|
PR PLMT URTRL STENT PRQ NEW ACCESS W/SEP NFROS CATH
|
Professional
|
Both
|
$1,388.91
|
|
|
Service Code
|
HCPCS 50695
|
| Min. Negotiated Rate |
$261.98 |
| Max. Negotiated Rate |
$842.09 |
| Rate for Payer: Cash Price |
$376.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$374.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$336.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$336.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$355.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$374.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$355.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$374.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$374.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$280.69
|
| Rate for Payer: Healthfirst Commercial |
$374.26
|
| Rate for Payer: Healthfirst Essential Plan |
$842.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$355.55
|
| Rate for Payer: Healthfirst QHP |
$374.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$261.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$374.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$318.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$261.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$374.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$280.69
|
| Rate for Payer: SOMOS Essential |
$280.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$374.26
|
|
|
PR PLMT URTRL STENT PRQ PRE-EXISTING NFROS TRACT
|
Professional
|
Both
|
$828.52
|
|
|
Service Code
|
HCPCS 50693
|
| Min. Negotiated Rate |
$156.82 |
| Max. Negotiated Rate |
$504.07 |
| Rate for Payer: Cash Price |
$224.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$224.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$201.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$201.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$212.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$224.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$212.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$224.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$224.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$168.02
|
| Rate for Payer: Healthfirst Commercial |
$224.03
|
| Rate for Payer: Healthfirst Essential Plan |
$504.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$212.83
|
| Rate for Payer: Healthfirst QHP |
$224.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$156.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$224.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$190.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$156.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$224.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$168.02
|
| Rate for Payer: SOMOS Essential |
$168.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$224.03
|
|
|
PR PLMT URTRL STNT PRQ NEW ACESS W/O SEP NFROS CATH
|
Professional
|
Both
|
$1,086.02
|
|
|
Service Code
|
HCPCS 50694
|
| Min. Negotiated Rate |
$204.53 |
| Max. Negotiated Rate |
$657.40 |
| Rate for Payer: Cash Price |
$293.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$292.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$262.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$262.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$277.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$292.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$277.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$292.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$292.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$219.13
|
| Rate for Payer: Healthfirst Commercial |
$292.18
|
| Rate for Payer: Healthfirst Essential Plan |
$657.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$277.57
|
| Rate for Payer: Healthfirst QHP |
$292.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$204.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$292.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$248.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$204.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$292.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$219.13
|
| Rate for Payer: SOMOS Essential |
$219.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.18
|
|
|
PR PLMT VEIN PATCH/CUFF DSTL ANAST BYP CONDUIT
|
Professional
|
Both
|
$880.53
|
|
|
Service Code
|
HCPCS 35685
|
| Min. Negotiated Rate |
$161.07 |
| Max. Negotiated Rate |
$517.73 |
| Rate for Payer: Cash Price |
$232.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$230.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$207.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$207.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$218.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$230.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$218.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$230.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$230.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$172.57
|
| Rate for Payer: Healthfirst Commercial |
$230.10
|
| Rate for Payer: Healthfirst Essential Plan |
$517.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$218.59
|
| Rate for Payer: Healthfirst QHP |
$230.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$161.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$230.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$195.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$161.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$230.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$172.57
|
| Rate for Payer: SOMOS Essential |
$172.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$230.10
|
|
|
PR PLSTC RPR CL LIP/NSL DFRM PRIM BI 1 2 STGS
|
Professional
|
Both
|
$4,363.70
|
|
|
Service Code
|
HCPCS 40702
|
| Min. Negotiated Rate |
$822.39 |
| Max. Negotiated Rate |
$2,643.39 |
| Rate for Payer: Cash Price |
$1,177.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,174.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,057.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,057.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,116.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,174.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,116.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,174.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,174.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$881.13
|
| Rate for Payer: Healthfirst Commercial |
$1,174.84
|
| Rate for Payer: Healthfirst Essential Plan |
$2,643.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,116.10
|
| Rate for Payer: Healthfirst QHP |
$1,174.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$822.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,174.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$998.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$822.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,174.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$881.13
|
| Rate for Payer: SOMOS Essential |
$881.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,174.84
|
|
|
PR PLSTC RPR CL LIP/NSL DFRM PRIM BI 1 STG PX
|
Professional
|
Both
|
$5,199.71
|
|
|
Service Code
|
HCPCS 40701
|
| Min. Negotiated Rate |
$976.86 |
| Max. Negotiated Rate |
$3,139.90 |
| Rate for Payer: Cash Price |
$1,401.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,395.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,255.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,255.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,325.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,395.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,325.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,395.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,395.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,046.63
|
| Rate for Payer: Healthfirst Commercial |
$1,395.51
|
| Rate for Payer: Healthfirst Essential Plan |
$3,139.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,325.73
|
| Rate for Payer: Healthfirst QHP |
$1,395.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$976.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,395.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,186.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$976.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,395.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,046.63
|
| Rate for Payer: SOMOS Essential |
$1,046.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,395.51
|
|
|
PR PLSTC RPR CL LIP/NSL DFRM PRIM PRTL/COMPL UNI
|
Professional
|
Both
|
$4,401.60
|
|
|
Service Code
|
HCPCS 40700
|
| Min. Negotiated Rate |
$829.70 |
| Max. Negotiated Rate |
$2,666.90 |
| Rate for Payer: Cash Price |
$1,188.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,185.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,066.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,066.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,126.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,185.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,126.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,185.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,185.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$888.97
|
| Rate for Payer: Healthfirst Commercial |
$1,185.29
|
| Rate for Payer: Healthfirst Essential Plan |
$2,666.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,126.03
|
| Rate for Payer: Healthfirst QHP |
$1,185.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$829.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,185.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,007.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$829.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,185.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$888.97
|
| Rate for Payer: SOMOS Essential |
$888.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,185.29
|
|
|
PR PLSTC RPR CL LIP/NSL DFRM SEC RECRTJ DFCT & RECL
|
Professional
|
Both
|
$4,487.53
|
|
|
Service Code
|
HCPCS 40720
|
| Min. Negotiated Rate |
$843.17 |
| Max. Negotiated Rate |
$2,710.19 |
| Rate for Payer: Cash Price |
$1,208.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,204.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,084.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,084.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,144.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,204.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,144.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,204.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,204.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$903.40
|
| Rate for Payer: Healthfirst Commercial |
$1,204.53
|
| Rate for Payer: Healthfirst Essential Plan |
$2,710.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,144.30
|
| Rate for Payer: Healthfirst QHP |
$1,204.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$843.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,204.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,023.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$843.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,204.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$903.40
|
| Rate for Payer: SOMOS Essential |
$903.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,204.53
|
|
|
PR PLSTC RPR CL LIP/NSL DFRM W/CROSS LIP PEDCL FLAP
|
Professional
|
Both
|
$4,714.29
|
|
|
Service Code
|
HCPCS 40761
|
| Min. Negotiated Rate |
$885.67 |
| Max. Negotiated Rate |
$2,846.81 |
| Rate for Payer: Cash Price |
$1,268.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,265.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,138.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,138.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,201.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,265.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,201.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,265.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,265.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$948.94
|
| Rate for Payer: Healthfirst Commercial |
$1,265.25
|
| Rate for Payer: Healthfirst Essential Plan |
$2,846.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,201.99
|
| Rate for Payer: Healthfirst QHP |
$1,265.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$885.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,265.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,075.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$885.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,265.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$948.94
|
| Rate for Payer: SOMOS Essential |
$948.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,265.25
|
|
|
PR PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY PRIM
|
Professional
|
Both
|
$1,492.72
|
|
|
Service Code
|
HCPCS 42500
|
| Min. Negotiated Rate |
$281.88 |
| Max. Negotiated Rate |
$906.03 |
| Rate for Payer: Cash Price |
$406.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$402.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$362.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$362.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$382.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$402.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$382.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$402.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$402.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$302.01
|
| Rate for Payer: Healthfirst Commercial |
$402.68
|
| Rate for Payer: Healthfirst Essential Plan |
$906.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$382.55
|
| Rate for Payer: Healthfirst QHP |
$402.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$281.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$402.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$342.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$281.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$402.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$302.01
|
| Rate for Payer: SOMOS Essential |
$302.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$402.68
|
|
|
PR PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY SEC/COMP
|
Professional
|
Both
|
$1,985.27
|
|
|
Service Code
|
HCPCS 42505
|
| Min. Negotiated Rate |
$372.53 |
| Max. Negotiated Rate |
$1,197.40 |
| Rate for Payer: Cash Price |
$539.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$532.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$478.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$478.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$505.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$532.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$505.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$532.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$532.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$399.13
|
| Rate for Payer: Healthfirst Commercial |
$532.18
|
| Rate for Payer: Healthfirst Essential Plan |
$1,197.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$505.57
|
| Rate for Payer: Healthfirst QHP |
$532.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$372.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$532.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$452.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$372.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$532.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$399.13
|
| Rate for Payer: SOMOS Essential |
$399.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$532.18
|
|
|
PR PNCRTECT DSTL NR-TOT W/PRSRV DUO CHLD-TYP PX
|
Professional
|
Both
|
$8,517.43
|
|
|
Service Code
|
HCPCS 48146
|
| Min. Negotiated Rate |
$1,572.36 |
| Max. Negotiated Rate |
$5,054.02 |
| Rate for Payer: Cash Price |
$2,267.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,246.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,021.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,021.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,133.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,246.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,133.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,246.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,246.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,684.67
|
| Rate for Payer: Healthfirst Commercial |
$2,246.23
|
| Rate for Payer: Healthfirst Essential Plan |
$5,054.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,133.92
|
| Rate for Payer: Healthfirst QHP |
$2,246.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,572.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,246.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,909.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,572.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,246.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,684.67
|
| Rate for Payer: SOMOS Essential |
$1,684.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,246.23
|
|
|
PR PNCRTECT DSTL STOT W/O PNCRTCOJEJUNOSTOMY
|
Professional
|
Both
|
$7,063.18
|
|
|
Service Code
|
HCPCS 48140
|
| Min. Negotiated Rate |
$1,306.29 |
| Max. Negotiated Rate |
$4,198.79 |
| Rate for Payer: Cash Price |
$1,881.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,866.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,679.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,679.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,772.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,866.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,772.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,866.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,866.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,399.60
|
| Rate for Payer: Healthfirst Commercial |
$1,866.13
|
| Rate for Payer: Healthfirst Essential Plan |
$4,198.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,772.82
|
| Rate for Payer: Healthfirst QHP |
$1,866.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,306.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,866.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,586.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,306.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,866.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,399.60
|
| Rate for Payer: SOMOS Essential |
$1,399.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,866.13
|
|
|
PR PNCRTECT DSTL STOT W/PNCRTCOJEJUNOSTOMY
|
Professional
|
Both
|
$7,391.79
|
|
|
Service Code
|
HCPCS 48145
|
| Min. Negotiated Rate |
$1,365.19 |
| Max. Negotiated Rate |
$4,388.11 |
| Rate for Payer: Cash Price |
$1,966.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,950.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,755.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,755.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,852.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,950.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,852.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,950.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,950.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,462.70
|
| Rate for Payer: Healthfirst Commercial |
$1,950.27
|
| Rate for Payer: Healthfirst Essential Plan |
$4,388.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,852.76
|
| Rate for Payer: Healthfirst QHP |
$1,950.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,365.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,950.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,657.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,365.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,950.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,462.70
|
| Rate for Payer: SOMOS Essential |
$1,462.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,950.27
|
|
|
PR PNCRTECT PROX STOT W/O PANCREATOJEJUNOSTOMY
|
Professional
|
Both
|
$13,105.05
|
|
|
Service Code
|
HCPCS 48154
|
| Min. Negotiated Rate |
$2,412.72 |
| Max. Negotiated Rate |
$7,755.19 |
| Rate for Payer: Cash Price |
$3,482.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,446.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,102.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,102.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,274.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,446.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,274.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,446.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,446.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,585.06
|
| Rate for Payer: Healthfirst Commercial |
$3,446.75
|
| Rate for Payer: Healthfirst Essential Plan |
$7,755.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,274.41
|
| Rate for Payer: Healthfirst QHP |
$3,446.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,412.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,446.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,929.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,412.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,446.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,585.06
|
| Rate for Payer: SOMOS Essential |
$2,585.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,446.75
|
|
|
PR PNCRTECT PROX STOT W/PANCREATOJEJUNOSTOMY
|
Professional
|
Both
|
$14,028.28
|
|
|
Service Code
|
HCPCS 48150
|
| Min. Negotiated Rate |
$2,591.13 |
| Max. Negotiated Rate |
$8,328.62 |
| Rate for Payer: Cash Price |
$3,736.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,701.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,331.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,331.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,516.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,701.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,516.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,701.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,701.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,776.21
|
| Rate for Payer: Healthfirst Commercial |
$3,701.61
|
| Rate for Payer: Healthfirst Essential Plan |
$8,328.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,516.53
|
| Rate for Payer: Healthfirst QHP |
$3,701.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,591.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,701.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,146.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,591.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,701.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,776.21
|
| Rate for Payer: SOMOS Essential |
$2,776.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,701.61
|
|
|
PR PNCRTECT WHIPPLE W/O PANCREATOJEJUNOSTOMY
|
Professional
|
Both
|
$13,053.81
|
|
|
Service Code
|
HCPCS 48152
|
| Min. Negotiated Rate |
$2,402.14 |
| Max. Negotiated Rate |
$7,721.17 |
| Rate for Payer: Cash Price |
$3,467.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,431.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,088.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,088.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,260.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,431.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,260.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,431.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,431.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,573.72
|
| Rate for Payer: Healthfirst Commercial |
$3,431.63
|
| Rate for Payer: Healthfirst Essential Plan |
$7,721.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,260.05
|
| Rate for Payer: Healthfirst QHP |
$3,431.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,402.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,431.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,916.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,402.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,431.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,573.72
|
| Rate for Payer: SOMOS Essential |
$2,573.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,431.63
|
|
|
PR PNCRTECT W/PANCREATOJEJUNOSTOMY
|
Professional
|
Both
|
$14,009.45
|
|
|
Service Code
|
HCPCS 48153
|
| Min. Negotiated Rate |
$2,578.27 |
| Max. Negotiated Rate |
$8,287.29 |
| Rate for Payer: Cash Price |
$3,725.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,683.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,314.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,314.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,499.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,683.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,499.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,683.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,683.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,762.43
|
| Rate for Payer: Healthfirst Commercial |
$3,683.24
|
| Rate for Payer: Healthfirst Essential Plan |
$8,287.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,499.08
|
| Rate for Payer: Healthfirst QHP |
$3,683.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,578.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,683.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,130.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,578.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,683.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,762.43
|
| Rate for Payer: SOMOS Essential |
$2,762.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,683.24
|
|
|
PR PNEUMONOLYSIS XTRPRIOSTEAL W/FILLING/PACKING PX
|
Professional
|
Both
|
$5,493.67
|
|
|
Service Code
|
HCPCS 32940
|
| Min. Negotiated Rate |
$1,014.89 |
| Max. Negotiated Rate |
$3,262.16 |
| Rate for Payer: Cash Price |
$1,462.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,449.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,304.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,304.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,377.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,449.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,377.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,449.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,449.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,087.39
|
| Rate for Payer: Healthfirst Commercial |
$1,449.85
|
| Rate for Payer: Healthfirst Essential Plan |
$3,262.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,377.36
|
| Rate for Payer: Healthfirst QHP |
$1,449.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,014.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,449.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,232.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,014.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,449.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,087.39
|
| Rate for Payer: SOMOS Essential |
$1,087.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,449.85
|
|
|
PR PNEUMONOSTOMY W/OPEN DRAINAGE ABSCESS/CYST
|
Professional
|
Both
|
$5,075.98
|
|
|
Service Code
|
HCPCS 32200
|
| Min. Negotiated Rate |
$941.76 |
| Max. Negotiated Rate |
$3,027.08 |
| Rate for Payer: Cash Price |
$1,356.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,345.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,210.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,210.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,278.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,345.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,278.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,345.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,345.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,009.03
|
| Rate for Payer: Healthfirst Commercial |
$1,345.37
|
| Rate for Payer: Healthfirst Essential Plan |
$3,027.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,278.10
|
| Rate for Payer: Healthfirst QHP |
$1,345.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$941.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,345.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,143.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$941.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,345.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,009.03
|
| Rate for Payer: SOMOS Essential |
$1,009.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,345.37
|
|
|
PR PNEUMOTHORAX THER INTRAPLEURAL INJECTION AIR
|
Professional
|
Both
|
$373.28
|
|
|
Service Code
|
HCPCS 32960
|
| Min. Negotiated Rate |
$70.04 |
| Max. Negotiated Rate |
$225.13 |
| Rate for Payer: Cash Price |
$100.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$100.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$90.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$90.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$95.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$100.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$95.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.05
|
| Rate for Payer: Healthfirst Commercial |
$100.06
|
| Rate for Payer: Healthfirst Essential Plan |
$225.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$95.06
|
| Rate for Payer: Healthfirst QHP |
$100.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$70.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$100.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$85.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$70.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$100.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$75.05
|
| Rate for Payer: SOMOS Essential |
$75.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$100.06
|
|
|
PR PNXR ASPIR HYDROCELE TUNICA VAGIS W/WO NJX MED
|
Professional
|
Both
|
$354.87
|
|
|
Service Code
|
HCPCS 55000
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$216.59 |
| Rate for Payer: Cash Price |
$97.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$96.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$86.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.19
|
| Rate for Payer: Healthfirst Commercial |
$96.26
|
| Rate for Payer: Healthfirst Essential Plan |
$216.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$91.45
|
| Rate for Payer: Healthfirst QHP |
$96.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$67.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$96.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$81.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$67.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.19
|
| Rate for Payer: SOMOS Essential |
$72.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.26
|
|
|
PR POLLICIZATION DIGIT
|
Professional
|
Both
|
$7,323.96
|
|
|
Service Code
|
HCPCS 26550
|
| Min. Negotiated Rate |
$1,357.85 |
| Max. Negotiated Rate |
$4,364.51 |
| Rate for Payer: Cash Price |
$1,965.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,939.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,745.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,745.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,842.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,939.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,842.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,939.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,939.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,454.84
|
| Rate for Payer: Healthfirst Commercial |
$1,939.78
|
| Rate for Payer: Healthfirst Essential Plan |
$4,364.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,842.79
|
| Rate for Payer: Healthfirst QHP |
$1,939.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,357.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,939.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,648.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,357.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,939.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,454.84
|
| Rate for Payer: SOMOS Essential |
$1,454.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,939.78
|
|
|
PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND
|
Professional
|
Both
|
$465.54
|
|
|
Service Code
|
HCPCS 95810 26
|
| Min. Negotiated Rate |
$87.93 |
| Max. Negotiated Rate |
$654.30 |
| Rate for Payer: Amida Care Medicaid |
$654.30
|
| Rate for Payer: Cash Price |
$127.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$125.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$113.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$119.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$125.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$119.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.21
|
| Rate for Payer: Healthfirst Commercial |
$125.61
|
| Rate for Payer: Healthfirst Essential Plan |
$282.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$119.33
|
| Rate for Payer: Healthfirst QHP |
$125.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$87.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$125.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$106.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$87.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$125.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$94.21
|
| Rate for Payer: SOMOS Essential |
$94.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$125.61
|
|
|
PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND
|
Professional
|
Both
|
$2,128.42
|
|
|
Service Code
|
HCPCS 95810 TC
|
| Min. Negotiated Rate |
$419.38 |
| Max. Negotiated Rate |
$1,348.00 |
| Rate for Payer: Amida Care Medicaid |
$654.30
|
| Rate for Payer: Cash Price |
$602.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$599.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$539.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$539.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$569.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$599.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$569.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$599.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$599.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$449.33
|
| Rate for Payer: Healthfirst Commercial |
$599.11
|
| Rate for Payer: Healthfirst Essential Plan |
$1,348.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$569.15
|
| Rate for Payer: Healthfirst QHP |
$599.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$419.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$599.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$509.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$419.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$599.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$449.33
|
| Rate for Payer: SOMOS Essential |
$449.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$599.11
|
|
