|
PR REVJ IMPLANTED INTRA-ARTERIAL INFUSION PUMP
|
Professional
|
Both
|
$1,847.34
|
|
|
Service Code
|
HCPCS 36261
|
| Min. Negotiated Rate |
$347.68 |
| Max. Negotiated Rate |
$1,117.53 |
| Rate for Payer: Cash Price |
$499.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$496.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$447.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$447.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$471.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$496.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$471.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$496.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$496.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$372.51
|
| Rate for Payer: Healthfirst Commercial |
$496.68
|
| Rate for Payer: Healthfirst Essential Plan |
$1,117.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$471.85
|
| Rate for Payer: Healthfirst QHP |
$496.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$347.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$496.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$422.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$347.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$496.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$372.51
|
| Rate for Payer: SOMOS Essential |
$372.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$496.68
|
|
|
PR REVJ INCL RPLCMT NSTIM ELTRD PLT/PDLE INCL FLUOR
|
Professional
|
Both
|
$4,152.54
|
|
|
Service Code
|
HCPCS 63664
|
| Min. Negotiated Rate |
$770.93 |
| Max. Negotiated Rate |
$2,477.99 |
| Rate for Payer: Cash Price |
$1,108.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,101.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$991.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$991.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,046.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,101.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,046.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,101.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,101.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$826.00
|
| Rate for Payer: Healthfirst Commercial |
$1,101.33
|
| Rate for Payer: Healthfirst Essential Plan |
$2,477.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,046.26
|
| Rate for Payer: Healthfirst QHP |
$1,101.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$770.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,101.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$936.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$770.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,101.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$826.00
|
| Rate for Payer: SOMOS Essential |
$826.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,101.33
|
|
|
PR REVJ INCL RPLCMT NSTIM ELTRD PRQ RA INCL FLUOR
|
Professional
|
Both
|
$1,927.14
|
|
|
Service Code
|
HCPCS 63663
|
| Min. Negotiated Rate |
$363.32 |
| Max. Negotiated Rate |
$1,167.82 |
| Rate for Payer: Cash Price |
$525.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$519.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$467.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$467.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$493.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$519.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$493.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$519.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$519.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$389.27
|
| Rate for Payer: Healthfirst Commercial |
$519.03
|
| Rate for Payer: Healthfirst Essential Plan |
$1,167.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$493.08
|
| Rate for Payer: Healthfirst QHP |
$519.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$363.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$519.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$441.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$363.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$519.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$389.27
|
| Rate for Payer: SOMOS Essential |
$389.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$519.03
|
|
|
PR REVJ LXTR ARTL BYP OPN VEIN PATCH ANGIOP
|
Professional
|
Both
|
$4,097.10
|
|
|
Service Code
|
HCPCS 35879
|
| Min. Negotiated Rate |
$751.96 |
| Max. Negotiated Rate |
$2,417.02 |
| Rate for Payer: Cash Price |
$1,084.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,074.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$966.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$966.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,020.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,074.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,020.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,074.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,074.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$805.67
|
| Rate for Payer: Healthfirst Commercial |
$1,074.23
|
| Rate for Payer: Healthfirst Essential Plan |
$2,417.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,020.52
|
| Rate for Payer: Healthfirst QHP |
$1,074.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$751.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,074.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$913.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$751.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,074.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$805.67
|
| Rate for Payer: SOMOS Essential |
$805.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,074.23
|
|
|
PR REVJ LXTR ARTL BYP OPN W/SGMTL VEIN INTERPOS
|
Professional
|
Both
|
$4,545.17
|
|
|
Service Code
|
HCPCS 35881
|
| Min. Negotiated Rate |
$833.54 |
| Max. Negotiated Rate |
$2,679.23 |
| Rate for Payer: Cash Price |
$1,211.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,190.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,071.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,071.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,131.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,190.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,131.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,190.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,190.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$893.08
|
| Rate for Payer: Healthfirst Commercial |
$1,190.77
|
| Rate for Payer: Healthfirst Essential Plan |
$2,679.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,131.23
|
| Rate for Payer: Healthfirst QHP |
$1,190.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$833.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,190.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,012.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$833.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,190.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$893.08
|
| Rate for Payer: SOMOS Essential |
$893.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,190.77
|
|
|
PR REVJ MASTOIDECTOMY RSLTG COMPL MASTOIDECTOMY
|
Professional
|
Both
|
$4,423.55
|
|
|
Service Code
|
HCPCS 69601
|
| Min. Negotiated Rate |
$819.54 |
| Max. Negotiated Rate |
$2,634.23 |
| Rate for Payer: Cash Price |
$1,192.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,170.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,053.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,053.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,112.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,170.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,112.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,170.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,170.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$878.08
|
| Rate for Payer: Healthfirst Commercial |
$1,170.77
|
| Rate for Payer: Healthfirst Essential Plan |
$2,634.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,112.23
|
| Rate for Payer: Healthfirst QHP |
$1,170.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$819.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,170.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$995.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$819.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,170.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$878.08
|
| Rate for Payer: SOMOS Essential |
$878.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,170.77
|
|
|
PR REVJ MASTOIDECTOMY RSLTG MODF RAD MSTDC
|
Professional
|
Both
|
$4,729.31
|
|
|
Service Code
|
HCPCS 69602
|
| Min. Negotiated Rate |
$875.32 |
| Max. Negotiated Rate |
$2,813.53 |
| Rate for Payer: Cash Price |
$1,276.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,250.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,125.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,125.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,187.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,250.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,187.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,250.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,250.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$937.85
|
| Rate for Payer: Healthfirst Commercial |
$1,250.46
|
| Rate for Payer: Healthfirst Essential Plan |
$2,813.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,187.94
|
| Rate for Payer: Healthfirst QHP |
$1,250.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$875.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,250.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,062.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$875.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,250.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$937.85
|
| Rate for Payer: SOMOS Essential |
$937.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,250.46
|
|
|
PR REVJ MASTOIDECTOMY RSLTG RAD MASTOIDECTOMY
|
Professional
|
Both
|
$5,584.29
|
|
|
Service Code
|
HCPCS 69603
|
| Min. Negotiated Rate |
$1,037.74 |
| Max. Negotiated Rate |
$3,335.60 |
| Rate for Payer: Cash Price |
$1,504.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,482.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,334.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,334.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,408.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,482.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,408.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,482.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,482.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,111.87
|
| Rate for Payer: Healthfirst Commercial |
$1,482.49
|
| Rate for Payer: Healthfirst Essential Plan |
$3,335.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,408.37
|
| Rate for Payer: Healthfirst QHP |
$1,482.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,037.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,482.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,260.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,037.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,482.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,111.87
|
| Rate for Payer: SOMOS Essential |
$1,111.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,482.49
|
|
|
PR REVJ MASTOIDECTOMY RSLTG TYMPANOPLASTY
|
Professional
|
Both
|
$4,831.02
|
|
|
Service Code
|
HCPCS 69604
|
| Min. Negotiated Rate |
$894.82 |
| Max. Negotiated Rate |
$2,876.22 |
| Rate for Payer: Cash Price |
$1,303.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,278.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,150.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,150.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,214.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,278.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,214.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,278.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,278.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$958.74
|
| Rate for Payer: Healthfirst Commercial |
$1,278.32
|
| Rate for Payer: Healthfirst Essential Plan |
$2,876.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,214.40
|
| Rate for Payer: Healthfirst QHP |
$1,278.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$894.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,278.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,086.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$894.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,278.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$958.74
|
| Rate for Payer: SOMOS Essential |
$958.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,278.32
|
|
|
PR REVJ OPN ARVEN FSTL W/O THRMBC DIAL GRF
|
Professional
|
Both
|
$3,352.20
|
|
|
Service Code
|
HCPCS 36832
|
| Min. Negotiated Rate |
$616.25 |
| Max. Negotiated Rate |
$1,980.81 |
| Rate for Payer: Cash Price |
$891.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$880.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$792.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$792.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$836.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$880.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$836.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$880.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$880.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$660.27
|
| Rate for Payer: Healthfirst Commercial |
$880.36
|
| Rate for Payer: Healthfirst Essential Plan |
$1,980.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$836.34
|
| Rate for Payer: Healthfirst QHP |
$880.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$616.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$880.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$748.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$616.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$880.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$660.27
|
| Rate for Payer: SOMOS Essential |
$660.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$880.36
|
|
|
PR REVJ OPN ARVEN FSTL W/THRMBC DIAL GRF
|
Professional
|
Both
|
$3,585.82
|
|
|
Service Code
|
HCPCS 36833
|
| Min. Negotiated Rate |
$657.71 |
| Max. Negotiated Rate |
$2,114.05 |
| Rate for Payer: Cash Price |
$951.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$939.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$845.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$845.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$892.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$939.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$892.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$939.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$939.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$704.68
|
| Rate for Payer: Healthfirst Commercial |
$939.58
|
| Rate for Payer: Healthfirst Essential Plan |
$2,114.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$892.60
|
| Rate for Payer: Healthfirst QHP |
$939.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$657.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$939.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$798.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$657.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$939.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$704.68
|
| Rate for Payer: SOMOS Essential |
$704.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$939.58
|
|
|
PR REVJ/RMVL IMPL SPI NPG/RCVR DTCH CONNJ ELTRD RA
|
Professional
|
Both
|
$1,667.93
|
|
|
Service Code
|
HCPCS 63688
|
| Min. Negotiated Rate |
$249.74 |
| Max. Negotiated Rate |
$802.73 |
| Rate for Payer: Cash Price |
$361.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$356.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$321.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$321.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$338.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$356.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$338.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$356.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$356.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$267.58
|
| Rate for Payer: Healthfirst Commercial |
$356.77
|
| Rate for Payer: Healthfirst Essential Plan |
$802.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$338.93
|
| Rate for Payer: Healthfirst QHP |
$356.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$249.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$356.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$303.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$249.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$356.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$267.58
|
| Rate for Payer: SOMOS Essential |
$267.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$356.77
|
|
|
PR REVJ/RMVL INTRACRANIAL NEUROSTIMULATOR ELTRDS
|
Professional
|
Both
|
$2,799.41
|
|
|
Service Code
|
HCPCS 61880
|
| Min. Negotiated Rate |
$518.34 |
| Max. Negotiated Rate |
$1,666.08 |
| Rate for Payer: Cash Price |
$744.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$740.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$666.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$666.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$703.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$740.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$703.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$740.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$740.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$555.36
|
| Rate for Payer: Healthfirst Commercial |
$740.48
|
| Rate for Payer: Healthfirst Essential Plan |
$1,666.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$703.46
|
| Rate for Payer: Healthfirst QHP |
$740.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$518.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$740.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$629.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$518.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$740.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$555.36
|
| Rate for Payer: SOMOS Essential |
$555.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$740.48
|
|
|
PR REVJ/RMVL NEUROSTIMULATOR PULSE GENERATOR
|
Professional
|
Both
|
$1,903.23
|
|
|
Service Code
|
HCPCS 61888
|
| Min. Negotiated Rate |
$348.77 |
| Max. Negotiated Rate |
$1,121.06 |
| Rate for Payer: Cash Price |
$503.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$498.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$448.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$448.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$473.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$498.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$473.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$498.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$498.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$373.69
|
| Rate for Payer: Healthfirst Commercial |
$498.25
|
| Rate for Payer: Healthfirst Essential Plan |
$1,121.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$473.34
|
| Rate for Payer: Healthfirst QHP |
$498.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$348.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$498.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$423.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$348.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$498.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$373.69
|
| Rate for Payer: SOMOS Essential |
$373.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$498.25
|
|
|
PR REVJ/RMVL PERPH NEUROSTIMULATOR ELECTRODE ARRAY
|
Professional
|
Both
|
$611.00
|
|
|
Service Code
|
HCPCS 64585
|
| Min. Negotiated Rate |
$116.41 |
| Max. Negotiated Rate |
$374.18 |
| Rate for Payer: Cash Price |
$167.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$166.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$149.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$149.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$157.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$166.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$157.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$166.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$166.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$124.72
|
| Rate for Payer: Healthfirst Commercial |
$166.30
|
| Rate for Payer: Healthfirst Essential Plan |
$374.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$157.99
|
| Rate for Payer: Healthfirst QHP |
$166.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$116.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$166.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$141.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$116.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$166.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$124.72
|
| Rate for Payer: SOMOS Essential |
$124.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$166.30
|
|
|
PR REVJ/RMVL PROSTHETIC VAGINAL GRAFT VAGINAL APP
|
Professional
|
Both
|
$2,174.87
|
|
|
Service Code
|
HCPCS 57295
|
| Min. Negotiated Rate |
$406.94 |
| Max. Negotiated Rate |
$1,308.04 |
| Rate for Payer: Cash Price |
$589.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$581.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$523.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$523.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$552.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$581.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$552.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$581.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$581.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$436.01
|
| Rate for Payer: Healthfirst Commercial |
$581.35
|
| Rate for Payer: Healthfirst Essential Plan |
$1,308.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$552.28
|
| Rate for Payer: Healthfirst QHP |
$581.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$406.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$581.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$494.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$406.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$581.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$436.01
|
| Rate for Payer: SOMOS Essential |
$436.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$581.35
|
|
|
PR REVJ RPLCMT DISC ARTHROPLASTY ANT 1 NTRSPC CRV
|
Professional
|
Both
|
$11,181.24
|
|
|
Service Code
|
HCPCS 22861
|
| Min. Negotiated Rate |
$2,043.32 |
| Max. Negotiated Rate |
$6,567.82 |
| Rate for Payer: Cash Price |
$2,945.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,919.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,627.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,627.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,773.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,919.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,773.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,919.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,919.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,189.27
|
| Rate for Payer: Healthfirst Commercial |
$2,919.03
|
| Rate for Payer: Healthfirst Essential Plan |
$6,567.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,773.08
|
| Rate for Payer: Healthfirst QHP |
$2,919.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,043.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,919.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,481.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,043.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,919.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,189.27
|
| Rate for Payer: SOMOS Essential |
$2,189.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,919.03
|
|
|
PR REVJ RPLCMT DISC ARTHROPLASTY ANT 1 NTRSPC LMBR
|
Professional
|
Both
|
$11,157.09
|
|
|
Service Code
|
HCPCS 22862
|
| Min. Negotiated Rate |
$2,041.21 |
| Max. Negotiated Rate |
$6,561.05 |
| Rate for Payer: Cash Price |
$2,944.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,916.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,624.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,624.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,770.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,916.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,770.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,916.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,916.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,187.01
|
| Rate for Payer: Healthfirst Commercial |
$2,916.02
|
| Rate for Payer: Healthfirst Essential Plan |
$6,561.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,770.22
|
| Rate for Payer: Healthfirst QHP |
$2,916.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,041.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,916.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,478.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,041.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,916.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,187.01
|
| Rate for Payer: SOMOS Essential |
$2,187.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,916.02
|
|
|
PR REVJ/RPLCMT HPGLSL NERVE NSTIM RA PG&RESPIR SNR
|
Professional
|
Both
|
$3,713.61
|
|
|
Service Code
|
HCPCS 64583
|
| Min. Negotiated Rate |
$697.45 |
| Max. Negotiated Rate |
$2,241.81 |
| Rate for Payer: Cash Price |
$1,004.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$996.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$896.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$896.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$946.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$996.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$946.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$996.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$996.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$747.27
|
| Rate for Payer: Healthfirst Commercial |
$996.36
|
| Rate for Payer: Healthfirst Essential Plan |
$2,241.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$946.54
|
| Rate for Payer: Healthfirst QHP |
$996.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$697.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$996.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$846.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$697.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$996.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$747.27
|
| Rate for Payer: SOMOS Essential |
$747.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$996.36
|
|
|
PR REVJ/RPR OPRATIVE WOUND ANTERIOR SEGMENT
|
Professional
|
Both
|
$2,291.80
|
|
|
Service Code
|
HCPCS 66250
|
| Min. Negotiated Rate |
$436.18 |
| Max. Negotiated Rate |
$1,402.00 |
| Rate for Payer: Cash Price |
$631.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$623.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$560.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$560.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$591.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$623.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$591.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$623.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$623.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$467.33
|
| Rate for Payer: Healthfirst Commercial |
$623.11
|
| Rate for Payer: Healthfirst Essential Plan |
$1,402.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$591.95
|
| Rate for Payer: Healthfirst QHP |
$623.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$436.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$623.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$529.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$436.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$623.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$467.33
|
| Rate for Payer: SOMOS Essential |
$467.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$623.11
|
|
|
PR REVJ SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT
|
Professional
|
Both
|
$3,269.81
|
|
|
Service Code
|
HCPCS 66184
|
| Min. Negotiated Rate |
$621.42 |
| Max. Negotiated Rate |
$1,997.41 |
| Rate for Payer: Cash Price |
$901.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$887.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$798.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$798.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$843.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$887.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$843.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$887.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$887.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$665.80
|
| Rate for Payer: Healthfirst Commercial |
$887.74
|
| Rate for Payer: Healthfirst Essential Plan |
$1,997.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$843.35
|
| Rate for Payer: Healthfirst QHP |
$887.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$621.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$887.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$754.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$621.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$887.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$665.80
|
| Rate for Payer: SOMOS Essential |
$665.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$887.74
|
|
|
PR REVJ TOTAL KNEE ARTHRP W/WO ALGRFT 1 COMPONENT
|
Professional
|
Both
|
$6,189.02
|
|
|
Service Code
|
HCPCS 27486
|
| Min. Negotiated Rate |
$1,162.15 |
| Max. Negotiated Rate |
$3,735.49 |
| Rate for Payer: Cash Price |
$1,667.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,660.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,494.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,494.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,577.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,660.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,577.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,660.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,660.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,245.16
|
| Rate for Payer: Healthfirst Commercial |
$1,660.22
|
| Rate for Payer: Healthfirst Essential Plan |
$3,735.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,577.21
|
| Rate for Payer: Healthfirst QHP |
$1,660.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,162.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,660.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,411.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,162.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,660.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,245.16
|
| Rate for Payer: SOMOS Essential |
$1,245.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,660.22
|
|
|
PR REVJ TOT HIP ARTHRP ACTBLR W/WO AGRFT/ALGRFT
|
Professional
|
Both
|
$6,455.65
|
|
|
Service Code
|
HCPCS 27137
|
| Min. Negotiated Rate |
$1,209.91 |
| Max. Negotiated Rate |
$3,889.01 |
| Rate for Payer: Cash Price |
$1,736.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,728.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,555.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,555.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,642.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,728.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,642.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,728.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,728.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,296.34
|
| Rate for Payer: Healthfirst Commercial |
$1,728.45
|
| Rate for Payer: Healthfirst Essential Plan |
$3,889.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,642.03
|
| Rate for Payer: Healthfirst QHP |
$1,728.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,209.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,728.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,469.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,209.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,728.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,296.34
|
| Rate for Payer: SOMOS Essential |
$1,296.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,728.45
|
|
|
PR REVJ TOT HIP ARTHRP BTH W/WO AGRFT/ALGRFT
|
Professional
|
Both
|
$8,388.59
|
|
|
Service Code
|
HCPCS 27134
|
| Min. Negotiated Rate |
$1,568.02 |
| Max. Negotiated Rate |
$5,040.07 |
| Rate for Payer: Cash Price |
$2,252.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,240.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,016.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,016.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,128.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,240.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,128.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,240.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,240.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,680.02
|
| Rate for Payer: Healthfirst Commercial |
$2,240.03
|
| Rate for Payer: Healthfirst Essential Plan |
$5,040.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,128.03
|
| Rate for Payer: Healthfirst QHP |
$2,240.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,568.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,240.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,904.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,568.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,240.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,680.02
|
| Rate for Payer: SOMOS Essential |
$1,680.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,240.03
|
|
|
PR REVJ TOT HIP ARTHRP FEM ONLY W/WO ALGRFT
|
Professional
|
Both
|
$6,704.74
|
|
|
Service Code
|
HCPCS 27138
|
| Min. Negotiated Rate |
$1,256.54 |
| Max. Negotiated Rate |
$4,038.89 |
| Rate for Payer: Cash Price |
$1,803.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,795.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,615.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,615.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,705.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,795.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,705.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,795.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,795.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,346.30
|
| Rate for Payer: Healthfirst Commercial |
$1,795.06
|
| Rate for Payer: Healthfirst Essential Plan |
$4,038.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,705.31
|
| Rate for Payer: Healthfirst QHP |
$1,795.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,256.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,795.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,525.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,256.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,795.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,346.30
|
| Rate for Payer: SOMOS Essential |
$1,346.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,795.06
|
|
