|
PR REPET TMS TX INITIAL W/MAP/MOTR THRESHLD/DEL&M
|
Professional
|
Both
|
$1,333.40
|
|
|
Service Code
|
HCPCS 90867
|
| Min. Negotiated Rate |
$304.78 |
| Max. Negotiated Rate |
$304.78 |
| Rate for Payer: Amida Care Medicaid |
$304.78
|
|
|
PR REPET TMS TX SUBSEQ MOTR THRESHLD W/DELIV & MN
|
Professional
|
Both
|
$1,117.62
|
|
|
Service Code
|
HCPCS 90869
|
| Min. Negotiated Rate |
$255.36 |
| Max. Negotiated Rate |
$255.36 |
| Rate for Payer: Amida Care Medicaid |
$255.36
|
|
|
PR REPLACE AORTA VALVE W/BYP CNTRL ART/VENOUS APRCH
|
Professional
|
Both
|
$4,299.75
|
|
|
Service Code
|
HCPCS 33369
|
| Min. Negotiated Rate |
$787.69 |
| Max. Negotiated Rate |
$2,531.86 |
| Rate for Payer: Cash Price |
$1,136.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,125.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,012.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,012.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,069.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,125.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,069.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,125.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,125.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$843.95
|
| Rate for Payer: Healthfirst Commercial |
$1,125.27
|
| Rate for Payer: Healthfirst Essential Plan |
$2,531.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,069.01
|
| Rate for Payer: Healthfirst QHP |
$1,125.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$787.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,125.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$956.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$787.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,125.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$843.95
|
| Rate for Payer: SOMOS Essential |
$843.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,125.27
|
|
|
PR REPLACE AORTIC VALVE OPEN AXILLRY ARTRY APPROACH
|
Professional
|
Both
|
$6,014.75
|
|
|
Service Code
|
HCPCS 33363
|
| Min. Negotiated Rate |
$1,107.83 |
| Max. Negotiated Rate |
$3,560.87 |
| Rate for Payer: Cash Price |
$1,600.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,582.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,424.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,424.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,503.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,582.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,503.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,582.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,582.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,186.96
|
| Rate for Payer: Healthfirst Commercial |
$1,582.61
|
| Rate for Payer: Healthfirst Essential Plan |
$3,560.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,503.48
|
| Rate for Payer: Healthfirst QHP |
$1,582.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,107.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,582.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,345.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,107.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,582.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,186.96
|
| Rate for Payer: SOMOS Essential |
$1,186.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,582.61
|
|
|
PR REPLACE AORTIC VALVE OPENFEMORAL ARTERY APPROACH
|
Professional
|
Both
|
$5,810.46
|
|
|
Service Code
|
HCPCS 33362
|
| Min. Negotiated Rate |
$1,069.95 |
| Max. Negotiated Rate |
$3,439.12 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,528.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,375.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,375.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,452.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,528.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,452.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,528.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,528.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,146.38
|
| Rate for Payer: Healthfirst Commercial |
$1,528.50
|
| Rate for Payer: Healthfirst Essential Plan |
$3,439.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,452.08
|
| Rate for Payer: Healthfirst QHP |
$1,528.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,069.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,528.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,299.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,069.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,528.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,146.38
|
| Rate for Payer: SOMOS Essential |
$1,146.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,528.50
|
|
|
PR REPLACE AORTIC VALVE OPEN ILIAC ARTERY APPROACH
|
Professional
|
Both
|
$6,011.99
|
|
|
Service Code
|
HCPCS 33364
|
| Min. Negotiated Rate |
$1,103.90 |
| Max. Negotiated Rate |
$3,548.25 |
| Rate for Payer: Cash Price |
$1,592.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,577.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,419.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,419.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,498.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,577.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,498.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,577.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,577.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,182.75
|
| Rate for Payer: Healthfirst Commercial |
$1,577.00
|
| Rate for Payer: Healthfirst Essential Plan |
$3,548.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,498.15
|
| Rate for Payer: Healthfirst QHP |
$1,577.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,103.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,577.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,340.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,103.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,577.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,182.75
|
| Rate for Payer: SOMOS Essential |
$1,182.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,577.00
|
|
|
PR REPLACE AORTIC VALVE OPEN TRANSAORTIC APPROACH
|
Professional
|
Both
|
$6,274.28
|
|
|
Service Code
|
HCPCS 33365
|
| Min. Negotiated Rate |
$1,153.48 |
| Max. Negotiated Rate |
$3,707.62 |
| Rate for Payer: Cash Price |
$1,665.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,647.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,483.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,483.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,565.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,647.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,565.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,647.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,647.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,235.87
|
| Rate for Payer: Healthfirst Commercial |
$1,647.83
|
| Rate for Payer: Healthfirst Essential Plan |
$3,707.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,565.44
|
| Rate for Payer: Healthfirst QHP |
$1,647.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,153.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,647.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,400.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,153.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,647.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,235.87
|
| Rate for Payer: SOMOS Essential |
$1,235.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,647.83
|
|
|
PR REPLACE AORTIC VALVE PERQ FEMORAL ARTRY APPROACH
|
Professional
|
Both
|
$5,322.38
|
|
|
Service Code
|
HCPCS 33361
|
| Min. Negotiated Rate |
$979.71 |
| Max. Negotiated Rate |
$3,149.08 |
| Rate for Payer: Cash Price |
$1,414.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,399.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,259.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,259.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,329.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,399.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,329.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,399.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,399.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,049.69
|
| Rate for Payer: Healthfirst Commercial |
$1,399.59
|
| Rate for Payer: Healthfirst Essential Plan |
$3,149.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,329.61
|
| Rate for Payer: Healthfirst QHP |
$1,399.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$979.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,399.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,189.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$979.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,399.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,049.69
|
| Rate for Payer: SOMOS Essential |
$1,049.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,399.59
|
|
|
PR REPLACE AORTIC VALVE W/BYP OPEN ART/VENOUS APRCH
|
Professional
|
Both
|
$3,256.65
|
|
|
Service Code
|
HCPCS 33368
|
| Min. Negotiated Rate |
$596.69 |
| Max. Negotiated Rate |
$1,917.92 |
| Rate for Payer: Cash Price |
$861.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$852.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$767.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$767.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$809.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$852.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$809.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$852.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$852.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$639.31
|
| Rate for Payer: Healthfirst Commercial |
$852.41
|
| Rate for Payer: Healthfirst Essential Plan |
$1,917.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$809.79
|
| Rate for Payer: Healthfirst QHP |
$852.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$596.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$852.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$724.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$596.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$852.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$639.31
|
| Rate for Payer: SOMOS Essential |
$639.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$852.41
|
|
|
PR REPLACE AORTIC VALVE W/BYP PRQ ART/VENOUS APPRCH
|
Professional
|
Both
|
$2,689.86
|
|
|
Service Code
|
HCPCS 33367
|
| Min. Negotiated Rate |
$493.19 |
| Max. Negotiated Rate |
$1,585.24 |
| Rate for Payer: Cash Price |
$710.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$704.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$634.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$634.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$669.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$704.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$669.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$704.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$704.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$528.41
|
| Rate for Payer: Healthfirst Commercial |
$704.55
|
| Rate for Payer: Healthfirst Essential Plan |
$1,585.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$669.32
|
| Rate for Payer: Healthfirst QHP |
$704.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$493.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$704.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$598.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$493.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$704.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$528.41
|
| Rate for Payer: SOMOS Essential |
$528.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$704.55
|
|
|
PR REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ
|
Professional
|
Both
|
$362.95
|
|
|
Service Code
|
HCPCS 49451
|
| Min. Negotiated Rate |
$68.24 |
| Max. Negotiated Rate |
$219.35 |
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$97.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$87.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$92.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$97.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$92.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.12
|
| Rate for Payer: Healthfirst Commercial |
$97.49
|
| Rate for Payer: Healthfirst Essential Plan |
$219.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$92.62
|
| Rate for Payer: Healthfirst QHP |
$97.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$97.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$82.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$97.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$73.12
|
| Rate for Payer: SOMOS Essential |
$73.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$97.49
|
|
|
PR REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS
|
Professional
|
Both
|
$277.24
|
|
|
Service Code
|
HCPCS 49450
|
| Min. Negotiated Rate |
$51.13 |
| Max. Negotiated Rate |
$164.34 |
| Rate for Payer: Cash Price |
$72.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$65.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$69.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.78
|
| Rate for Payer: Healthfirst Commercial |
$73.04
|
| Rate for Payer: Healthfirst Essential Plan |
$164.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.39
|
| Rate for Payer: Healthfirst QHP |
$73.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$73.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.78
|
| Rate for Payer: SOMOS Essential |
$54.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.04
|
|
|
PR REPLACEMENT AORTIC&PULMON VALVES ROSS PROCEDUR
|
Professional
|
Both
|
$14,175.67
|
|
|
Service Code
|
HCPCS 33413
|
| Min. Negotiated Rate |
$2,608.15 |
| Max. Negotiated Rate |
$8,383.34 |
| Rate for Payer: Cash Price |
$3,761.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,725.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,353.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,353.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,539.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,725.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,539.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,725.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,725.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,794.45
|
| Rate for Payer: Healthfirst Commercial |
$3,725.93
|
| Rate for Payer: Healthfirst Essential Plan |
$8,383.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,539.63
|
| Rate for Payer: Healthfirst QHP |
$3,725.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,608.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,725.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,167.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,608.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,725.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,794.45
|
| Rate for Payer: SOMOS Essential |
$2,794.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,725.93
|
|
|
PR REPLACEMENT AORTIC VALVE KONNO PROCEDURE
|
Professional
|
Both
|
$13,843.52
|
|
|
Service Code
|
HCPCS 33412
|
| Min. Negotiated Rate |
$2,544.88 |
| Max. Negotiated Rate |
$8,179.97 |
| Rate for Payer: Cash Price |
$3,670.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,635.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,271.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,271.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,453.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,635.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,453.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,635.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,635.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,726.66
|
| Rate for Payer: Healthfirst Commercial |
$3,635.54
|
| Rate for Payer: Healthfirst Essential Plan |
$8,179.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,453.76
|
| Rate for Payer: Healthfirst QHP |
$3,635.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,544.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,635.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,090.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,544.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,635.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,726.66
|
| Rate for Payer: SOMOS Essential |
$2,726.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,635.54
|
|
|
PR REPLACEMENT GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS
|
Professional
|
Both
|
$559.76
|
|
|
Service Code
|
HCPCS 49452
|
| Min. Negotiated Rate |
$104.61 |
| Max. Negotiated Rate |
$336.24 |
| Rate for Payer: Cash Price |
$150.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$149.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$134.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$134.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$141.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$149.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$141.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$149.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$149.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.08
|
| Rate for Payer: Healthfirst Commercial |
$149.44
|
| Rate for Payer: Healthfirst Essential Plan |
$336.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$141.97
|
| Rate for Payer: Healthfirst QHP |
$149.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$104.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$149.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$127.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$104.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$149.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$112.08
|
| Rate for Payer: SOMOS Essential |
$112.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$149.44
|
|
|
PR REPLACEMENT MITRAL VALVE W/CARDIOPULMONARY BYP
|
Professional
|
Both
|
$12,393.01
|
|
|
Service Code
|
HCPCS 33430
|
| Min. Negotiated Rate |
$2,284.11 |
| Max. Negotiated Rate |
$7,341.77 |
| Rate for Payer: Cash Price |
$3,295.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,263.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,936.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,936.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,099.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,263.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,099.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,263.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,263.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,447.26
|
| Rate for Payer: Healthfirst Commercial |
$3,263.01
|
| Rate for Payer: Healthfirst Essential Plan |
$7,341.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,099.86
|
| Rate for Payer: Healthfirst QHP |
$3,263.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,284.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,263.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,773.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,284.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,263.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,447.26
|
| Rate for Payer: SOMOS Essential |
$2,447.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,263.01
|
|
|
PR REPLACEMENT OF CONTACT LENS
|
Professional
|
Both
|
$168.04
|
|
|
Service Code
|
HCPCS 92326
|
| Min. Negotiated Rate |
$31.41 |
| Max. Negotiated Rate |
$100.96 |
| Rate for Payer: Amida Care Medicaid |
$65.65
|
| Rate for Payer: Cash Price |
$46.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$44.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.65
|
| Rate for Payer: Healthfirst Commercial |
$44.87
|
| Rate for Payer: Healthfirst Essential Plan |
$100.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.63
|
| Rate for Payer: Healthfirst QHP |
$44.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.65
|
| Rate for Payer: SOMOS Essential |
$33.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.87
|
|
|
PR REPLACEMENT PULMONARY VALVE
|
Professional
|
Both
|
$10,237.54
|
|
|
Service Code
|
HCPCS 33475
|
| Min. Negotiated Rate |
$1,881.11 |
| Max. Negotiated Rate |
$6,046.43 |
| Rate for Payer: Cash Price |
$2,722.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,687.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,418.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,418.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,552.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,687.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,552.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,687.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,687.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,015.47
|
| Rate for Payer: Healthfirst Commercial |
$2,687.30
|
| Rate for Payer: Healthfirst Essential Plan |
$6,046.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,552.93
|
| Rate for Payer: Healthfirst QHP |
$2,687.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,881.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,687.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,284.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,881.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,687.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,015.47
|
| Rate for Payer: SOMOS Essential |
$2,015.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,687.30
|
|
|
PR REPLACEMENT TISSUE EXPANDER W/PERMANENT IMPLANT
|
Professional
|
Both
|
$2,454.76
|
|
|
Service Code
|
HCPCS 11970
|
| Min. Negotiated Rate |
$464.49 |
| Max. Negotiated Rate |
$1,493.01 |
| Rate for Payer: Cash Price |
$665.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$663.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$597.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$597.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$630.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$663.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$630.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$663.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$663.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$497.67
|
| Rate for Payer: Healthfirst Commercial |
$663.56
|
| Rate for Payer: Healthfirst Essential Plan |
$1,493.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$630.38
|
| Rate for Payer: Healthfirst QHP |
$663.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$464.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$663.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$564.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$464.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$663.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$497.67
|
| Rate for Payer: SOMOS Essential |
$497.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$663.56
|
|
|
PR REPLACEMENT TRICUSPID VALVE W/CARD BYPASS
|
Professional
|
Both
|
$12,172.76
|
|
|
Service Code
|
HCPCS 33465
|
| Min. Negotiated Rate |
$2,240.01 |
| Max. Negotiated Rate |
$7,200.05 |
| Rate for Payer: Cash Price |
$3,235.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,200.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,880.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,880.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,040.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,200.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,040.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,200.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,200.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,400.01
|
| Rate for Payer: Healthfirst Commercial |
$3,200.02
|
| Rate for Payer: Healthfirst Essential Plan |
$7,200.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,040.02
|
| Rate for Payer: Healthfirst QHP |
$3,200.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,240.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,200.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,720.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,240.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,200.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,400.01
|
| Rate for Payer: SOMOS Essential |
$2,400.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,200.02
|
|
|
PR REPLANTATION ARM COMPLETE AMPUTATION
|
Professional
|
Both
|
$12,073.08
|
|
|
Service Code
|
HCPCS 20802
|
| Min. Negotiated Rate |
$2,258.57 |
| Max. Negotiated Rate |
$7,259.69 |
| Rate for Payer: Cash Price |
$3,246.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,226.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,903.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,903.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,065.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,226.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,065.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,226.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,226.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,419.90
|
| Rate for Payer: Healthfirst Commercial |
$3,226.53
|
| Rate for Payer: Healthfirst Essential Plan |
$7,259.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,065.20
|
| Rate for Payer: Healthfirst QHP |
$3,226.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,258.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,226.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,742.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,258.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,226.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,419.90
|
| Rate for Payer: SOMOS Essential |
$2,419.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,226.53
|
|
|
PR REPLANTATION FOOT COMPLETE AMPUTATION
|
Professional
|
Both
|
$12,254.45
|
|
|
Service Code
|
HCPCS 20838
|
| Min. Negotiated Rate |
$2,292.21 |
| Max. Negotiated Rate |
$7,367.83 |
| Rate for Payer: Cash Price |
$3,294.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,274.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,947.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,947.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,110.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,274.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,110.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,274.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,274.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,455.94
|
| Rate for Payer: Healthfirst Commercial |
$3,274.59
|
| Rate for Payer: Healthfirst Essential Plan |
$7,367.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,110.86
|
| Rate for Payer: Healthfirst QHP |
$3,274.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,292.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,274.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,783.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,292.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,274.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,455.94
|
| Rate for Payer: SOMOS Essential |
$2,455.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,274.59
|
|
|
PR REPLANTATION FOREARM COMPLETE AMPUTATION
|
Professional
|
Both
|
$14,349.86
|
|
|
Service Code
|
HCPCS 20805
|
| Min. Negotiated Rate |
$2,681.62 |
| Max. Negotiated Rate |
$8,619.48 |
| Rate for Payer: Cash Price |
$3,854.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,830.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,447.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,447.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,639.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,830.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,639.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,830.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,830.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,873.16
|
| Rate for Payer: Healthfirst Commercial |
$3,830.88
|
| Rate for Payer: Healthfirst Essential Plan |
$8,619.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,639.34
|
| Rate for Payer: Healthfirst QHP |
$3,830.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,681.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,830.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,256.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,681.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,830.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,873.16
|
| Rate for Payer: SOMOS Essential |
$2,873.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,830.88
|
|
|
PR REPLANTATION HAND COMPLETE AMPUTATION
|
Professional
|
Both
|
$17,308.10
|
|
|
Service Code
|
HCPCS 20808
|
| Min. Negotiated Rate |
$3,232.85 |
| Max. Negotiated Rate |
$10,391.31 |
| Rate for Payer: Cash Price |
$4,648.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,618.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,156.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,156.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,387.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,618.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,387.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,618.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,618.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,463.77
|
| Rate for Payer: Healthfirst Commercial |
$4,618.36
|
| Rate for Payer: Healthfirst Essential Plan |
$10,391.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,387.44
|
| Rate for Payer: Healthfirst QHP |
$4,618.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,232.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,618.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,925.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3,232.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,618.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,463.77
|
| Rate for Payer: SOMOS Essential |
$3,463.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,618.36
|
|
|
PR REPLANTATION PENIS COMP AMPUTATION W/URETH REP
|
Professional
|
Both
|
$5,571.37
|
|
|
Service Code
|
HCPCS 54438
|
| Rate for Payer: Cash Price |
$1,522.74
|
|
