|
PROTAMINE SULFATE 10 MG/ML IV SOLN
|
Facility
|
OP
|
$2.23
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
6332322930
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.39
|
| Rate for Payer: Aetna Government |
$1.39
|
| Rate for Payer: Brighton Health Commercial |
$1.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.52
|
| Rate for Payer: EmblemHealth Commercial |
$1.11
|
| Rate for Payer: Group Health Inc Commercial |
$1.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.45
|
|
|
PROTAMINE SULFATE 10 MG/ML IV SOLN
|
Facility
|
IP
|
$2.23
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
6332322930
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.11
|
|
|
PROTAMINE SULFATE 10 MG/ML IV SOLN
|
Facility
|
OP
|
$3.72
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
6332322905
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$2.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.39
|
| Rate for Payer: Aetna Government |
$1.39
|
| Rate for Payer: Brighton Health Commercial |
$2.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.53
|
| Rate for Payer: EmblemHealth Commercial |
$1.86
|
| Rate for Payer: Group Health Inc Commercial |
$1.86
|
| Rate for Payer: Group Health Inc Medicare |
$1.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.41
|
|
|
PROTAMINE SULFATE 10 MG/ML IV SOLN
|
Facility
|
IP
|
$3.72
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
6332322905
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.86
|
|
|
PR OTHER CRANIAL DECOMPRESSION POSTERIOR FOSSA
|
Professional
|
Both
|
$9,862.06
|
|
|
Service Code
|
HCPCS 61345
|
| Min. Negotiated Rate |
$1,802.51 |
| Max. Negotiated Rate |
$5,793.80 |
| Rate for Payer: Cash Price |
$2,599.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,575.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,317.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,317.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,446.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,575.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,446.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,575.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,575.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,931.27
|
| Rate for Payer: Healthfirst Commercial |
$2,575.02
|
| Rate for Payer: Healthfirst Essential Plan |
$5,793.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,446.27
|
| Rate for Payer: Healthfirst QHP |
$2,575.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,802.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,575.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,188.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,802.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,575.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,931.27
|
| Rate for Payer: SOMOS Essential |
$1,931.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,575.02
|
|
|
PR OTH RESP PROC, GROUP
|
Professional
|
Both
|
$55.93
|
|
|
Service Code
|
HCPCS G0239
|
| Min. Negotiated Rate |
$11.03 |
| Max. Negotiated Rate |
$35.46 |
| Rate for Payer: Cash Price |
$15.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.82
|
| Rate for Payer: Healthfirst Commercial |
$15.76
|
| Rate for Payer: Healthfirst Essential Plan |
$35.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.97
|
| Rate for Payer: Healthfirst QHP |
$15.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.82
|
| Rate for Payer: SOMOS Essential |
$11.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.76
|
|
|
PR OTH RESP PROC, INDIV
|
Professional
|
Both
|
$45.85
|
|
|
Service Code
|
HCPCS G0238
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$27.59 |
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.20
|
| Rate for Payer: Healthfirst Commercial |
$12.26
|
| Rate for Payer: Healthfirst Essential Plan |
$27.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.65
|
| Rate for Payer: Healthfirst QHP |
$12.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.20
|
| Rate for Payer: SOMOS Essential |
$9.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.26
|
|
|
PROTHROMBIN COMPLEX CONC HUMAN 1000 UNITS IV KIT
|
Facility
|
OP
|
$3.58
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
6383338702
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.14
|
| Rate for Payer: Aetna Government |
$2.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1.50
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1.50
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1.50
|
| Rate for Payer: Brighton Health Commercial |
$2.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.14
|
| Rate for Payer: EmblemHealth Commercial |
$2.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1.90
|
| Rate for Payer: Group Health Inc Commercial |
$2.14
|
| Rate for Payer: Group Health Inc Medicare |
$2.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1.82
|
| Rate for Payer: Healthfirst QHP |
$2.14
|
| Rate for Payer: Humana Medicare |
$2.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.03
|
| Rate for Payer: Wellcare Medicare |
$2.03
|
|
|
PROTHROMBIN COMPLEX CONC HUMAN 1000 UNITS IV KIT
|
Facility
|
IP
|
$3.58
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
6383338702
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.79
|
|
|
PROTHROMBIN COMPLEX CONC HUMAN 500 UNITS IV KIT
|
Facility
|
IP
|
$3.58
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
6383338602
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.79
|
|
|
PROTHROMBIN COMPLEX CONC HUMAN 500 UNITS IV KIT
|
Facility
|
OP
|
$3.58
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
6383338602
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.14
|
| Rate for Payer: Aetna Government |
$2.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1.50
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1.50
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1.50
|
| Rate for Payer: Brighton Health Commercial |
$2.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.14
|
| Rate for Payer: EmblemHealth Commercial |
$2.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1.90
|
| Rate for Payer: Group Health Inc Commercial |
$2.14
|
| Rate for Payer: Group Health Inc Medicare |
$2.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1.82
|
| Rate for Payer: Healthfirst QHP |
$2.14
|
| Rate for Payer: Humana Medicare |
$2.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.03
|
| Rate for Payer: Wellcare Medicare |
$2.03
|
|
|
PR OTOLARYNGOLOGIC EXAM UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$388.99
|
|
|
Service Code
|
HCPCS 92502
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$240.12 |
| Rate for Payer: Amida Care Medicaid |
$47.81
|
| Rate for Payer: Cash Price |
$107.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$106.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$101.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$106.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$101.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.04
|
| Rate for Payer: Healthfirst Commercial |
$106.72
|
| Rate for Payer: Healthfirst Essential Plan |
$240.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$101.38
|
| Rate for Payer: Healthfirst QHP |
$106.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$106.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$90.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$74.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$106.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$80.04
|
| Rate for Payer: SOMOS Essential |
$80.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$106.72
|
|
|
PR OTOPLASTY PROTRUDING EAR W/WO SIZE RDCTJ
|
Professional
|
Both
|
$2,021.60
|
|
|
Service Code
|
HCPCS 69300
|
| Min. Negotiated Rate |
$383.13 |
| Max. Negotiated Rate |
$1,231.49 |
| Rate for Payer: Cash Price |
$552.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$547.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$492.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$492.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$519.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$547.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$519.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$547.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$547.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$410.50
|
| Rate for Payer: Healthfirst Commercial |
$547.33
|
| Rate for Payer: Healthfirst Essential Plan |
$1,231.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$519.96
|
| Rate for Payer: Healthfirst QHP |
$547.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$383.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$547.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$465.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$383.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$547.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$410.50
|
| Rate for Payer: SOMOS Essential |
$410.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$547.33
|
|
|
PR OUTFLOW TRACT AGMNTJ W/WO COMMISSUR/INFUND RESCJ
|
Professional
|
Both
|
$7,009.98
|
|
|
Service Code
|
HCPCS 33478
|
| Min. Negotiated Rate |
$1,294.30 |
| Max. Negotiated Rate |
$4,160.25 |
| Rate for Payer: Cash Price |
$1,865.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,849.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,664.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,664.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,756.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,849.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,756.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,849.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,849.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,386.75
|
| Rate for Payer: Healthfirst Commercial |
$1,849.00
|
| Rate for Payer: Healthfirst Essential Plan |
$4,160.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,756.55
|
| Rate for Payer: Healthfirst QHP |
$1,849.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,294.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,849.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,571.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,294.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,849.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,386.75
|
| Rate for Payer: SOMOS Essential |
$1,386.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,849.00
|
|
|
PR OUTPATIENT CARDIAC REHAB W/CONT ECG MONITORING
|
Professional
|
Both
|
$54.92
|
|
|
Service Code
|
HCPCS 93798
|
| Min. Negotiated Rate |
$7.32 |
| Max. Negotiated Rate |
$33.21 |
| Rate for Payer: Amida Care Medicaid |
$7.32
|
| Rate for Payer: Cash Price |
$14.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.07
|
| Rate for Payer: Healthfirst Commercial |
$14.76
|
| Rate for Payer: Healthfirst Essential Plan |
$33.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.02
|
| Rate for Payer: Healthfirst QHP |
$14.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.07
|
| Rate for Payer: SOMOS Essential |
$11.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.76
|
|
|
PR OUTPATIENT CARDIAC REHAB W/O CONT ECG MONITOR
|
Professional
|
Both
|
$35.35
|
|
|
Service Code
|
HCPCS 93797
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$20.59 |
| Rate for Payer: Amida Care Medicaid |
$4.68
|
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.86
|
| Rate for Payer: Healthfirst Commercial |
$9.15
|
| Rate for Payer: Healthfirst Essential Plan |
$20.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.69
|
| Rate for Payer: Healthfirst QHP |
$9.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.86
|
| Rate for Payer: SOMOS Essential |
$6.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.15
|
|
|
PR OVARIAN CYSTECTOMY UNI/BI
|
Professional
|
Both
|
$3,379.71
|
|
|
Service Code
|
HCPCS 58925
|
| Min. Negotiated Rate |
$630.43 |
| Max. Negotiated Rate |
$2,026.37 |
| Rate for Payer: Cash Price |
$909.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$900.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$810.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$810.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$855.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$900.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$855.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$900.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$900.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$675.46
|
| Rate for Payer: Healthfirst Commercial |
$900.61
|
| Rate for Payer: Healthfirst Essential Plan |
$2,026.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$855.58
|
| Rate for Payer: Healthfirst QHP |
$900.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$630.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$900.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$765.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$630.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$900.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$675.46
|
| Rate for Payer: SOMOS Essential |
$675.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$900.61
|
|
|
PR PALATOP CL PALATE ATTACHMENT PHARYNGEAL FLAP
|
Professional
|
Both
|
$4,295.76
|
|
|
Service Code
|
HCPCS 42225
|
| Min. Negotiated Rate |
$810.44 |
| Max. Negotiated Rate |
$2,604.98 |
| Rate for Payer: Cash Price |
$1,156.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,157.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,041.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,041.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,099.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,157.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,099.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,157.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,157.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$868.33
|
| Rate for Payer: Healthfirst Commercial |
$1,157.77
|
| Rate for Payer: Healthfirst Essential Plan |
$2,604.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,099.88
|
| Rate for Payer: Healthfirst QHP |
$1,157.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$810.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,157.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$984.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$810.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,157.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$868.33
|
| Rate for Payer: SOMOS Essential |
$868.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,157.77
|
|
|
PR PALATOP CL PALATE SOFT&/HARD PALATE ONLY
|
Professional
|
Both
|
$4,057.76
|
|
|
Service Code
|
HCPCS 42200
|
| Min. Negotiated Rate |
$760.61 |
| Max. Negotiated Rate |
$2,444.80 |
| Rate for Payer: Cash Price |
$1,092.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,086.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$977.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$977.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,032.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,086.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,032.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,086.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,086.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$814.93
|
| Rate for Payer: Healthfirst Commercial |
$1,086.58
|
| Rate for Payer: Healthfirst Essential Plan |
$2,444.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,032.25
|
| Rate for Payer: Healthfirst QHP |
$1,086.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$760.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,086.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$923.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$760.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,086.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$814.93
|
| Rate for Payer: SOMOS Essential |
$814.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,086.58
|
|
|
PR PALATOP CLSR ALVEOLAR RIDGE GRF ALVEOLAR RIDGE
|
Professional
|
Both
|
$4,709.78
|
|
|
Service Code
|
HCPCS 42210
|
| Min. Negotiated Rate |
$882.91 |
| Max. Negotiated Rate |
$2,837.93 |
| Rate for Payer: Cash Price |
$1,267.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,261.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,135.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,135.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,198.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,261.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,198.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,261.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,261.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$945.98
|
| Rate for Payer: Healthfirst Commercial |
$1,261.30
|
| Rate for Payer: Healthfirst Essential Plan |
$2,837.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,198.23
|
| Rate for Payer: Healthfirst QHP |
$1,261.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$882.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,261.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,072.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$882.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,261.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$945.98
|
| Rate for Payer: SOMOS Essential |
$945.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,261.30
|
|
|
PR PALATOPHARYNGOPLASTY
|
Professional
|
Both
|
$2,972.45
|
|
|
Service Code
|
HCPCS 42145
|
| Min. Negotiated Rate |
$557.85 |
| Max. Negotiated Rate |
$1,793.09 |
| Rate for Payer: Cash Price |
$807.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$796.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$717.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$717.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$757.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$796.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$757.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$796.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$796.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$597.70
|
| Rate for Payer: Healthfirst Commercial |
$796.93
|
| Rate for Payer: Healthfirst Essential Plan |
$1,793.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$757.08
|
| Rate for Payer: Healthfirst QHP |
$796.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$557.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$796.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$677.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$557.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$796.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$597.70
|
| Rate for Payer: SOMOS Essential |
$597.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$796.93
|
|
|
PR PALATOPLASTY CLEFT PALATE MAJOR REVJ
|
Professional
|
Both
|
$3,073.00
|
|
|
Service Code
|
HCPCS 42215
|
| Min. Negotiated Rate |
$577.67 |
| Max. Negotiated Rate |
$1,856.79 |
| Rate for Payer: Cash Price |
$829.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$825.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$742.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$742.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$783.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$825.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$783.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$825.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$825.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$618.93
|
| Rate for Payer: Healthfirst Commercial |
$825.24
|
| Rate for Payer: Healthfirst Essential Plan |
$1,856.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$783.98
|
| Rate for Payer: Healthfirst QHP |
$825.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$577.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$825.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$701.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$577.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$825.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$618.93
|
| Rate for Payer: SOMOS Essential |
$618.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$825.24
|
|
|
PR PALATOPLASTY CLEFT PALATE SEC LNGTH PX
|
Professional
|
Both
|
$2,531.97
|
|
|
Service Code
|
HCPCS 42220
|
| Min. Negotiated Rate |
$475.89 |
| Max. Negotiated Rate |
$1,529.66 |
| Rate for Payer: Cash Price |
$684.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$679.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$611.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$611.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$645.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$679.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$645.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$679.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$679.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$509.89
|
| Rate for Payer: Healthfirst Commercial |
$679.85
|
| Rate for Payer: Healthfirst Essential Plan |
$1,529.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$645.86
|
| Rate for Payer: Healthfirst QHP |
$679.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$475.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$679.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$577.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$475.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$679.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$509.89
|
| Rate for Payer: SOMOS Essential |
$509.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$679.85
|
|
|
PR PALATOPLASTY W/CLSR ALVEOLAR RIDGE SOFT TISSUE
|
Professional
|
Both
|
$4,219.67
|
|
|
Service Code
|
HCPCS 42205
|
| Min. Negotiated Rate |
$789.94 |
| Max. Negotiated Rate |
$2,539.08 |
| Rate for Payer: Cash Price |
$1,136.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,128.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,015.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,015.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,072.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,128.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,072.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,128.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,128.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$846.36
|
| Rate for Payer: Healthfirst Commercial |
$1,128.48
|
| Rate for Payer: Healthfirst Essential Plan |
$2,539.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,072.06
|
| Rate for Payer: Healthfirst QHP |
$1,128.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$789.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,128.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$959.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$789.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,128.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$846.36
|
| Rate for Payer: SOMOS Essential |
$846.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,128.48
|
|
|
PR PANCREATECTOMY TOTAL
|
Professional
|
Both
|
$8,225.70
|
|
|
Service Code
|
HCPCS 48155
|
| Min. Negotiated Rate |
$1,515.18 |
| Max. Negotiated Rate |
$4,870.22 |
| Rate for Payer: Cash Price |
$2,183.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,164.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,948.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,948.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,056.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,164.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,056.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,164.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,164.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,623.40
|
| Rate for Payer: Healthfirst Commercial |
$2,164.54
|
| Rate for Payer: Healthfirst Essential Plan |
$4,870.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,056.31
|
| Rate for Payer: Healthfirst QHP |
$2,164.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,515.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,164.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,839.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,515.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,164.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,623.40
|
| Rate for Payer: SOMOS Essential |
$1,623.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,164.54
|
|
