|
PR REPOSITIONING IO LENS PROSTHESIS REQ INC SPX
|
Professional
|
Both
|
$3,474.94
|
|
|
Service Code
|
HCPCS 66825
|
| Min. Negotiated Rate |
$650.66 |
| Max. Negotiated Rate |
$2,091.42 |
| Rate for Payer: Cash Price |
$951.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$929.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$836.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$836.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$883.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$929.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$883.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$929.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$929.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$697.14
|
| Rate for Payer: Healthfirst Commercial |
$929.52
|
| Rate for Payer: Healthfirst Essential Plan |
$2,091.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$883.04
|
| Rate for Payer: Healthfirst QHP |
$929.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$650.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$929.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$790.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$650.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$929.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$697.14
|
| Rate for Payer: SOMOS Essential |
$697.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$929.52
|
|
|
PR REPOSITIONING PERQ R/L VAD W/IMG GDN SEP INSJ
|
Professional
|
Both
|
$724.26
|
|
|
Service Code
|
HCPCS 33993
|
| Min. Negotiated Rate |
$132.72 |
| Max. Negotiated Rate |
$426.60 |
| Rate for Payer: Cash Price |
$192.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$189.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$170.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$170.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$180.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$189.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$180.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$189.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$189.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$142.20
|
| Rate for Payer: Healthfirst Commercial |
$189.60
|
| Rate for Payer: Healthfirst Essential Plan |
$426.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$180.12
|
| Rate for Payer: Healthfirst QHP |
$189.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$132.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$189.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$161.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$132.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$189.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$142.20
|
| Rate for Payer: SOMOS Essential |
$142.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$189.60
|
|
|
PR REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO
|
Professional
|
Both
|
$452.45
|
|
|
Service Code
|
HCPCS 43761
|
| Min. Negotiated Rate |
$83.01 |
| Max. Negotiated Rate |
$266.83 |
| Rate for Payer: Cash Price |
$120.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$118.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$112.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$118.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$112.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$118.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.94
|
| Rate for Payer: Healthfirst Commercial |
$118.59
|
| Rate for Payer: Healthfirst Essential Plan |
$266.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$112.66
|
| Rate for Payer: Healthfirst QHP |
$118.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$83.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$118.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$100.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$83.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$118.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.94
|
| Rate for Payer: SOMOS Essential |
$88.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$118.59
|
|
|
PR REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB
|
Professional
|
Both
|
$1,766.77
|
|
|
Service Code
|
HCPCS 33273
|
| Min. Negotiated Rate |
$327.13 |
| Max. Negotiated Rate |
$1,051.49 |
| Rate for Payer: Cash Price |
$473.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$467.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$420.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$420.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$443.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$467.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$443.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$467.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$467.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$350.50
|
| Rate for Payer: Healthfirst Commercial |
$467.33
|
| Rate for Payer: Healthfirst Essential Plan |
$1,051.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$443.96
|
| Rate for Payer: Healthfirst QHP |
$467.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$327.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$467.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$397.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$327.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$467.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$350.50
|
| Rate for Payer: SOMOS Essential |
$350.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$467.33
|
|
|
PR REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT
|
Professional
|
Both
|
$218.30
|
|
|
Service Code
|
HCPCS 62252 26
|
| Min. Negotiated Rate |
$40.01 |
| Max. Negotiated Rate |
$128.61 |
| Rate for Payer: Cash Price |
$56.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$57.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$51.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$54.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$57.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$54.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.87
|
| Rate for Payer: Healthfirst Commercial |
$57.16
|
| Rate for Payer: Healthfirst Essential Plan |
$128.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$54.30
|
| Rate for Payer: Healthfirst QHP |
$57.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$57.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.87
|
| Rate for Payer: SOMOS Essential |
$42.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57.16
|
|
|
PR REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT
|
Professional
|
Both
|
$166.60
|
|
|
Service Code
|
HCPCS 62252 TC
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$110.56 |
| Rate for Payer: Cash Price |
$48.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.85
|
| Rate for Payer: Healthfirst Commercial |
$49.14
|
| Rate for Payer: Healthfirst Essential Plan |
$110.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.68
|
| Rate for Payer: Healthfirst QHP |
$49.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.85
|
| Rate for Payer: SOMOS Essential |
$36.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.14
|
|
|
PR REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT
|
Professional
|
Both
|
$384.93
|
|
|
Service Code
|
HCPCS 62252
|
| Min. Negotiated Rate |
$74.41 |
| Max. Negotiated Rate |
$239.18 |
| Rate for Payer: Cash Price |
$105.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$106.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$95.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$95.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$100.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$106.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$100.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.72
|
| Rate for Payer: Healthfirst Commercial |
$106.30
|
| Rate for Payer: Healthfirst Essential Plan |
$239.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$100.98
|
| Rate for Payer: Healthfirst QHP |
$106.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$106.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$90.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$74.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$106.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$79.72
|
| Rate for Payer: SOMOS Essential |
$79.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$106.30
|
|
|
PR REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I
|
Professional
|
Both
|
$1,532.37
|
|
|
Service Code
|
HCPCS 37192
|
| Min. Negotiated Rate |
$280.62 |
| Max. Negotiated Rate |
$902.00 |
| Rate for Payer: Cash Price |
$404.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$400.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$360.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$360.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$380.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$400.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$380.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$400.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$400.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$300.67
|
| Rate for Payer: Healthfirst Commercial |
$400.89
|
| Rate for Payer: Healthfirst Essential Plan |
$902.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$380.85
|
| Rate for Payer: Healthfirst QHP |
$400.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$280.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$400.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$340.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$280.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$400.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$300.67
|
| Rate for Payer: SOMOS Essential |
$300.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$400.89
|
|
|
PR RESCJ APICAL LUNG TUMOR W/CHEST WALL RCNSTJ
|
Professional
|
Both
|
$9,099.09
|
|
|
Service Code
|
HCPCS 32504
|
| Min. Negotiated Rate |
$1,675.65 |
| Max. Negotiated Rate |
$5,386.01 |
| Rate for Payer: Cash Price |
$2,420.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,393.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,154.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,154.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,274.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,393.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,274.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,393.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,393.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,795.34
|
| Rate for Payer: Healthfirst Commercial |
$2,393.78
|
| Rate for Payer: Healthfirst Essential Plan |
$5,386.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,274.09
|
| Rate for Payer: Healthfirst QHP |
$2,393.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,675.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,393.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,034.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,675.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,393.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,795.34
|
| Rate for Payer: SOMOS Essential |
$1,795.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,393.78
|
|
|
PR RESCJ APICAL LUNG TUMOR W/O CHEST WALL RCNSTJ
|
Professional
|
Both
|
$7,990.61
|
|
|
Service Code
|
HCPCS 32503
|
| Min. Negotiated Rate |
$1,472.59 |
| Max. Negotiated Rate |
$4,733.32 |
| Rate for Payer: Cash Price |
$2,124.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,103.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,893.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,893.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,998.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,103.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,998.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,103.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,103.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,577.78
|
| Rate for Payer: Healthfirst Commercial |
$2,103.70
|
| Rate for Payer: Healthfirst Essential Plan |
$4,733.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,998.52
|
| Rate for Payer: Healthfirst QHP |
$2,103.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,472.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,103.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,788.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,472.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,103.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,577.78
|
| Rate for Payer: SOMOS Essential |
$1,577.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,103.70
|
|
|
PR RESCJ&BRONCHOPLASTY PFRMD TM LOBEC/SGMECTOMY
|
Professional
|
Both
|
$1,082.24
|
|
|
Service Code
|
HCPCS 32501
|
| Min. Negotiated Rate |
$198.21 |
| Max. Negotiated Rate |
$637.11 |
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$254.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$254.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$269.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$269.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$283.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$212.37
|
| Rate for Payer: Healthfirst Commercial |
$283.16
|
| Rate for Payer: Healthfirst Essential Plan |
$637.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$269.00
|
| Rate for Payer: Healthfirst QHP |
$283.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$198.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$283.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$240.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$198.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$212.37
|
| Rate for Payer: SOMOS Essential |
$212.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.16
|
|
|
PR RESCJ DIAPHRAGM W/COMPLEX REPAIR
|
Professional
|
Both
|
$5,594.37
|
|
|
Service Code
|
HCPCS 39561
|
| Min. Negotiated Rate |
$1,044.05 |
| Max. Negotiated Rate |
$3,355.88 |
| Rate for Payer: Cash Price |
$1,499.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,491.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,342.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,342.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,416.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,491.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,416.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,491.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,491.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,118.62
|
| Rate for Payer: Healthfirst Commercial |
$1,491.50
|
| Rate for Payer: Healthfirst Essential Plan |
$3,355.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,416.92
|
| Rate for Payer: Healthfirst QHP |
$1,491.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,044.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,491.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,267.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,044.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,491.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,118.62
|
| Rate for Payer: SOMOS Essential |
$1,118.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,491.50
|
|
|
PR RESCJ DIAPHRAGM W/SIMPLE REPAIR
|
Professional
|
Both
|
$3,562.41
|
|
|
Service Code
|
HCPCS 39560
|
| Min. Negotiated Rate |
$664.58 |
| Max. Negotiated Rate |
$2,136.15 |
| Rate for Payer: Cash Price |
$955.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$949.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$854.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$854.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$901.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$949.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$901.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$949.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$949.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$712.05
|
| Rate for Payer: Healthfirst Commercial |
$949.40
|
| Rate for Payer: Healthfirst Essential Plan |
$2,136.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$901.93
|
| Rate for Payer: Healthfirst QHP |
$949.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$664.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$949.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$806.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$664.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$949.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$712.05
|
| Rate for Payer: SOMOS Essential |
$712.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$949.40
|
|
|
PR RESCJ/EXC LES BASE ANT CRANIAL FOSSA EXTRADURAL
|
Professional
|
Both
|
$9,488.85
|
|
|
Service Code
|
HCPCS 61600
|
| Min. Negotiated Rate |
$1,740.07 |
| Max. Negotiated Rate |
$5,593.10 |
| Rate for Payer: Cash Price |
$2,530.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,485.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,237.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,237.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,361.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,485.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,361.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,485.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,485.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,864.37
|
| Rate for Payer: Healthfirst Commercial |
$2,485.82
|
| Rate for Payer: Healthfirst Essential Plan |
$5,593.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,361.53
|
| Rate for Payer: Healthfirst QHP |
$2,485.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,740.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,485.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,112.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,740.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,485.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,864.37
|
| Rate for Payer: SOMOS Essential |
$1,864.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,485.82
|
|
|
PR RESCJ/EXC LES BASE ANT CRNL FOSSA INDRL W/WO GRF
|
Professional
|
Both
|
$11,519.20
|
|
|
Service Code
|
HCPCS 61601
|
| Min. Negotiated Rate |
$2,085.49 |
| Max. Negotiated Rate |
$6,703.36 |
| Rate for Payer: Cash Price |
$3,044.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,979.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,681.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,681.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,830.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,979.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,830.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,979.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,979.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,234.45
|
| Rate for Payer: Healthfirst Commercial |
$2,979.27
|
| Rate for Payer: Healthfirst Essential Plan |
$6,703.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,830.31
|
| Rate for Payer: Healthfirst QHP |
$2,979.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,085.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,979.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,532.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,085.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,979.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,234.45
|
| Rate for Payer: SOMOS Essential |
$2,234.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,979.27
|
|
|
PR RESCJ/EXC LES BASE PCF FORAMEN VRT BODIES IDRL
|
Professional
|
Both
|
$15,759.63
|
|
|
Service Code
|
HCPCS 61616
|
| Min. Negotiated Rate |
$2,859.81 |
| Max. Negotiated Rate |
$9,192.24 |
| Rate for Payer: Cash Price |
$4,168.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,085.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,676.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,676.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,881.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,085.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,881.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,085.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,085.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,064.08
|
| Rate for Payer: Healthfirst Commercial |
$4,085.44
|
| Rate for Payer: Healthfirst Essential Plan |
$9,192.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,881.17
|
| Rate for Payer: Healthfirst QHP |
$4,085.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,859.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,085.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,472.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,859.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,085.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,064.08
|
| Rate for Payer: SOMOS Essential |
$3,064.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,085.44
|
|
|
PR RESCJ/EXC LES BASE POST CRNL FOSSA JUG FRMN XDRL
|
Professional
|
Both
|
$13,461.74
|
|
|
Service Code
|
HCPCS 61615
|
| Min. Negotiated Rate |
$2,445.71 |
| Max. Negotiated Rate |
$7,861.21 |
| Rate for Payer: Cash Price |
$3,544.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,493.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,144.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,144.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,319.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,493.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,319.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,493.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,493.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,620.40
|
| Rate for Payer: Healthfirst Commercial |
$3,493.87
|
| Rate for Payer: Healthfirst Essential Plan |
$7,861.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,319.18
|
| Rate for Payer: Healthfirst QHP |
$3,493.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,445.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,493.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,969.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,445.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,493.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,620.40
|
| Rate for Payer: SOMOS Essential |
$2,620.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,493.87
|
|
|
PR RESCJ/EXC LES INFRATEMPOR FOSSA SPACE APEX XDRL
|
Professional
|
Both
|
$9,465.23
|
|
|
Service Code
|
HCPCS 61605
|
| Min. Negotiated Rate |
$1,760.76 |
| Max. Negotiated Rate |
$5,659.58 |
| Rate for Payer: Cash Price |
$2,534.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,515.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,263.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,263.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,389.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,515.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,389.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,515.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,515.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,886.53
|
| Rate for Payer: Healthfirst Commercial |
$2,515.37
|
| Rate for Payer: Healthfirst Essential Plan |
$5,659.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,389.60
|
| Rate for Payer: Healthfirst QHP |
$2,515.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,760.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,515.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,138.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,760.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,515.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,886.53
|
| Rate for Payer: SOMOS Essential |
$1,886.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,515.37
|
|
|
PR RESCJ/EXC LES ITPRL FOSSA SPACE APEX IDRL W/RPR
|
Professional
|
Both
|
$13,691.58
|
|
|
Service Code
|
HCPCS 61606
|
| Min. Negotiated Rate |
$2,488.11 |
| Max. Negotiated Rate |
$7,997.51 |
| Rate for Payer: Cash Price |
$3,594.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,554.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,199.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,199.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,376.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,554.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,376.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,554.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,554.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,665.84
|
| Rate for Payer: Healthfirst Commercial |
$3,554.45
|
| Rate for Payer: Healthfirst Essential Plan |
$7,997.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,376.73
|
| Rate for Payer: Healthfirst QHP |
$3,554.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,488.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,554.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,021.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,488.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,554.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,665.84
|
| Rate for Payer: SOMOS Essential |
$2,665.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,554.45
|
|
|
PR RESCJ/EXC LES PARASELLAR SINUS CLIVUS/MSB IDRL
|
Professional
|
Both
|
$15,705.66
|
|
|
Service Code
|
HCPCS 61608
|
| Min. Negotiated Rate |
$2,850.53 |
| Max. Negotiated Rate |
$9,162.43 |
| Rate for Payer: Cash Price |
$4,134.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,072.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,664.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,664.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,868.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,072.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,868.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,072.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,072.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,054.14
|
| Rate for Payer: Healthfirst Commercial |
$4,072.19
|
| Rate for Payer: Healthfirst Essential Plan |
$9,162.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,868.58
|
| Rate for Payer: Healthfirst QHP |
$4,072.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,850.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,072.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,461.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,850.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,072.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,054.14
|
| Rate for Payer: SOMOS Essential |
$3,054.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,072.19
|
|
|
PR RESCJ/EXC LES PARASELLAR SINUS CLIVUS/MSB XDRL
|
Professional
|
Both
|
$12,012.88
|
|
|
Service Code
|
HCPCS 61607
|
| Min. Negotiated Rate |
$2,649.53 |
| Max. Negotiated Rate |
$8,516.36 |
| Rate for Payer: Cash Price |
$3,835.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,785.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,406.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,406.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,595.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,785.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,595.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,785.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,785.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,838.79
|
| Rate for Payer: Healthfirst Commercial |
$3,785.05
|
| Rate for Payer: Healthfirst Essential Plan |
$8,516.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,595.80
|
| Rate for Payer: Healthfirst QHP |
$3,785.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,649.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,785.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,217.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,649.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,785.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,838.79
|
| Rate for Payer: SOMOS Essential |
$2,838.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,785.05
|
|
|
PR RESCJ LAT PHRNGL WALL/PYRIFORM SINUS DIR CLSR
|
Professional
|
Both
|
$8,025.89
|
|
|
Service Code
|
HCPCS 42892
|
| Min. Negotiated Rate |
$1,494.12 |
| Max. Negotiated Rate |
$4,802.53 |
| Rate for Payer: Cash Price |
$2,163.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,134.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,921.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,921.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,027.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,134.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,027.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,134.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,134.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,600.85
|
| Rate for Payer: Healthfirst Commercial |
$2,134.46
|
| Rate for Payer: Healthfirst Essential Plan |
$4,802.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,027.74
|
| Rate for Payer: Healthfirst QHP |
$2,134.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,494.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,134.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,814.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,494.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,134.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,600.85
|
| Rate for Payer: SOMOS Essential |
$1,600.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,134.46
|
|
|
PR RESCJ LIP > ONE-FOURTH W/O RCNSTJ
|
Professional
|
Both
|
$1,763.06
|
|
|
Service Code
|
HCPCS 40530
|
| Min. Negotiated Rate |
$332.09 |
| Max. Negotiated Rate |
$1,067.44 |
| Rate for Payer: Cash Price |
$478.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$474.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$426.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$426.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$450.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$474.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$450.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$474.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$474.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$355.81
|
| Rate for Payer: Healthfirst Commercial |
$474.42
|
| Rate for Payer: Healthfirst Essential Plan |
$1,067.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$450.70
|
| Rate for Payer: Healthfirst QHP |
$474.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$332.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$474.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$403.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$332.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$474.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$355.81
|
| Rate for Payer: SOMOS Essential |
$355.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$474.42
|
|
|
PR RESCJ OVARIAN/TUBAL/PERITONEAL MALIGNANCY W/BSO
|
Professional
|
Both
|
$5,024.95
|
|
|
Service Code
|
HCPCS 58950
|
| Min. Negotiated Rate |
$938.81 |
| Max. Negotiated Rate |
$3,017.61 |
| Rate for Payer: Cash Price |
$1,356.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,341.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,207.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,207.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,274.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,341.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,274.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,341.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,341.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,005.87
|
| Rate for Payer: Healthfirst Commercial |
$1,341.16
|
| Rate for Payer: Healthfirst Essential Plan |
$3,017.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,274.10
|
| Rate for Payer: Healthfirst QHP |
$1,341.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$938.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,341.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,139.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$938.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,341.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,005.87
|
| Rate for Payer: SOMOS Essential |
$1,005.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,341.16
|
|
|
PR RESCJ PALATE/EXTENSIVE RESCJ LESION
|
Professional
|
Both
|
$4,334.37
|
|
|
Service Code
|
HCPCS 42120
|
| Min. Negotiated Rate |
$811.12 |
| Max. Negotiated Rate |
$2,607.19 |
| Rate for Payer: Cash Price |
$1,169.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,158.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,042.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,042.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,100.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,158.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,100.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,158.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,158.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$869.06
|
| Rate for Payer: Healthfirst Commercial |
$1,158.75
|
| Rate for Payer: Healthfirst Essential Plan |
$2,607.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,100.81
|
| Rate for Payer: Healthfirst QHP |
$1,158.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$811.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,158.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$984.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$811.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,158.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$869.06
|
| Rate for Payer: SOMOS Essential |
$869.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,158.75
|
|
