507.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$6,439.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$5,473.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$4,507.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,439.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,829.98
|
| Rate for Payer: SOMOS Essential |
$4,829.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,439.97
|
|
|
PR LYMPHANGIOTOMY/OTH OPRATIONS LYMPHATIC CHANNELS
|
Professional
|
Both
|
$2,080.61
|
|
|
Service Code
|
HCPCS 38308
|
| Min. Negotiated Rate |
$394.25 |
| Max. Negotiated Rate |
$1,267.24 |
| Rate for Payer: Cash Price |
$565.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$563.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$506.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$506.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$535.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$563.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$535.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$563.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$563.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$422.42
|
| Rate for Payer: Healthfirst Commercial |
$563.22
|
| Rate for Payer: Healthfirst Essential Plan |
$1,267.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$535.06
|
| Rate for Payer: Healthfirst QHP |
$563.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$394.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$563.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$478.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$394.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$563.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$422.42
|
| Rate for Payer: SOMOS Essential |
$422.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$563.22
|
|
|
PR LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS
|
Professional
|
Both
|
$844.41
|
|
|
Service Code
|
HCPCS 54162
|
| Min. Negotiated Rate |
$160.95 |
| Max. Negotiated Rate |
$517.34 |
| Rate for Payer: Cash Price |
$231.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$229.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$206.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$206.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$218.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$229.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$218.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$229.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$229.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$172.45
|
| Rate for Payer: Healthfirst Commercial |
$229.93
|
| Rate for Payer: Healthfirst Essential Plan |
$517.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$218.43
|
| Rate for Payer: Healthfirst QHP |
$229.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$160.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$229.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$195.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$160.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$229.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$172.45
|
| Rate for Payer: SOMOS Essential |
$172.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$229.93
|
|
|
PR LYSIS INTRANASAL SYNECHIA
|
Professional
|
Both
|
$654.50
|
|
|
Service Code
|
HCPCS 30560
|
| Min. Negotiated Rate |
$122.57 |
| Max. Negotiated Rate |
$393.98 |
| Rate for Payer: Cash Price |
$178.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$175.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$157.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$157.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$166.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$175.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$166.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$131.32
|
| Rate for Payer: Healthfirst Commercial |
$175.10
|
| Rate for Payer: Healthfirst Essential Plan |
$393.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$166.34
|
| Rate for Payer: Healthfirst QHP |
$175.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$122.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$175.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$148.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$122.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$175.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$131.32
|
| Rate for Payer: SOMOS Essential |
$131.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$175.10
|
|
