|
PR RESCJ PHRNGL WALL CLSR W/FLP OR FLP W/MVASC ANAS
|
Professional
|
Both
|
$10,191.09
|
|
|
Service Code
|
HCPCS 42894
|
| Min. Negotiated Rate |
$1,895.48 |
| Max. Negotiated Rate |
$6,092.62 |
| Rate for Payer: Cash Price |
$2,742.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,707.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,437.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,437.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,572.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,707.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,572.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,707.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,707.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,030.87
|
| Rate for Payer: Healthfirst Commercial |
$2,707.83
|
| Rate for Payer: Healthfirst Essential Plan |
$6,092.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,572.44
|
| Rate for Payer: Healthfirst QHP |
$2,707.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,895.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,707.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,301.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,895.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,707.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,030.87
|
| Rate for Payer: SOMOS Essential |
$2,030.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,707.83
|
|
|
PR RESCJ PRIM PRTL MAL W/BSO & OMNTC RAD DEBULKING
|
Professional
|
Both
|
$7,166.95
|
|
|
Service Code
|
HCPCS 58952
|
| Min. Negotiated Rate |
$1,339.07 |
| Max. Negotiated Rate |
$4,304.16 |
| Rate for Payer: Cash Price |
$1,939.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,912.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,721.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,721.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,817.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,912.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,817.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,912.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,912.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,434.72
|
| Rate for Payer: Healthfirst Commercial |
$1,912.96
|
| Rate for Payer: Healthfirst Essential Plan |
$4,304.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,817.31
|
| Rate for Payer: Healthfirst QHP |
$1,912.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,339.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,912.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,626.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,339.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,912.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,434.72
|
| Rate for Payer: SOMOS Essential |
$1,434.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,912.96
|
|
|
PR RESCJ PRIM PRTL MAL W/BSO & OMNTC TAH & LMPHAD
|
Professional
|
Both
|
$6,272.98
|
|
|
Service Code
|
HCPCS 58951
|
| Min. Negotiated Rate |
$1,173.90 |
| Max. Negotiated Rate |
$3,773.25 |
| Rate for Payer: Cash Price |
$1,696.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,677.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,509.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,509.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,593.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,677.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,593.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,677.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,677.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,257.75
|
| Rate for Payer: Healthfirst Commercial |
$1,677.00
|
| Rate for Payer: Healthfirst Essential Plan |
$3,773.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,593.15
|
| Rate for Payer: Healthfirst QHP |
$1,677.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,173.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,677.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,425.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,173.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,677.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,257.75
|
| Rate for Payer: SOMOS Essential |
$1,257.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,677.00
|
|
|
PR RESCJ TEMPORAL BONE EXTERNAL APPROACH
|
Professional
|
Both
|
$11,527.57
|
|
|
Service Code
|
HCPCS 69535
|
| Min. Negotiated Rate |
$2,143.86 |
| Max. Negotiated Rate |
$6,890.98 |
| Rate for Payer: Cash Price |
$3,101.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,062.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,756.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,756.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,909.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,062.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,909.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,062.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,062.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,296.99
|
| Rate for Payer: Healthfirst Commercial |
$3,062.66
|
| Rate for Payer: Healthfirst Essential Plan |
$6,890.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,909.53
|
| Rate for Payer: Healthfirst QHP |
$3,062.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,143.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,062.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,603.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,143.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,062.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,296.99
|
| Rate for Payer: SOMOS Essential |
$2,296.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,062.66
|
|
|
PR RESECJ/DBRDMT PANCREAS NECROTIZING PANCREATITIS
|
Professional
|
Both
|
$12,566.86
|
|
|
Service Code
|
HCPCS 48105
|
| Min. Negotiated Rate |
$2,327.60 |
| Max. Negotiated Rate |
$7,481.56 |
| Rate for Payer: Cash Price |
$3,338.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,325.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,992.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,992.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,158.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,325.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,158.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,325.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,325.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,493.86
|
| Rate for Payer: Healthfirst Commercial |
$3,325.14
|
| Rate for Payer: Healthfirst Essential Plan |
$7,481.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,158.88
|
| Rate for Payer: Healthfirst QHP |
$3,325.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,327.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,325.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,826.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,327.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,325.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,493.86
|
| Rate for Payer: SOMOS Essential |
$2,493.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,325.14
|
|
|
PR RESECJ RECUR OVARIAN/TUBAL/PERITONEAL MALIGNANCY
|
Professional
|
Both
|
$6,911.38
|
|
|
Service Code
|
HCPCS 58957
|
| Rate for Payer: Cash Price |
$1,874.36
|
|
|
PR RESECTION CONDYLE DISTAL END PHALANX EACH TOE
|
Professional
|
Both
|
$1,105.02
|
|
|
Service Code
|
HCPCS 28153
|
| Min. Negotiated Rate |
$212.58 |
| Max. Negotiated Rate |
$683.30 |
| Rate for Payer: Cash Price |
$306.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$303.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$273.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$273.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$288.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$303.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$288.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$303.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$303.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$227.77
|
| Rate for Payer: Healthfirst Commercial |
$303.69
|
| Rate for Payer: Healthfirst Essential Plan |
$683.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$288.51
|
| Rate for Payer: Healthfirst QHP |
$303.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$212.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$303.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$258.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$212.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$303.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$227.77
|
| Rate for Payer: SOMOS Essential |
$227.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$303.69
|
|
|
PR RESECTION ELBOW JOINT ARTHRECTOMY
|
Professional
|
Both
|
$3,778.92
|
|
|
Service Code
|
HCPCS 24155
|
| Min. Negotiated Rate |
$709.75 |
| Max. Negotiated Rate |
$2,281.34 |
| Rate for Payer: Cash Price |
$1,019.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,013.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$912.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$912.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$963.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,013.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$963.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,013.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,013.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$760.45
|
| Rate for Payer: Healthfirst Commercial |
$1,013.93
|
| Rate for Payer: Healthfirst Essential Plan |
$2,281.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$963.23
|
| Rate for Payer: Healthfirst QHP |
$1,013.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$709.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,013.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$861.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$709.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,013.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$760.45
|
| Rate for Payer: SOMOS Essential |
$760.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,013.93
|
|
|
PR RESECTION EXTERNAL CARDIAC TUMOR
|
Professional
|
Both
|
$6,020.77
|
|
|
Service Code
|
HCPCS 33130
|
| Min. Negotiated Rate |
$1,112.85 |
| Max. Negotiated Rate |
$3,577.03 |
| Rate for Payer: Cash Price |
$1,602.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,589.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,430.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,430.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,510.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,589.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,510.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,589.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,589.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,192.34
|
| Rate for Payer: Healthfirst Commercial |
$1,589.79
|
| Rate for Payer: Healthfirst Essential Plan |
$3,577.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,510.30
|
| Rate for Payer: Healthfirst QHP |
$1,589.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,112.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,589.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,351.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,112.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,589.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,192.34
|
| Rate for Payer: SOMOS Essential |
$1,192.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,589.79
|
|
|
PR RESECTION HUMERAL HEAD
|
Professional
|
Both
|
$3,282.72
|
|
|
Service Code
|
HCPCS 23195
|
| Min. Negotiated Rate |
$625.18 |
| Max. Negotiated Rate |
$2,009.52 |
| Rate for Payer: Cash Price |
$895.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$893.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$803.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$803.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$848.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$893.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$848.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$893.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$893.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$669.84
|
| Rate for Payer: Healthfirst Commercial |
$893.12
|
| Rate for Payer: Healthfirst Essential Plan |
$2,009.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$848.46
|
| Rate for Payer: Healthfirst QHP |
$893.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$625.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$893.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$759.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$625.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$893.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$669.84
|
| Rate for Payer: SOMOS Essential |
$669.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$893.12
|
|
|
PR RESECTION/INCISION SUBVALVULAR TISSUE
|
Professional
|
Both
|
$8,965.92
|
|
|
Service Code
|
HCPCS 33415
|
| Min. Negotiated Rate |
$1,652.05 |
| Max. Negotiated Rate |
$5,310.16 |
| Rate for Payer: Cash Price |
$2,383.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,360.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,124.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,124.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,242.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,360.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,242.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,360.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,360.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,770.05
|
| Rate for Payer: Healthfirst Commercial |
$2,360.07
|
| Rate for Payer: Healthfirst Essential Plan |
$5,310.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,242.07
|
| Rate for Payer: Healthfirst QHP |
$2,360.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,652.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,360.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,006.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,652.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,360.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,770.05
|
| Rate for Payer: SOMOS Essential |
$1,770.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,360.07
|
|
|
PR RESECTION MEDIASTINAL TUMOR
|
Professional
|
Both
|
$5,020.68
|
|
|
Service Code
|
HCPCS 39220
|
| Min. Negotiated Rate |
$933.53 |
| Max. Negotiated Rate |
$3,000.64 |
| Rate for Payer: Cash Price |
$1,342.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,333.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,200.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,200.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,266.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,333.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,266.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,333.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,333.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,000.22
|
| Rate for Payer: Healthfirst Commercial |
$1,333.62
|
| Rate for Payer: Healthfirst Essential Plan |
$3,000.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,266.94
|
| Rate for Payer: Healthfirst QHP |
$1,333.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$933.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,333.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,133.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$933.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,333.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,000.22
|
| Rate for Payer: SOMOS Essential |
$1,000.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,333.62
|
|
|
PR RESECTION OF MEDIASTINAL CYST
|
Professional
|
Both
|
$3,880.84
|
|
|
Service Code
|
HCPCS 39200
|
| Min. Negotiated Rate |
$716.85 |
| Max. Negotiated Rate |
$2,304.16 |
| Rate for Payer: Cash Price |
$1,033.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,024.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$921.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$921.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$972.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,024.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$972.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,024.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,024.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$768.05
|
| Rate for Payer: Healthfirst Commercial |
$1,024.07
|
| Rate for Payer: Healthfirst Essential Plan |
$2,304.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$972.87
|
| Rate for Payer: Healthfirst QHP |
$1,024.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$716.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,024.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$870.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$716.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,024.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$768.05
|
| Rate for Payer: SOMOS Essential |
$768.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,024.07
|
|
|
PR RESECTION PARTIAL/COMPLETE PHALANGEAL BASE EACH
|
Professional
|
Both
|
$1,045.91
|
|
|
Service Code
|
HCPCS 28126
|
| Min. Negotiated Rate |
$202.47 |
| Max. Negotiated Rate |
$650.79 |
| Rate for Payer: Cash Price |
$292.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$289.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$260.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$260.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$274.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$289.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$274.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$289.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$289.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$216.93
|
| Rate for Payer: Healthfirst Commercial |
$289.24
|
| Rate for Payer: Healthfirst Essential Plan |
$650.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$274.78
|
| Rate for Payer: Healthfirst QHP |
$289.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$202.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$289.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$245.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$202.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$289.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$216.93
|
| Rate for Payer: SOMOS Essential |
$216.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$289.24
|
|
|
PR RESECTION PERICARDIAL CYST/TUMOR
|
Professional
|
Both
|
$4,476.78
|
|
|
Service Code
|
HCPCS 33050
|
| Min. Negotiated Rate |
$830.07 |
| Max. Negotiated Rate |
$2,668.07 |
| Rate for Payer: Cash Price |
$1,196.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,185.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,067.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,067.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,126.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,185.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,126.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,185.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,185.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$889.36
|
| Rate for Payer: Healthfirst Commercial |
$1,185.81
|
| Rate for Payer: Healthfirst Essential Plan |
$2,668.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,126.52
|
| Rate for Payer: Healthfirst QHP |
$1,185.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$830.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,185.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,007.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$830.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,185.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$889.36
|
| Rate for Payer: SOMOS Essential |
$889.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,185.81
|
|
|
PR RESECTION RECRT MAL W/OMENTECTOMY PEL LMPHADEC
|
Professional
|
Both
|
$7,224.07
|
|
|
Service Code
|
HCPCS 58958
|
| Min. Negotiated Rate |
$1,340.78 |
| Max. Negotiated Rate |
$4,309.65 |
| Rate for Payer: Cash Price |
$1,943.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,915.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,723.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,723.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,819.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,915.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,819.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,915.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,915.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,436.55
|
| Rate for Payer: Healthfirst Commercial |
$1,915.40
|
| Rate for Payer: Healthfirst Essential Plan |
$4,309.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,819.63
|
| Rate for Payer: Healthfirst QHP |
$1,915.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,340.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,915.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,628.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,340.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,915.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,436.55
|
| Rate for Payer: SOMOS Essential |
$1,436.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,915.40
|
|
|
PR RESECTION RIBS EXTRAPLEURAL ALL STAGES
|
Professional
|
Both
|
$6,346.34
|
|
|
Service Code
|
HCPCS 32900
|
| Min. Negotiated Rate |
$1,202.38 |
| Max. Negotiated Rate |
$3,864.78 |
| Rate for Payer: Cash Price |
$1,614.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,717.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,545.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,545.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,631.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,717.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,631.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,717.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,717.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,288.26
|
| Rate for Payer: Healthfirst Commercial |
$1,717.68
|
| Rate for Payer: Healthfirst Essential Plan |
$3,864.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,631.80
|
| Rate for Payer: Healthfirst QHP |
$1,717.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,202.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,717.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,460.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,202.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,717.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,288.26
|
| Rate for Payer: SOMOS Essential |
$1,288.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,717.68
|
|
|
PR RESECTION SCROTUM
|
Professional
|
Both
|
$2,087.65
|
|
|
Service Code
|
HCPCS 55150
|
| Min. Negotiated Rate |
$397.63 |
| Max. Negotiated Rate |
$1,278.11 |
| Rate for Payer: Cash Price |
$571.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$568.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$511.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$511.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$539.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$568.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$539.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$568.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$568.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$426.04
|
| Rate for Payer: Healthfirst Commercial |
$568.05
|
| Rate for Payer: Healthfirst Essential Plan |
$1,278.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$539.65
|
| Rate for Payer: Healthfirst QHP |
$568.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$397.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$568.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$482.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$397.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$568.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$426.04
|
| Rate for Payer: SOMOS Essential |
$426.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$568.05
|
|
|
PR RESECTION/TRANSPLANTATION LONG TENDON BICEPS
|
Professional
|
Both
|
$3,349.05
|
|
|
Service Code
|
HCPCS 23440
|
| Min. Negotiated Rate |
$630.94 |
| Max. Negotiated Rate |
$2,028.02 |
| Rate for Payer: Cash Price |
$907.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$901.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$811.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$811.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$856.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$901.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$856.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$901.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$901.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$676.00
|
| Rate for Payer: Healthfirst Commercial |
$901.34
|
| Rate for Payer: Healthfirst Essential Plan |
$2,028.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$856.27
|
| Rate for Payer: Healthfirst QHP |
$901.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$630.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$901.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$766.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$630.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$901.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$676.00
|
| Rate for Payer: SOMOS Essential |
$676.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$901.34
|
|
|
PR RESPIRATORY FLOW VOLUME LOOP
|
Professional
|
Both
|
$55.93
|
|
|
Service Code
|
HCPCS 94375 26
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$34.16 |
| Rate for Payer: Amida Care Medicaid |
$29.26
|
| Rate for Payer: Cash Price |
$15.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.38
|
| Rate for Payer: Healthfirst Commercial |
$15.18
|
| Rate for Payer: Healthfirst Essential Plan |
$34.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.42
|
| Rate for Payer: Healthfirst QHP |
$15.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.38
|
| Rate for Payer: SOMOS Essential |
$11.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.18
|
|
|
PR RESPIRATORY FLOW VOLUME LOOP
|
Professional
|
Both
|
$104.79
|
|
|
Service Code
|
HCPCS 94375 TC
|
| Min. Negotiated Rate |
$20.54 |
| Max. Negotiated Rate |
$66.02 |
| Rate for Payer: Amida Care Medicaid |
$29.26
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.00
|
| Rate for Payer: Healthfirst Commercial |
$29.34
|
| Rate for Payer: Healthfirst Essential Plan |
$66.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.87
|
| Rate for Payer: Healthfirst QHP |
$29.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.00
|
| Rate for Payer: SOMOS Essential |
$22.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.34
|
|
|
PR RESPIRATORY FLOW VOLUME LOOP
|
Professional
|
Both
|
$160.72
|
|
|
Service Code
|
HCPCS 94375
|
| Min. Negotiated Rate |
$29.26 |
| Max. Negotiated Rate |
$100.17 |
| Rate for Payer: Amida Care Medicaid |
$29.26
|
| Rate for Payer: Cash Price |
$45.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$44.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.39
|
| Rate for Payer: Healthfirst Commercial |
$44.52
|
| Rate for Payer: Healthfirst Essential Plan |
$100.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.29
|
| Rate for Payer: Healthfirst QHP |
$44.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.39
|
| Rate for Payer: SOMOS Essential |
$33.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.52
|
|
|
PR RETROBULBAR INJECTION ALCOHOL
|
Professional
|
Both
|
$297.33
|
|
|
Service Code
|
HCPCS 67505
|
| Min. Negotiated Rate |
$55.55 |
| Max. Negotiated Rate |
$178.56 |
| Rate for Payer: Cash Price |
$80.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$79.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.52
|
| Rate for Payer: Healthfirst Commercial |
$79.36
|
| Rate for Payer: Healthfirst Essential Plan |
$178.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$75.39
|
| Rate for Payer: Healthfirst QHP |
$79.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$79.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$67.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$59.52
|
| Rate for Payer: SOMOS Essential |
$59.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.36
|
|
|
PR RETROBULBAR INJECTION MEDICATION SPX
|
Professional
|
Both
|
$261.42
|
|
|
Service Code
|
HCPCS 67500
|
| Min. Negotiated Rate |
$50.44 |
| Max. Negotiated Rate |
$162.13 |
| Rate for Payer: Cash Price |
$72.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$64.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$68.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$68.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.05
|
| Rate for Payer: Healthfirst Commercial |
$72.06
|
| Rate for Payer: Healthfirst Essential Plan |
$162.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.46
|
| Rate for Payer: Healthfirst QHP |
$72.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$50.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$72.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$61.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.05
|
| Rate for Payer: SOMOS Essential |
$54.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.06
|
|
|
PR REVASCULARIZATION ILIAC ART ANGIOP EA IPSI VSL
|
Professional
|
Both
|
$809.69
|
|
|
Service Code
|
HCPCS 37222
|
| Min. Negotiated Rate |
$149.06 |
| Max. Negotiated Rate |
$479.14 |
| Rate for Payer: Cash Price |
$213.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$212.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$191.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$191.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$202.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$212.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$202.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$212.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$159.71
|
| Rate for Payer: Healthfirst Commercial |
$212.95
|
| Rate for Payer: Healthfirst Essential Plan |
$479.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$202.30
|
| Rate for Payer: Healthfirst QHP |
$212.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$149.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$212.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$181.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$149.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$212.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$159.71
|
| Rate for Payer: SOMOS Essential |
$159.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$212.95
|
|
