|
PR PROSTATECTOMY RETROPUBIC SUBTOTAL
|
Professional
|
Both
|
$3,603.88
|
|
|
Service Code
|
HCPCS 55831
|
| Min. Negotiated Rate |
$684.35 |
| Max. Negotiated Rate |
$2,199.69 |
| Rate for Payer: Cash Price |
$983.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$977.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$879.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$879.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$928.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$977.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$928.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$977.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$977.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$733.23
|
| Rate for Payer: Healthfirst Commercial |
$977.64
|
| Rate for Payer: Healthfirst Essential Plan |
$2,199.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$928.76
|
| Rate for Payer: Healthfirst QHP |
$977.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$684.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$977.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$830.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$684.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$977.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$733.23
|
| Rate for Payer: SOMOS Essential |
$733.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$977.64
|
|
|
PR PROSTATECTOMY RETROPUBIC W/WO NERVE SPARING
|
Professional
|
Both
|
$4,879.53
|
|
|
Service Code
|
HCPCS 55840
|
| Min. Negotiated Rate |
$929.66 |
| Max. Negotiated Rate |
$2,988.20 |
| Rate for Payer: Cash Price |
$1,335.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,328.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,195.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,195.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,261.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,328.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,261.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,328.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,328.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$996.07
|
| Rate for Payer: Healthfirst Commercial |
$1,328.09
|
| Rate for Payer: Healthfirst Essential Plan |
$2,988.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,261.69
|
| Rate for Payer: Healthfirst QHP |
$1,328.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$929.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,328.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,128.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$929.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,328.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$996.07
|
| Rate for Payer: SOMOS Essential |
$996.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,328.09
|
|
|
PR PROSTATECTOMY SUPRAPUBIC SUBTOTAL 1/2 STAGES
|
Professional
|
Both
|
$3,505.11
|
|
|
Service Code
|
HCPCS 55821
|
| Min. Negotiated Rate |
$667.11 |
| Max. Negotiated Rate |
$2,144.30 |
| Rate for Payer: Cash Price |
$959.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$953.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$857.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$857.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$905.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$953.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$905.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$953.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$953.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$714.76
|
| Rate for Payer: Healthfirst Commercial |
$953.02
|
| Rate for Payer: Healthfirst Essential Plan |
$2,144.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$905.37
|
| Rate for Payer: Healthfirst QHP |
$953.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$667.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$953.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$810.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$667.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$953.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$714.76
|
| Rate for Payer: SOMOS Essential |
$714.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$953.02
|
|
|
PR PROSTATE NEEDLE BIOPSY ANY APPROACH
|
Professional
|
Both
|
$540.40
|
|
|
Service Code
|
HCPCS 55700
|
| Min. Negotiated Rate |
$101.91 |
| Max. Negotiated Rate |
$327.56 |
| Rate for Payer: Cash Price |
$147.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$145.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$131.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$131.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$138.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$145.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$138.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$145.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$145.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$109.19
|
| Rate for Payer: Healthfirst Commercial |
$145.58
|
| Rate for Payer: Healthfirst Essential Plan |
$327.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$138.30
|
| Rate for Payer: Healthfirst QHP |
$145.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$101.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$145.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$123.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$101.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$145.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$109.19
|
| Rate for Payer: SOMOS Essential |
$109.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$145.58
|
|
|
PR PROSTATOTOMY EXTERNAL DRG ABSCESS COMPLICATED
|
Professional
|
Both
|
$2,504.22
|
|
|
Service Code
|
HCPCS 55725
|
| Min. Negotiated Rate |
$478.70 |
| Max. Negotiated Rate |
$1,538.68 |
| Rate for Payer: Cash Price |
$687.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$683.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$615.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$615.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$649.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$683.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$649.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$683.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$683.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$512.89
|
| Rate for Payer: Healthfirst Commercial |
$683.86
|
| Rate for Payer: Healthfirst Essential Plan |
$1,538.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$649.67
|
| Rate for Payer: Healthfirst QHP |
$683.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$478.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$683.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$581.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$478.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$683.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$512.89
|
| Rate for Payer: SOMOS Essential |
$512.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$683.86
|
|
|
PR PROSTATOTOMY EXTERNAL DRG ABSCESS SIMPLE
|
Professional
|
Both
|
$1,897.11
|
|
|
Service Code
|
HCPCS 55720
|
| Min. Negotiated Rate |
$362.07 |
| Max. Negotiated Rate |
$1,163.79 |
| Rate for Payer: Cash Price |
$521.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$517.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$465.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$465.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$491.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$517.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$491.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$517.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$517.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$387.93
|
| Rate for Payer: Healthfirst Commercial |
$517.24
|
| Rate for Payer: Healthfirst Essential Plan |
$1,163.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$491.38
|
| Rate for Payer: Healthfirst QHP |
$517.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$362.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$517.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$439.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$362.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$517.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$387.93
|
| Rate for Payer: SOMOS Essential |
$387.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$517.24
|
|
|
PR PROSTECT RETROPUBIC RAD W/WO NRV SPAR W/LYMPH BX
|
Professional
|
Both
|
$4,884.99
|
|
|
Service Code
|
HCPCS 55842
|
| Min. Negotiated Rate |
$926.53 |
| Max. Negotiated Rate |
$2,978.12 |
| Rate for Payer: Cash Price |
$1,334.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,323.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,191.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,191.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,257.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,323.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,257.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,323.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,323.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$992.71
|
| Rate for Payer: Healthfirst Commercial |
$1,323.61
|
| Rate for Payer: Healthfirst Essential Plan |
$2,978.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,257.43
|
| Rate for Payer: Healthfirst QHP |
$1,323.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$926.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,323.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,125.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$926.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,323.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$992.71
|
| Rate for Payer: SOMOS Essential |
$992.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,323.61
|
|
|
PR PROSTECT RETROPUB RAD W/WO NRV SPAR & BI PLV LYM
|
Professional
|
Both
|
$5,676.30
|
|
|
Service Code
|
HCPCS 55845
|
| Min. Negotiated Rate |
$1,078.91 |
| Max. Negotiated Rate |
$3,467.93 |
| Rate for Payer: Cash Price |
$1,551.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,541.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,387.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,387.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,464.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,541.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,464.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,541.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,541.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,155.97
|
| Rate for Payer: Healthfirst Commercial |
$1,541.30
|
| Rate for Payer: Healthfirst Essential Plan |
$3,467.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,464.23
|
| Rate for Payer: Healthfirst QHP |
$1,541.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,078.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,541.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,310.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,078.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,541.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,155.97
|
| Rate for Payer: SOMOS Essential |
$1,155.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,541.30
|
|
|
PR PROSTHESIS REMOVAL HUMERAL AND GLENOID COMPONENT
|
Professional
|
Both
|
$5,573.19
|
|
|
Service Code
|
HCPCS 23335
|
| Min. Negotiated Rate |
$1,045.72 |
| Max. Negotiated Rate |
$3,361.25 |
| Rate for Payer: Cash Price |
$1,503.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,493.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,344.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,344.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,419.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,493.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,419.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,493.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,493.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,120.42
|
| Rate for Payer: Healthfirst Commercial |
$1,493.89
|
| Rate for Payer: Healthfirst Essential Plan |
$3,361.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,419.20
|
| Rate for Payer: Healthfirst QHP |
$1,493.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,045.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,493.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,269.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,045.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,493.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,120.42
|
| Rate for Payer: SOMOS Essential |
$1,120.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,493.89
|
|
|
PR PROSTHESIS REMOVAL HUMERAL AND ULNAR COMPONENTS
|
Professional
|
Both
|
$5,525.24
|
|
|
Service Code
|
HCPCS 24160
|
| Min. Negotiated Rate |
$1,041.89 |
| Max. Negotiated Rate |
$3,348.95 |
| Rate for Payer: Cash Price |
$1,495.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,488.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,339.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,339.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,414.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,488.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,414.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,488.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,488.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,116.32
|
| Rate for Payer: Healthfirst Commercial |
$1,488.42
|
| Rate for Payer: Healthfirst Essential Plan |
$3,348.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,414.00
|
| Rate for Payer: Healthfirst QHP |
$1,488.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,041.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,488.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,265.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,041.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,488.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,116.32
|
| Rate for Payer: SOMOS Essential |
$1,116.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,488.42
|
|
|
PR PROSTHESIS REMOVAL HUMERAL/GLENOID COMPONENT
|
Professional
|
Both
|
$4,646.43
|
|
|
Service Code
|
HCPCS 23334
|
| Min. Negotiated Rate |
$880.66 |
| Max. Negotiated Rate |
$2,830.68 |
| Rate for Payer: Cash Price |
$1,257.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,258.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,132.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,132.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,195.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,258.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,195.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,258.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,258.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$943.56
|
| Rate for Payer: Healthfirst Commercial |
$1,258.08
|
| Rate for Payer: Healthfirst Essential Plan |
$2,830.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,195.18
|
| Rate for Payer: Healthfirst QHP |
$1,258.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$880.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,258.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,069.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$880.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,258.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$943.56
|
| Rate for Payer: SOMOS Essential |
$943.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,258.08
|
|
|
PR PROSTHESIS REMOVAL RADIAL HEAD
|
Professional
|
Both
|
$3,216.96
|
|
|
Service Code
|
HCPCS 24164
|
| Min. Negotiated Rate |
$607.26 |
| Max. Negotiated Rate |
$1,951.92 |
| Rate for Payer: Cash Price |
$870.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$867.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$780.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$780.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$824.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$867.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$824.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$867.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$867.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$650.64
|
| Rate for Payer: Healthfirst Commercial |
$867.52
|
| Rate for Payer: Healthfirst Essential Plan |
$1,951.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$824.14
|
| Rate for Payer: Healthfirst QHP |
$867.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$607.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$867.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$737.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$607.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$867.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$650.64
|
| Rate for Payer: SOMOS Essential |
$650.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$867.52
|
|
|
PR PROSTHETICS TRAINING INITIAL ENCTR EA 15 MINS
|
Professional
|
Both
|
$171.75
|
|
|
Service Code
|
HCPCS 97761
|
| Min. Negotiated Rate |
$32.60 |
| Max. Negotiated Rate |
$104.78 |
| Rate for Payer: Cash Price |
$47.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.93
|
| Rate for Payer: Healthfirst Commercial |
$46.57
|
| Rate for Payer: Healthfirst Essential Plan |
$104.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.24
|
| Rate for Payer: Healthfirst QHP |
$46.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.93
|
| Rate for Payer: SOMOS Essential |
$34.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.57
|
|
|
PR PROTEIN ANALYSIS W/PROBE
|
Professional
|
Both
|
$69.20
|
|
|
Service Code
|
HCPCS 88372 26
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$43.18 |
| Rate for Payer: Cash Price |
$19.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.39
|
| Rate for Payer: Healthfirst Commercial |
$19.19
|
| Rate for Payer: Healthfirst Essential Plan |
$43.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.23
|
| Rate for Payer: Healthfirst QHP |
$19.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.68
|
| Rate for Payer: SOMOS Essential |
$7.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.19
|
|
|
PR PROTEIN, WESTERN BLOT TISSUE
|
Professional
|
Both
|
$74.97
|
|
|
Service Code
|
HCPCS 88371 26
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$45.79 |
| Rate for Payer: Cash Price |
$20.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.26
|
| Rate for Payer: Healthfirst Commercial |
$20.35
|
| Rate for Payer: Healthfirst Essential Plan |
$45.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.33
|
| Rate for Payer: Healthfirst QHP |
$20.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.14
|
| Rate for Payer: SOMOS Essential |
$8.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.35
|
|
|
PR PROVIDE TEST MATERIAL,EQUIPM
|
Professional
|
Both
|
$290.22
|
|
|
Service Code
|
HCPCS G0249
|
| Min. Negotiated Rate |
$51.24 |
| Max. Negotiated Rate |
$164.70 |
| Rate for Payer: Cash Price |
$77.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$65.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$69.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.90
|
| Rate for Payer: Healthfirst Commercial |
$73.20
|
| Rate for Payer: Healthfirst Essential Plan |
$164.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.54
|
| Rate for Payer: Healthfirst QHP |
$73.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$73.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.90
|
| Rate for Payer: SOMOS Essential |
$54.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.20
|
|
|
PR PRQ ASPIR PULPOSUS/INTERVERTEBRAL DISC/PVRT TISS
|
Professional
|
Both
|
$636.23
|
|
|
Service Code
|
HCPCS 62267
|
| Min. Negotiated Rate |
$119.94 |
| Max. Negotiated Rate |
$385.54 |
| Rate for Payer: Cash Price |
$172.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$171.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$154.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$154.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$171.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$171.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$128.51
|
| Rate for Payer: Healthfirst Commercial |
$171.35
|
| Rate for Payer: Healthfirst Essential Plan |
$385.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$162.78
|
| Rate for Payer: Healthfirst QHP |
$171.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$119.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$171.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$145.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$119.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$171.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$128.51
|
| Rate for Payer: SOMOS Essential |
$128.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$171.35
|
|
|
PR PRQ BALLOON VALVULOPLASTY AORTIC VALVE
|
Professional
|
Both
|
$5,787.25
|
|
|
Service Code
|
HCPCS 92986
|
| Min. Negotiated Rate |
$699.94 |
| Max. Negotiated Rate |
$3,455.80 |
| Rate for Payer: Amida Care Medicaid |
$699.94
|
| Rate for Payer: Cash Price |
$1,551.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,535.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,382.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,382.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,459.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,535.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,459.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,535.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,535.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,151.93
|
| Rate for Payer: Healthfirst Commercial |
$1,535.91
|
| Rate for Payer: Healthfirst Essential Plan |
$3,455.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,459.11
|
| Rate for Payer: Healthfirst QHP |
$1,535.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,075.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,535.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,305.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,075.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,535.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,151.93
|
| Rate for Payer: SOMOS Essential |
$1,151.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,535.91
|
|
|
PR PRQ BALLOON VALVULOPLASTY MITRAL VALVE
|
Professional
|
Both
|
$5,990.01
|
|
|
Service Code
|
HCPCS 92987
|
| Min. Negotiated Rate |
$725.26 |
| Max. Negotiated Rate |
$3,561.57 |
| Rate for Payer: Amida Care Medicaid |
$725.26
|
| Rate for Payer: Cash Price |
$1,598.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,582.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,424.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,424.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,503.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,582.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,503.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,582.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,582.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,187.19
|
| Rate for Payer: Healthfirst Commercial |
$1,582.92
|
| Rate for Payer: Healthfirst Essential Plan |
$3,561.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,503.77
|
| Rate for Payer: Healthfirst QHP |
$1,582.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,108.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,582.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,345.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,108.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,582.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,187.19
|
| Rate for Payer: SOMOS Essential |
$1,187.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,582.92
|
|
|
PR PRQ BALLOON VALVULOPLASTY PULMONARY VALVE
|
Professional
|
Both
|
$4,788.25
|
|
|
Service Code
|
HCPCS 92990
|
| Min. Negotiated Rate |
$552.91 |
| Max. Negotiated Rate |
$2,855.47 |
| Rate for Payer: Amida Care Medicaid |
$552.91
|
| Rate for Payer: Cash Price |
$1,281.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,269.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,142.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,142.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,205.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,269.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,205.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,269.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,269.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$951.83
|
| Rate for Payer: Healthfirst Commercial |
$1,269.10
|
| Rate for Payer: Healthfirst Essential Plan |
$2,855.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,205.64
|
| Rate for Payer: Healthfirst QHP |
$1,269.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$888.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,269.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,078.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$888.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,269.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$951.83
|
| Rate for Payer: SOMOS Essential |
$951.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,269.10
|
|
|
PR PRQ IMPLTJ NEUROSTIM ELTRD SACRAL NRVE W/IMAGING
|
Professional
|
Both
|
$1,283.73
|
|
|
Service Code
|
HCPCS 64561
|
| Min. Negotiated Rate |
$241.95 |
| Max. Negotiated Rate |
$777.69 |
| Rate for Payer: Cash Price |
$349.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$345.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$311.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$311.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$328.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$345.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$328.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$345.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$345.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$259.23
|
| Rate for Payer: Healthfirst Commercial |
$345.64
|
| Rate for Payer: Healthfirst Essential Plan |
$777.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$328.36
|
| Rate for Payer: Healthfirst QHP |
$345.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$241.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$345.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$293.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$241.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$345.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$259.23
|
| Rate for Payer: SOMOS Essential |
$259.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$345.64
|
|
|
PR PRQ IMPLTJ NEUROSTIMULATOR ELTRD CRANIAL NERVE
|
Professional
|
Both
|
$1,669.47
|
|
|
Service Code
|
HCPCS 64553
|
| Min. Negotiated Rate |
$396.36 |
| Max. Negotiated Rate |
$1,274.02 |
| Rate for Payer: Cash Price |
$572.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$566.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$509.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$509.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$537.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$566.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$537.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$566.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$566.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$424.67
|
| Rate for Payer: Healthfirst Commercial |
$566.23
|
| Rate for Payer: Healthfirst Essential Plan |
$1,274.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$537.92
|
| Rate for Payer: Healthfirst QHP |
$566.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$396.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$566.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$481.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$396.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$566.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$424.67
|
| Rate for Payer: SOMOS Essential |
$424.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$566.23
|
|
|
PR PRQ IMPLTJ NEUROSTIMULATOR ELTRD PERIPHERAL NRV
|
Professional
|
Both
|
$1,363.74
|
|
|
Service Code
|
HCPCS 64555
|
| Min. Negotiated Rate |
$259.08 |
| Max. Negotiated Rate |
$832.77 |
| Rate for Payer: Cash Price |
$369.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$370.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$333.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$333.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$351.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$370.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$351.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$370.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$370.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$277.59
|
| Rate for Payer: Healthfirst Commercial |
$370.12
|
| Rate for Payer: Healthfirst Essential Plan |
$832.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$351.61
|
| Rate for Payer: Healthfirst QHP |
$370.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$259.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$370.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$314.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$259.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$370.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$277.59
|
| Rate for Payer: SOMOS Essential |
$277.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$370.12
|
|
|
PR PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL
|
Professional
|
Both
|
$1,734.11
|
|
|
Service Code
|
HCPCS 63650
|
| Min. Negotiated Rate |
$330.44 |
| Max. Negotiated Rate |
$1,062.13 |
| Rate for Payer: Cash Price |
$475.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$472.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$424.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$424.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$448.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$472.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$448.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$472.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$472.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$354.05
|
| Rate for Payer: Healthfirst Commercial |
$472.06
|
| Rate for Payer: Healthfirst Essential Plan |
$1,062.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$448.46
|
| Rate for Payer: Healthfirst QHP |
$472.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$330.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$472.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$401.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$330.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$472.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$354.05
|
| Rate for Payer: SOMOS Essential |
$354.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$472.06
|
|
|
PR PRQ LYSIS EPIDURAL ADHESIONS MULT SESS 2/> DAYS
|
Professional
|
Both
|
$1,321.22
|
|
|
Service Code
|
HCPCS 62263
|
| Min. Negotiated Rate |
$258.50 |
| Max. Negotiated Rate |
$830.88 |
| Rate for Payer: Cash Price |
$371.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$369.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$332.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$332.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$350.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$369.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$350.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$369.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$369.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$276.96
|
| Rate for Payer: Healthfirst Commercial |
$369.28
|
| Rate for Payer: Healthfirst Essential Plan |
$830.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$350.82
|
| Rate for Payer: Healthfirst QHP |
$369.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$258.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$369.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$313.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$258.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$369.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$276.96
|
| Rate for Payer: SOMOS Essential |
$276.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$369.28
|
|
