|
PROMETHAZINE HCL 25 MG RE SUPP
|
Facility
|
OP
|
$17.71
|
|
|
Service Code
|
NDC 0713052612
|
| Hospital Charge Code |
0713052612
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.85
|
| Rate for Payer: Aetna Government |
$8.85
|
| Rate for Payer: Brighton Health Commercial |
$13.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.04
|
| Rate for Payer: EmblemHealth Commercial |
$8.85
|
| Rate for Payer: Group Health Inc Commercial |
$8.85
|
| Rate for Payer: Group Health Inc Medicare |
$6.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.51
|
|
|
PROMETHAZINE HCL 6.25 MG/5ML PO SOLN
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 6043260816
|
| Hospital Charge Code |
6043260816
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna Government |
$0.05
|
| Rate for Payer: Brighton Health Commercial |
$0.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.07
|
| Rate for Payer: EmblemHealth Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.06
|
|
|
PROMETHAZINE HCL 6.25 MG/5ML PO SOLN
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 6043260816
|
| Hospital Charge Code |
6043260816
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
|
|
PR OMNTC EPIPLOECTOMY RESCJ OMENTUM SPX
|
Professional
|
Both
|
$3,521.11
|
|
|
Service Code
|
HCPCS 49255
|
| Min. Negotiated Rate |
$658.91 |
| Max. Negotiated Rate |
$2,117.93 |
| Rate for Payer: Cash Price |
$946.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$941.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$847.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$847.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$894.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$941.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$894.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$941.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$941.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$705.98
|
| Rate for Payer: Healthfirst Commercial |
$941.30
|
| Rate for Payer: Healthfirst Essential Plan |
$2,117.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$894.24
|
| Rate for Payer: Healthfirst QHP |
$941.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$658.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$941.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$800.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$658.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$941.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$705.98
|
| Rate for Payer: SOMOS Essential |
$705.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$941.30
|
|
|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 11-20 MINUTES
|
Professional
|
Both
|
$103.74
|
|
|
Service Code
|
HCPCS 99422
|
| Min. Negotiated Rate |
$19.77 |
| Max. Negotiated Rate |
$63.54 |
| Rate for Payer: Amida Care Medicaid |
$23.81
|
| Rate for Payer: Cash Price |
$28.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.18
|
| Rate for Payer: Healthfirst Commercial |
$28.24
|
| Rate for Payer: Healthfirst Essential Plan |
$63.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.83
|
| Rate for Payer: Healthfirst QHP |
$28.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.18
|
| Rate for Payer: SOMOS Essential |
$21.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.24
|
|
|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 21+ MINUTES
|
Professional
|
Both
|
$164.05
|
|
|
Service Code
|
HCPCS 99423
|
| Min. Negotiated Rate |
$30.26 |
| Max. Negotiated Rate |
$97.27 |
| Rate for Payer: Amida Care Medicaid |
$38.76
|
| Rate for Payer: Cash Price |
$45.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.42
|
| Rate for Payer: Healthfirst Commercial |
$43.23
|
| Rate for Payer: Healthfirst Essential Plan |
$97.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.07
|
| Rate for Payer: Healthfirst QHP |
$43.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.42
|
| Rate for Payer: SOMOS Essential |
$32.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.23
|
|
|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 5-10 MINUTES
|
Professional
|
Both
|
$52.61
|
|
|
Service Code
|
HCPCS 99421
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$31.77 |
| Rate for Payer: Amida Care Medicaid |
$12.18
|
| Rate for Payer: Cash Price |
$14.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.59
|
| Rate for Payer: Healthfirst Commercial |
$14.12
|
| Rate for Payer: Healthfirst Essential Plan |
$31.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.41
|
| Rate for Payer: Healthfirst QHP |
$14.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.59
|
| Rate for Payer: SOMOS Essential |
$10.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.12
|
|
|
PR OOPHORECTOMY PARTIAL/TOTAL UNI/BI
|
Professional
|
Both
|
$2,455.57
|
|
|
Service Code
|
HCPCS 58940
|
| Min. Negotiated Rate |
$456.14 |
| Max. Negotiated Rate |
$1,466.17 |
| Rate for Payer: Cash Price |
$660.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$651.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$586.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$586.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$619.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$651.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$619.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$651.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$651.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$488.72
|
| Rate for Payer: Healthfirst Commercial |
$651.63
|
| Rate for Payer: Healthfirst Essential Plan |
$1,466.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$619.05
|
| Rate for Payer: Healthfirst QHP |
$651.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$456.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$651.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$553.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$456.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$651.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$488.72
|
| Rate for Payer: SOMOS Essential |
$488.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$651.63
|
|
|
PR OOPHORECTOMY PRTL/TOT UNI/BI OVARIAN MALIGNANCY
|
Professional
|
Both
|
$5,110.00
|
|
|
Service Code
|
HCPCS 58943
|
| Min. Negotiated Rate |
$978.20 |
| Max. Negotiated Rate |
$3,144.22 |
| Rate for Payer: Cash Price |
$1,414.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,397.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,257.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,257.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,327.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,397.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,327.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,397.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,397.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,048.07
|
| Rate for Payer: Healthfirst Commercial |
$1,397.43
|
| Rate for Payer: Healthfirst Essential Plan |
$3,144.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,327.56
|
| Rate for Payer: Healthfirst QHP |
$1,397.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$978.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,397.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,187.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$978.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,397.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,048.07
|
| Rate for Payer: SOMOS Essential |
$1,048.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,397.43
|
|
|
PROPAFENONE HCL 150 MG PO TABS
|
Facility
|
IP
|
$1.64
|
|
|
Service Code
|
NDC 5348955101
|
| Hospital Charge Code |
5348955101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.82
|
|
|
PROPAFENONE HCL 150 MG PO TABS
|
Facility
|
OP
|
$1.64
|
|
|
Service Code
|
NDC 5348955101
|
| Hospital Charge Code |
5348955101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$1.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.82
|
| Rate for Payer: Aetna Government |
$0.82
|
| Rate for Payer: Brighton Health Commercial |
$1.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.11
|
| Rate for Payer: EmblemHealth Commercial |
$0.82
|
| Rate for Payer: Group Health Inc Commercial |
$0.82
|
| Rate for Payer: Group Health Inc Medicare |
$0.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.06
|
|
|
PROPARACAINE HCL 0.5 % OP SOLN
|
Facility
|
IP
|
$2.93
|
|
|
Service Code
|
NDC 6131401601
|
| Hospital Charge Code |
6131401601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.46
|
|
|
PROPARACAINE HCL 0.5 % OP SOLN
|
Facility
|
IP
|
$2.93
|
|
|
Service Code
|
NDC 1747826312
|
| Hospital Charge Code |
1747826312
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.46
|
|
|
PROPARACAINE HCL 0.5 % OP SOLN
|
Facility
|
IP
|
$2.81
|
|
|
Service Code
|
NDC 2420873006
|
| Hospital Charge Code |
2420873006
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.40
|
|
|
PROPARACAINE HCL 0.5 % OP SOLN
|
Facility
|
OP
|
$2.81
|
|
|
Service Code
|
NDC 2420873006
|
| Hospital Charge Code |
2420873006
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.40
|
| Rate for Payer: Aetna Government |
$1.40
|
| Rate for Payer: Brighton Health Commercial |
$2.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.91
|
| Rate for Payer: EmblemHealth Commercial |
$1.40
|
| Rate for Payer: Group Health Inc Commercial |
$1.40
|
| Rate for Payer: Group Health Inc Medicare |
$0.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.82
|
|
|
PROPARACAINE HCL 0.5 % OP SOLN
|
Facility
|
OP
|
$2.93
|
|
|
Service Code
|
NDC 6131401601
|
| Hospital Charge Code |
6131401601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.46
|
| Rate for Payer: Aetna Government |
$1.46
|
| Rate for Payer: Brighton Health Commercial |
$2.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.99
|
| Rate for Payer: EmblemHealth Commercial |
$1.46
|
| Rate for Payer: Group Health Inc Commercial |
$1.46
|
| Rate for Payer: Group Health Inc Medicare |
$1.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.90
|
|
|
PROPARACAINE HCL 0.5 % OP SOLN
|
Facility
|
OP
|
$2.93
|
|
|
Service Code
|
NDC 1747826312
|
| Hospital Charge Code |
1747826312
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.46
|
| Rate for Payer: Aetna Government |
$1.46
|
| Rate for Payer: Brighton Health Commercial |
$2.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.99
|
| Rate for Payer: EmblemHealth Commercial |
$1.46
|
| Rate for Payer: Group Health Inc Commercial |
$1.46
|
| Rate for Payer: Group Health Inc Medicare |
$1.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.90
|
|
|
PR OPEN ABLATION RENAL MASS CRYOSURG ULTRASOUND
|
Professional
|
Both
|
$5,076.40
|
|
|
Service Code
|
HCPCS 50250
|
| Min. Negotiated Rate |
$963.82 |
| Max. Negotiated Rate |
$3,097.98 |
| Rate for Payer: Cash Price |
$1,386.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,376.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,239.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,239.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,308.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,376.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,308.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,376.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,376.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,032.66
|
| Rate for Payer: Healthfirst Commercial |
$1,376.88
|
| Rate for Payer: Healthfirst Essential Plan |
$3,097.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,308.04
|
| Rate for Payer: Healthfirst QHP |
$1,376.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$963.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,376.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,170.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$963.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,376.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,032.66
|
| Rate for Payer: SOMOS Essential |
$1,032.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,376.88
|
|
|
PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES
|
Professional
|
Both
|
$2,004.14
|
|
|
Service Code
|
HCPCS 38531
|
| Min. Negotiated Rate |
$374.41 |
| Max. Negotiated Rate |
$1,203.46 |
| Rate for Payer: Cash Price |
$539.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$534.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$481.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$481.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$508.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$534.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$508.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$534.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$534.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$401.15
|
| Rate for Payer: Healthfirst Commercial |
$534.87
|
| Rate for Payer: Healthfirst Essential Plan |
$1,203.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$508.13
|
| Rate for Payer: Healthfirst QHP |
$534.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$374.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$534.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$454.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$374.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$534.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$401.15
|
| Rate for Payer: SOMOS Essential |
$401.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$534.87
|
|
|
PR OPEN CLOSURE MAJOR BRONCHIAL FISTULA
|
Professional
|
Both
|
$12,482.89
|
|
|
Service Code
|
HCPCS 32815
|
| Min. Negotiated Rate |
$2,295.36 |
| Max. Negotiated Rate |
$7,377.93 |
| Rate for Payer: Cash Price |
$3,311.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,279.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,951.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,951.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,115.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,279.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,115.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,279.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,279.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,459.31
|
| Rate for Payer: Healthfirst Commercial |
$3,279.08
|
| Rate for Payer: Healthfirst Essential Plan |
$7,377.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,115.13
|
| Rate for Payer: Healthfirst QHP |
$3,279.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,295.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,279.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,787.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,295.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,279.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,459.31
|
| Rate for Payer: SOMOS Essential |
$2,459.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,279.08
|
|
|
PR OPEN HARVEST UPPER EXTREMITY ART 1 SEGMENT CAB
|
Professional
|
Both
|
$820.51
|
|
|
Service Code
|
HCPCS 35600
|
| Min. Negotiated Rate |
$150.79 |
| Max. Negotiated Rate |
$484.69 |
| Rate for Payer: Cash Price |
$217.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$215.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$193.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$193.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$204.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$215.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$204.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$215.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$215.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$161.56
|
| Rate for Payer: Healthfirst Commercial |
$215.42
|
| Rate for Payer: Healthfirst Essential Plan |
$484.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$204.65
|
| Rate for Payer: Healthfirst QHP |
$215.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$150.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$215.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$183.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$150.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$215.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$161.56
|
| Rate for Payer: SOMOS Essential |
$161.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$215.42
|
|
|
PR OPEN IMPLANTATION CRANIAL NERVE NEA & PULSE GEN
|
Professional
|
Both
|
$2,656.05
|
|
|
Service Code
|
HCPCS 64568
|
| Min. Negotiated Rate |
$501.67 |
| Max. Negotiated Rate |
$1,612.51 |
| Rate for Payer: Cash Price |
$721.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$716.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$645.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$645.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$680.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$716.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$680.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$716.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$716.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$537.50
|
| Rate for Payer: Healthfirst Commercial |
$716.67
|
| Rate for Payer: Healthfirst Essential Plan |
$1,612.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$680.84
|
| Rate for Payer: Healthfirst QHP |
$716.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$501.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$716.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$609.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$501.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$716.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$537.50
|
| Rate for Payer: SOMOS Essential |
$537.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$716.67
|
|
|
PR OPEN IMPLANTATION NEA NEUROMUSCULAR
|
Professional
|
Both
|
$1,420.02
|
|
|
Service Code
|
HCPCS 64580
|
| Min. Negotiated Rate |
$265.26 |
| Max. Negotiated Rate |
$852.62 |
| Rate for Payer: Cash Price |
$381.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$378.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$341.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$341.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$359.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$378.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$359.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$378.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$378.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$284.20
|
| Rate for Payer: Healthfirst Commercial |
$378.94
|
| Rate for Payer: Healthfirst Essential Plan |
$852.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$359.99
|
| Rate for Payer: Healthfirst QHP |
$378.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$265.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$378.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$322.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$265.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$378.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$284.20
|
| Rate for Payer: SOMOS Essential |
$284.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$378.94
|
|
|
PR OPEN IMPLANTATION NEA PERIPHERAL NERVE
|
Professional
|
Both
|
$1,331.09
|
|
|
Service Code
|
HCPCS 64575
|
| Min. Negotiated Rate |
$257.82 |
| Max. Negotiated Rate |
$828.72 |
| Rate for Payer: Cash Price |
$370.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$368.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$331.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$331.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$349.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$368.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$349.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$368.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$368.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$276.24
|
| Rate for Payer: Healthfirst Commercial |
$368.32
|
| Rate for Payer: Healthfirst Essential Plan |
$828.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$349.90
|
| Rate for Payer: Healthfirst QHP |
$368.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$257.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$368.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$313.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$257.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$368.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$276.24
|
| Rate for Payer: SOMOS Essential |
$276.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$368.32
|
|
|
PR OPEN IMPLANTATION NEA SACRAL NERVE
|
Professional
|
Both
|
$2,781.91
|
|
|
Service Code
|
HCPCS 64581
|
| Min. Negotiated Rate |
$525.57 |
| Max. Negotiated Rate |
$1,689.32 |
| Rate for Payer: Cash Price |
$756.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$750.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$675.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$675.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$713.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$750.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$713.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$750.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$750.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$563.11
|
| Rate for Payer: Healthfirst Commercial |
$750.81
|
| Rate for Payer: Healthfirst Essential Plan |
$1,689.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$713.27
|
| Rate for Payer: Healthfirst QHP |
$750.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$525.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$750.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$638.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$525.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$750.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$563.11
|
| Rate for Payer: SOMOS Essential |
$563.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$750.81
|
|
