|
PR PRGRMG DEV EVAL SCRMS PHYS/QHP IN PERSON
|
Professional
|
Both
|
$255.89
|
|
|
Service Code
|
HCPCS 93285
|
| Min. Negotiated Rate |
$38.12 |
| Max. Negotiated Rate |
$150.16 |
| Rate for Payer: Amida Care Medicaid |
$38.12
|
| Rate for Payer: Cash Price |
$68.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$66.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$63.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$66.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$63.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.05
|
| Rate for Payer: Healthfirst Commercial |
$66.74
|
| Rate for Payer: Healthfirst Essential Plan |
$150.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$63.40
|
| Rate for Payer: Healthfirst QHP |
$66.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$66.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$56.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$66.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$50.05
|
| Rate for Payer: SOMOS Essential |
$50.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.74
|
|
|
PR PRGRMG EVAL IMPLANTABLE IN PERSON MULTI LEAD DFB
|
Professional
|
Both
|
$440.48
|
|
|
Service Code
|
HCPCS 93284
|
| Min. Negotiated Rate |
$80.26 |
| Max. Negotiated Rate |
$262.80 |
| Rate for Payer: Amida Care Medicaid |
$80.26
|
| Rate for Payer: Cash Price |
$119.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$116.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$105.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$105.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$110.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$116.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$110.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$116.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$116.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$87.60
|
| Rate for Payer: Healthfirst Commercial |
$116.80
|
| Rate for Payer: Healthfirst Essential Plan |
$262.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.96
|
| Rate for Payer: Healthfirst QHP |
$116.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$81.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$116.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$99.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$81.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$116.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$87.60
|
| Rate for Payer: SOMOS Essential |
$87.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$116.80
|
|
|
PR PRGRMG EVAL IMPLANTABLE IN PERSON MULTI LEAD DFB
|
Professional
|
Both
|
$201.11
|
|
|
Service Code
|
HCPCS 93284 TC
|
| Min. Negotiated Rate |
$36.57 |
| Max. Negotiated Rate |
$117.54 |
| Rate for Payer: Amida Care Medicaid |
$80.26
|
| Rate for Payer: Cash Price |
$54.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.18
|
| Rate for Payer: Healthfirst Commercial |
$52.24
|
| Rate for Payer: Healthfirst Essential Plan |
$117.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.63
|
| Rate for Payer: Healthfirst QHP |
$52.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.18
|
| Rate for Payer: SOMOS Essential |
$39.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.24
|
|
|
PR PRGRMG EVAL IMPLANTABLE IN PERSON MULTI LEAD DFB
|
Professional
|
Both
|
$239.37
|
|
|
Service Code
|
HCPCS 93284 26
|
| Min. Negotiated Rate |
$45.19 |
| Max. Negotiated Rate |
$145.24 |
| Rate for Payer: Amida Care Medicaid |
$80.26
|
| Rate for Payer: Cash Price |
$64.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$64.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$61.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.41
|
| Rate for Payer: Healthfirst Commercial |
$64.55
|
| Rate for Payer: Healthfirst Essential Plan |
$145.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.32
|
| Rate for Payer: Healthfirst QHP |
$64.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$64.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$54.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.41
|
| Rate for Payer: SOMOS Essential |
$48.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.55
|
|
|
PR PRGRMG EVAL IMPLANTABLE IN PRSN DUAL LEAD DFB
|
Professional
|
Both
|
$188.16
|
|
|
Service Code
|
HCPCS 93283 TC
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$109.69 |
| Rate for Payer: Amida Care Medicaid |
$68.55
|
| Rate for Payer: Cash Price |
$50.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$48.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.56
|
| Rate for Payer: Healthfirst Commercial |
$48.75
|
| Rate for Payer: Healthfirst Essential Plan |
$109.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.31
|
| Rate for Payer: Healthfirst QHP |
$48.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.56
|
| Rate for Payer: SOMOS Essential |
$36.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.75
|
|
|
PR PRGRMG EVAL IMPLANTABLE IN PRSN DUAL LEAD DFB
|
Professional
|
Both
|
$409.29
|
|
|
Service Code
|
HCPCS 93283
|
| Min. Negotiated Rate |
$68.55 |
| Max. Negotiated Rate |
$243.70 |
| Rate for Payer: Amida Care Medicaid |
$68.55
|
| Rate for Payer: Cash Price |
$110.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$108.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$97.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$97.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$108.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$108.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$108.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$81.23
|
| Rate for Payer: Healthfirst Commercial |
$108.31
|
| Rate for Payer: Healthfirst Essential Plan |
$243.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$102.89
|
| Rate for Payer: Healthfirst QHP |
$108.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$108.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$92.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$108.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$81.23
|
| Rate for Payer: SOMOS Essential |
$81.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$108.31
|
|
|
PR PRGRMG EVAL IMPLANTABLE IN PRSN DUAL LEAD DFB
|
Professional
|
Both
|
$221.10
|
|
|
Service Code
|
HCPCS 93283 26
|
| Min. Negotiated Rate |
$41.69 |
| Max. Negotiated Rate |
$134.01 |
| Rate for Payer: Amida Care Medicaid |
$68.55
|
| Rate for Payer: Cash Price |
$59.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$59.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.67
|
| Rate for Payer: Healthfirst Commercial |
$59.56
|
| Rate for Payer: Healthfirst Essential Plan |
$134.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.58
|
| Rate for Payer: Healthfirst QHP |
$59.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.67
|
| Rate for Payer: SOMOS Essential |
$44.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.56
|
|
|
PR PRGRMNG DEV EVAL IMPLANTABLE IN PERSN 1 LD DFB
|
Professional
|
Both
|
$172.38
|
|
|
Service Code
|
HCPCS 93282 TC
|
| Min. Negotiated Rate |
$31.14 |
| Max. Negotiated Rate |
$100.08 |
| Rate for Payer: Amida Care Medicaid |
$56.32
|
| Rate for Payer: Cash Price |
$46.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$44.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.36
|
| Rate for Payer: Healthfirst Commercial |
$44.48
|
| Rate for Payer: Healthfirst Essential Plan |
$100.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.26
|
| Rate for Payer: Healthfirst QHP |
$44.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.36
|
| Rate for Payer: SOMOS Essential |
$33.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.48
|
|
|
PR PRGRMNG DEV EVAL IMPLANTABLE IN PERSN 1 LD DFB
|
Professional
|
Both
|
$166.29
|
|
|
Service Code
|
HCPCS 93282 26
|
| Min. Negotiated Rate |
$30.77 |
| Max. Negotiated Rate |
$98.89 |
| Rate for Payer: Amida Care Medicaid |
$56.32
|
| Rate for Payer: Cash Price |
$44.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.96
|
| Rate for Payer: Healthfirst Commercial |
$43.95
|
| Rate for Payer: Healthfirst Essential Plan |
$98.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.75
|
| Rate for Payer: Healthfirst QHP |
$43.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.96
|
| Rate for Payer: SOMOS Essential |
$32.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.95
|
|
|
PR PRGRMNG DEV EVAL IMPLANTABLE IN PERSN 1 LD DFB
|
Professional
|
Both
|
$338.63
|
|
|
Service Code
|
HCPCS 93282
|
| Min. Negotiated Rate |
$56.32 |
| Max. Negotiated Rate |
$198.97 |
| Rate for Payer: Amida Care Medicaid |
$56.32
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$88.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$79.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$88.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.32
|
| Rate for Payer: Healthfirst Commercial |
$88.43
|
| Rate for Payer: Healthfirst Essential Plan |
$198.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$84.01
|
| Rate for Payer: Healthfirst QHP |
$88.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$61.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$88.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$61.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$88.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$66.32
|
| Rate for Payer: SOMOS Essential |
$66.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$88.43
|
|
|
PR PRICARDIECTOMY STOT/COMPL W/CARDPULM BYPASS
|
Professional
|
Both
|
$10,958.08
|
|
|
Service Code
|
HCPCS 33031
|
| Min. Negotiated Rate |
$2,018.29 |
| Max. Negotiated Rate |
$6,487.36 |
| Rate for Payer: Cash Price |
$2,912.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,883.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,594.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,594.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,739.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,883.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,739.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,883.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,883.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,162.45
|
| Rate for Payer: Healthfirst Commercial |
$2,883.27
|
| Rate for Payer: Healthfirst Essential Plan |
$6,487.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,739.11
|
| Rate for Payer: Healthfirst QHP |
$2,883.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,018.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,883.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,450.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,018.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,883.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,162.45
|
| Rate for Payer: SOMOS Essential |
$2,162.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,883.27
|
|
|
PR PRICARDIECTOMY STOT/COMPL W/O CARDPULM BYPASS
|
Professional
|
Both
|
$8,856.79
|
|
|
Service Code
|
HCPCS 33030
|
| Min. Negotiated Rate |
$1,635.90 |
| Max. Negotiated Rate |
$5,258.25 |
| Rate for Payer: Cash Price |
$2,358.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,337.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,103.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,103.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,220.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,337.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,220.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,337.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,337.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,752.75
|
| Rate for Payer: Healthfirst Commercial |
$2,337.00
|
| Rate for Payer: Healthfirst Essential Plan |
$5,258.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,220.15
|
| Rate for Payer: Healthfirst QHP |
$2,337.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,635.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,337.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,986.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,635.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,337.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,752.75
|
| Rate for Payer: SOMOS Essential |
$1,752.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,337.00
|
|
|
PR PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST
|
Professional
|
Both
|
$1,854.97
|
|
|
Service Code
|
HCPCS 37184
|
| Min. Negotiated Rate |
$341.66 |
| Max. Negotiated Rate |
$1,098.20 |
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$488.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$439.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$439.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$463.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$488.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$463.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$488.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$488.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$366.07
|
| Rate for Payer: Healthfirst Commercial |
$488.09
|
| Rate for Payer: Healthfirst Essential Plan |
$1,098.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$463.69
|
| Rate for Payer: Healthfirst QHP |
$488.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$341.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$488.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$414.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$341.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$488.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$366.07
|
| Rate for Payer: SOMOS Essential |
$366.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$488.09
|
|
|
PR PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA SBSQ
|
Professional
|
Both
|
$706.55
|
|
|
Service Code
|
HCPCS 37185
|
| Min. Negotiated Rate |
$128.97 |
| Max. Negotiated Rate |
$414.54 |
| Rate for Payer: Cash Price |
$186.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$165.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$165.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$184.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$138.18
|
| Rate for Payer: Healthfirst Commercial |
$184.24
|
| Rate for Payer: Healthfirst Essential Plan |
$414.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$175.03
|
| Rate for Payer: Healthfirst QHP |
$184.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$128.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$184.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$156.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$128.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.18
|
| Rate for Payer: SOMOS Essential |
$138.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.24
|
|
|
PR PRINCIPAL CARE MGMT SVC 1ST 30 PHYS/QHP CAL MO
|
Professional
|
Both
|
$298.10
|
|
|
Service Code
|
HCPCS 99424
|
| Min. Negotiated Rate |
$58.09 |
| Max. Negotiated Rate |
$186.73 |
| Rate for Payer: Cash Price |
$82.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$82.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$78.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$82.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$78.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.24
|
| Rate for Payer: Healthfirst Commercial |
$82.99
|
| Rate for Payer: Healthfirst Essential Plan |
$186.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$78.84
|
| Rate for Payer: Healthfirst QHP |
$82.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$82.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$82.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62.24
|
| Rate for Payer: SOMOS Essential |
$62.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.99
|
|
|
PR PRINCIPAL CARE MGMT SVC 1ST 30 STAFF CAL MO
|
Professional
|
Both
|
$200.34
|
|
|
Service Code
|
HCPCS 99426
|
| Min. Negotiated Rate |
$37.85 |
| Max. Negotiated Rate |
$121.66 |
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.55
|
| Rate for Payer: Healthfirst Commercial |
$54.07
|
| Rate for Payer: Healthfirst Essential Plan |
$121.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.37
|
| Rate for Payer: Healthfirst QHP |
$54.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$54.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.55
|
| Rate for Payer: SOMOS Essential |
$40.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.07
|
|
|
PR PRINCIPAL CARE MGMT SVC EA ADDL 30 STAFF CAL MO
|
Professional
|
Both
|
$142.73
|
|
|
Service Code
|
HCPCS 99427
|
| Min. Negotiated Rate |
$27.27 |
| Max. Negotiated Rate |
$87.66 |
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.22
|
| Rate for Payer: Healthfirst Commercial |
$38.96
|
| Rate for Payer: Healthfirst Essential Plan |
$87.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.01
|
| Rate for Payer: Healthfirst QHP |
$38.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.22
|
| Rate for Payer: SOMOS Essential |
$29.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.96
|
|
|
PR PRINCIPAL CARE MGMT SVC EA ADL 30 PHY/QHP CAL MO
|
Professional
|
Both
|
$206.22
|
|
|
Service Code
|
HCPCS 99425
|
| Min. Negotiated Rate |
$39.21 |
| Max. Negotiated Rate |
$126.02 |
| Rate for Payer: Cash Price |
$56.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$53.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.01
|
| Rate for Payer: Healthfirst Commercial |
$56.01
|
| Rate for Payer: Healthfirst Essential Plan |
$126.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$53.21
|
| Rate for Payer: Healthfirst QHP |
$56.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$56.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.01
|
| Rate for Payer: SOMOS Essential |
$42.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.01
|
|
|
PR PROBE LACRIMAL CANALICULI W/WO IRRIGATION
|
Professional
|
Both
|
$486.29
|
|
|
Service Code
|
HCPCS 68840
|
| Min. Negotiated Rate |
$93.01 |
| Max. Negotiated Rate |
$298.96 |
| Rate for Payer: Cash Price |
$134.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$132.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$119.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$119.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$126.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$132.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$126.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$132.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$132.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$99.65
|
| Rate for Payer: Healthfirst Commercial |
$132.87
|
| Rate for Payer: Healthfirst Essential Plan |
$298.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$126.23
|
| Rate for Payer: Healthfirst QHP |
$132.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$93.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$132.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$112.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$93.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$132.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$99.65
|
| Rate for Payer: SOMOS Essential |
$99.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$132.87
|
|
|
PR PROBE NASOLACRIMAL DUCT WITH CATHETER DILATION
|
Professional
|
Both
|
$650.09
|
|
|
Service Code
|
HCPCS 68816
|
| Min. Negotiated Rate |
$123.05 |
| Max. Negotiated Rate |
$395.50 |
| Rate for Payer: Cash Price |
$178.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$175.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$158.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$158.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$166.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$175.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$166.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$131.84
|
| Rate for Payer: Healthfirst Commercial |
$175.78
|
| Rate for Payer: Healthfirst Essential Plan |
$395.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$166.99
|
| Rate for Payer: Healthfirst QHP |
$175.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$123.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$175.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$149.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$123.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$175.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$131.84
|
| Rate for Payer: SOMOS Essential |
$131.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$175.78
|
|
|
PR PROBE NASOLACRIMAL DUCT W/WO IRRG INSJ TUBE/STNT
|
Professional
|
Both
|
$918.75
|
|
|
Service Code
|
HCPCS 68815
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Cash Price |
$253.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$225.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$225.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$237.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$250.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$237.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$250.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$187.50
|
| Rate for Payer: Healthfirst Commercial |
$250.00
|
| Rate for Payer: Healthfirst Essential Plan |
$562.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$237.50
|
| Rate for Payer: Healthfirst QHP |
$250.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$175.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$250.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$212.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$175.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$250.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$187.50
|
| Rate for Payer: SOMOS Essential |
$187.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$250.00
|
|
|
PR PROBE NASOLACRIMAL DUCT W/WO IRRIGATION
|
Professional
|
Both
|
$529.03
|
|
|
Service Code
|
HCPCS 68810
|
| Min. Negotiated Rate |
$101.45 |
| Max. Negotiated Rate |
$326.09 |
| Rate for Payer: Cash Price |
$145.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$144.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$130.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$130.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$137.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$144.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$137.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$108.70
|
| Rate for Payer: Healthfirst Commercial |
$144.93
|
| Rate for Payer: Healthfirst Essential Plan |
$326.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$137.68
|
| Rate for Payer: Healthfirst QHP |
$144.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$101.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$144.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$123.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$101.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$144.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$108.70
|
| Rate for Payer: SOMOS Essential |
$108.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$144.93
|
|
|
PR PROBE NASOLACRIMAL DUCT W/WO IRRIG REQ GEN ANES
|
Professional
|
Both
|
$556.68
|
|
|
Service Code
|
HCPCS 68811
|
| Min. Negotiated Rate |
$107.30 |
| Max. Negotiated Rate |
$344.90 |
| Rate for Payer: Cash Price |
$153.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$153.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$137.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$137.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$145.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$153.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$145.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$153.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$153.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.97
|
| Rate for Payer: Healthfirst Commercial |
$153.29
|
| Rate for Payer: Healthfirst Essential Plan |
$344.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$145.63
|
| Rate for Payer: Healthfirst QHP |
$153.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$107.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$153.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$130.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$107.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$153.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$114.97
|
| Rate for Payer: SOMOS Essential |
$114.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$153.29
|
|
|
PR PROCTOPEXY ABDOMINAL APPROACH
|
Professional
|
Both
|
$4,548.11
|
|
|
Service Code
|
HCPCS 45540
|
| Min. Negotiated Rate |
$848.37 |
| Max. Negotiated Rate |
$2,726.89 |
| Rate for Payer: Cash Price |
$1,220.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,211.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,090.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,090.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,151.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,211.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,151.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,211.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,211.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$908.96
|
| Rate for Payer: Healthfirst Commercial |
$1,211.95
|
| Rate for Payer: Healthfirst Essential Plan |
$2,726.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,151.35
|
| Rate for Payer: Healthfirst QHP |
$1,211.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$848.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,211.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,030.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$848.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,211.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$908.96
|
| Rate for Payer: SOMOS Essential |
$908.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,211.95
|
|
|
PR PROCTOPEXY PERINEAL APPROACH
|
Professional
|
Both
|
$4,108.69
|
|
|
Service Code
|
HCPCS 45541
|
| Min. Negotiated Rate |
$770.25 |
| Max. Negotiated Rate |
$2,475.79 |
| Rate for Payer: Cash Price |
$1,104.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,100.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$990.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$990.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,045.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,100.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,045.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$825.26
|
| Rate for Payer: Healthfirst Commercial |
$1,100.35
|
| Rate for Payer: Healthfirst Essential Plan |
$2,475.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,045.33
|
| Rate for Payer: Healthfirst QHP |
$1,100.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$770.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,100.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$935.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$770.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,100.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$825.26
|
| Rate for Payer: SOMOS Essential |
$825.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,100.35
|
|
