|
PR REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE
|
Professional
|
Both
|
$7,720.27
|
|
|
Service Code
|
HCPCS 27487
|
| Min. Negotiated Rate |
$1,446.07 |
| Max. Negotiated Rate |
$4,648.07 |
| Rate for Payer: Cash Price |
$2,077.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,065.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,859.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,859.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,962.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,065.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,962.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,065.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,065.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,549.36
|
| Rate for Payer: Healthfirst Commercial |
$2,065.81
|
| Rate for Payer: Healthfirst Essential Plan |
$4,648.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,962.52
|
| Rate for Payer: Healthfirst QHP |
$2,065.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,446.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,065.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,755.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,446.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,065.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,549.36
|
| Rate for Payer: SOMOS Essential |
$1,549.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,065.81
|
|
|
PR REVJ TRANSVNS INTRAHEPATIC PORTOSYSTEMIC SHUNT
|
Professional
|
Both
|
$1,527.72
|
|
|
Service Code
|
HCPCS 37183
|
| Min. Negotiated Rate |
$286.09 |
| Max. Negotiated Rate |
$919.58 |
| Rate for Payer: Cash Price |
$410.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$408.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$367.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$367.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$388.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$408.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$388.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$408.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$408.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$306.52
|
| Rate for Payer: Healthfirst Commercial |
$408.70
|
| Rate for Payer: Healthfirst Essential Plan |
$919.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$388.26
|
| Rate for Payer: Healthfirst QHP |
$408.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$286.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$408.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$347.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$286.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$408.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$306.52
|
| Rate for Payer: SOMOS Essential |
$306.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$408.70
|
|
|
PR REVJ UR-CUTAN ANAST RPR FSCAL DFCT & HERNIA
|
Professional
|
Both
|
$2,934.26
|
|
|
Service Code
|
HCPCS 50728
|
| Min. Negotiated Rate |
$559.74 |
| Max. Negotiated Rate |
$1,799.17 |
| Rate for Payer: Cash Price |
$804.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$799.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$719.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$719.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$759.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$799.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$759.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$799.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$799.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$599.72
|
| Rate for Payer: Healthfirst Commercial |
$799.63
|
| Rate for Payer: Healthfirst Essential Plan |
$1,799.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$759.65
|
| Rate for Payer: Healthfirst QHP |
$799.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$559.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$799.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$679.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$559.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$799.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$599.72
|
| Rate for Payer: SOMOS Essential |
$599.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$799.63
|
|
|
PR REVJ URINARY-CUTANEOUS ANASTAMOSIS
|
Professional
|
Both
|
$2,159.40
|
|
|
Service Code
|
HCPCS 50727
|
| Min. Negotiated Rate |
$410.84 |
| Max. Negotiated Rate |
$1,320.57 |
| Rate for Payer: Cash Price |
$594.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$586.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$528.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$528.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$557.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$586.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$557.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$586.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$586.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$440.19
|
| Rate for Payer: Healthfirst Commercial |
$586.92
|
| Rate for Payer: Healthfirst Essential Plan |
$1,320.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$557.57
|
| Rate for Payer: Healthfirst QHP |
$586.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$410.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$586.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$498.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$410.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$586.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$440.19
|
| Rate for Payer: SOMOS Essential |
$440.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$586.92
|
|
|
PR REVJ W/RMVL PROSTHETIC VAGINAL GRAFT ABDML APPR
|
Professional
|
Both
|
$4,185.13
|
|
|
Service Code
|
HCPCS 57296
|
| Min. Negotiated Rate |
$777.20 |
| Max. Negotiated Rate |
$2,498.15 |
| Rate for Payer: Cash Price |
$1,125.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,110.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$999.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$999.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,054.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,110.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,054.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,110.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,110.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$832.72
|
| Rate for Payer: Healthfirst Commercial |
$1,110.29
|
| Rate for Payer: Healthfirst Essential Plan |
$2,498.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,054.78
|
| Rate for Payer: Healthfirst QHP |
$1,110.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$777.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,110.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$943.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$777.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,110.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$832.72
|
| Rate for Payer: SOMOS Essential |
$832.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,110.29
|
|
|
PR REV/RMV PRPH SAC/GSTRC NPG/RCV DTCH CONN ELTR RA
|
Professional
|
Both
|
$544.36
|
|
|
Service Code
|
HCPCS 64595
|
| Min. Negotiated Rate |
$185.84 |
| Max. Negotiated Rate |
$597.33 |
| Rate for Payer: Cash Price |
$267.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$265.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$238.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$238.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$265.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$265.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$265.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$199.11
|
| Rate for Payer: Healthfirst Commercial |
$265.48
|
| Rate for Payer: Healthfirst Essential Plan |
$597.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$252.21
|
| Rate for Payer: Healthfirst QHP |
$265.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$185.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$265.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$225.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$185.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$265.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$199.11
|
| Rate for Payer: SOMOS Essential |
$199.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$265.48
|
|
|
PR REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI
|
Professional
|
Both
|
$1,946.00
|
|
|
Service Code
|
HCPCS 37224
|
| Min. Negotiated Rate |
$357.27 |
| Max. Negotiated Rate |
$1,148.36 |
| Rate for Payer: Cash Price |
$516.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$510.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$459.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$459.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$484.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$510.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$484.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$510.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$510.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$382.79
|
| Rate for Payer: Healthfirst Commercial |
$510.38
|
| Rate for Payer: Healthfirst Essential Plan |
$1,148.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$484.86
|
| Rate for Payer: Healthfirst QHP |
$510.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$357.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$510.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$433.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$357.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$510.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$382.79
|
| Rate for Payer: SOMOS Essential |
$382.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$510.38
|
|
|
PR REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL
|
Professional
|
Both
|
$2,603.06
|
|
|
Service Code
|
HCPCS 37225
|
| Min. Negotiated Rate |
$476.51 |
| Max. Negotiated Rate |
$1,531.64 |
| Rate for Payer: Cash Price |
$691.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$680.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$612.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$612.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$680.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$646.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$680.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$680.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$510.55
|
| Rate for Payer: Healthfirst Commercial |
$680.73
|
| Rate for Payer: Healthfirst Essential Plan |
$1,531.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$646.69
|
| Rate for Payer: Healthfirst QHP |
$680.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$476.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$680.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$578.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$476.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$680.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$510.55
|
| Rate for Payer: SOMOS Essential |
$510.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$680.73
|
|
|
PR REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL
|
Professional
|
Both
|
$2,275.84
|
|
|
Service Code
|
HCPCS 37226
|
| Min. Negotiated Rate |
$417.31 |
| Max. Negotiated Rate |
$1,341.34 |
| Rate for Payer: Cash Price |
$601.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$596.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$536.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$536.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$566.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$596.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$566.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$596.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$596.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$447.11
|
| Rate for Payer: Healthfirst Commercial |
$596.15
|
| Rate for Payer: Healthfirst Essential Plan |
$1,341.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$566.34
|
| Rate for Payer: Healthfirst QHP |
$596.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$417.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$596.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$506.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$417.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$596.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$447.11
|
| Rate for Payer: SOMOS Essential |
$447.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$596.15
|
|
|
PR REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL
|
Professional
|
Both
|
$3,125.75
|
|
|
Service Code
|
HCPCS 37227
|
| Min. Negotiated Rate |
$572.17 |
| Max. Negotiated Rate |
$1,839.13 |
| Rate for Payer: Cash Price |
$826.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$817.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$735.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$735.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$776.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$817.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$776.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$817.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$817.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$613.04
|
| Rate for Payer: Healthfirst Commercial |
$817.39
|
| Rate for Payer: Healthfirst Essential Plan |
$1,839.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$776.52
|
| Rate for Payer: Healthfirst QHP |
$817.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$572.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$817.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$694.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$572.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$817.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$613.04
|
| Rate for Payer: SOMOS Essential |
$613.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$817.39
|
|
|
PR REVSC OPN/PRQ ILIAC ART W/STNT & ANGIOP IPSILATL
|
Professional
|
Both
|
$928.80
|
|
|
Service Code
|
HCPCS 37223
|
| Min. Negotiated Rate |
$170.70 |
| Max. Negotiated Rate |
$548.68 |
| Rate for Payer: Cash Price |
$246.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$243.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$219.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$219.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$231.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$243.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$231.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$243.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$243.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$182.90
|
| Rate for Payer: Healthfirst Commercial |
$243.86
|
| Rate for Payer: Healthfirst Essential Plan |
$548.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$231.67
|
| Rate for Payer: Healthfirst QHP |
$243.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$170.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$243.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$207.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$170.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$243.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$182.90
|
| Rate for Payer: SOMOS Essential |
$182.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$243.86
|
|
|
PR REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOPLSTY
|
Professional
|
Both
|
$2,158.77
|
|
|
Service Code
|
HCPCS 37221
|
| Min. Negotiated Rate |
$396.22 |
| Max. Negotiated Rate |
$1,273.57 |
| Rate for Payer: Cash Price |
$571.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$566.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$509.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$509.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$537.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$566.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$537.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$566.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$566.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$424.52
|
| Rate for Payer: Healthfirst Commercial |
$566.03
|
| Rate for Payer: Healthfirst Essential Plan |
$1,273.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$537.73
|
| Rate for Payer: Healthfirst QHP |
$566.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$396.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$566.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$481.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$396.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$566.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$424.52
|
| Rate for Payer: SOMOS Essential |
$424.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$566.03
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI
|
Professional
|
Both
|
$2,366.32
|
|
|
Service Code
|
HCPCS 37228
|
| Min. Negotiated Rate |
$434.38 |
| Max. Negotiated Rate |
$1,396.21 |
| Rate for Payer: Cash Price |
$625.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$620.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$558.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$558.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$589.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$620.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$589.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$620.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$620.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$465.40
|
| Rate for Payer: Healthfirst Commercial |
$620.54
|
| Rate for Payer: Healthfirst Essential Plan |
$1,396.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$589.51
|
| Rate for Payer: Healthfirst QHP |
$620.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$434.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$620.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$527.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$434.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$620.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$465.40
|
| Rate for Payer: SOMOS Essential |
$465.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$620.54
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL
|
Professional
|
Both
|
$859.46
|
|
|
Service Code
|
HCPCS 37232
|
| Min. Negotiated Rate |
$158.56 |
| Max. Negotiated Rate |
$509.67 |
| Rate for Payer: Cash Price |
$228.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$226.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$203.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$203.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$215.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$226.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$215.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$226.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$226.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$169.89
|
| Rate for Payer: Healthfirst Commercial |
$226.52
|
| Rate for Payer: Healthfirst Essential Plan |
$509.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$215.19
|
| Rate for Payer: Healthfirst QHP |
$226.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$158.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$226.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$192.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$158.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$226.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$169.89
|
| Rate for Payer: SOMOS Essential |
$169.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$226.52
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL
|
Professional
|
Both
|
$3,002.55
|
|
|
Service Code
|
HCPCS 37229
|
| Min. Negotiated Rate |
$550.67 |
| Max. Negotiated Rate |
$1,770.01 |
| Rate for Payer: Cash Price |
$795.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$786.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$708.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$708.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$747.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$786.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$747.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$786.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$786.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$590.00
|
| Rate for Payer: Healthfirst Commercial |
$786.67
|
| Rate for Payer: Healthfirst Essential Plan |
$1,770.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$747.34
|
| Rate for Payer: Healthfirst QHP |
$786.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$550.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$786.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$668.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$550.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$786.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$590.00
|
| Rate for Payer: SOMOS Essential |
$590.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$786.67
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL
|
Professional
|
Both
|
$1,387.72
|
|
|
Service Code
|
HCPCS 37233
|
| Min. Negotiated Rate |
$255.23 |
| Max. Negotiated Rate |
$820.37 |
| Rate for Payer: Cash Price |
$368.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$364.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$328.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$328.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$346.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$364.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$346.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$364.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$364.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$273.46
|
| Rate for Payer: Healthfirst Commercial |
$364.61
|
| Rate for Payer: Healthfirst Essential Plan |
$820.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$346.38
|
| Rate for Payer: Healthfirst QHP |
$364.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$255.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$364.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$309.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$255.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$364.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$273.46
|
| Rate for Payer: SOMOS Essential |
$273.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$364.61
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL
|
Professional
|
Both
|
$3,022.32
|
|
|
Service Code
|
HCPCS 37230
|
| Min. Negotiated Rate |
$557.47 |
| Max. Negotiated Rate |
$1,791.88 |
| Rate for Payer: Cash Price |
$801.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$796.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$716.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$716.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$756.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$796.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$756.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$796.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$796.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$597.29
|
| Rate for Payer: Healthfirst Commercial |
$796.39
|
| Rate for Payer: Healthfirst Essential Plan |
$1,791.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$756.57
|
| Rate for Payer: Healthfirst QHP |
$796.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$557.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$796.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$676.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$557.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$796.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$597.29
|
| Rate for Payer: SOMOS Essential |
$597.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$796.39
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP UNI EA VSL
|
Professional
|
Both
|
$1,218.00
|
|
|
Service Code
|
HCPCS 37234
|
| Min. Negotiated Rate |
$224.94 |
| Max. Negotiated Rate |
$723.01 |
| Rate for Payer: Cash Price |
$324.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$321.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$289.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$289.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$305.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$321.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$305.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$321.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$321.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$241.00
|
| Rate for Payer: Healthfirst Commercial |
$321.34
|
| Rate for Payer: Healthfirst Essential Plan |
$723.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$305.27
|
| Rate for Payer: Healthfirst QHP |
$321.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$224.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$321.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$273.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$224.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$321.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$241.00
|
| Rate for Payer: SOMOS Essential |
$241.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$321.34
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP EA VSL
|
Professional
|
Both
|
$1,542.98
|
|
|
Service Code
|
HCPCS 37235
|
| Min. Negotiated Rate |
$290.56 |
| Max. Negotiated Rate |
$933.95 |
| Rate for Payer: Cash Price |
$411.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$415.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$373.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$373.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$394.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$415.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$394.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$415.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$415.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$311.32
|
| Rate for Payer: Healthfirst Commercial |
$415.09
|
| Rate for Payer: Healthfirst Essential Plan |
$933.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$394.34
|
| Rate for Payer: Healthfirst QHP |
$415.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$290.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$415.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$352.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$290.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$415.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$311.32
|
| Rate for Payer: SOMOS Essential |
$311.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$415.09
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP SM VSL
|
Professional
|
Both
|
$3,137.58
|
|
|
Service Code
|
HCPCS 37231
|
| Min. Negotiated Rate |
$586.57 |
| Max. Negotiated Rate |
$1,885.39 |
| Rate for Payer: Cash Price |
$836.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$837.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$754.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$754.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$796.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$837.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$796.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$837.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$837.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$628.46
|
| Rate for Payer: Healthfirst Commercial |
$837.95
|
| Rate for Payer: Healthfirst Essential Plan |
$1,885.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$796.05
|
| Rate for Payer: Healthfirst QHP |
$837.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$586.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$837.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$712.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$586.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$837.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$628.46
|
| Rate for Payer: SOMOS Essential |
$628.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$837.95
|
|
|
PR RFL&MAIN IMPLT PMP/RSVR DLVR SPI/BRN PHY/QHP
|
Professional
|
Both
|
$169.79
|
|
|
Service Code
|
HCPCS 95991
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$98.75 |
| Rate for Payer: Amida Care Medicaid |
$17.92
|
| Rate for Payer: Cash Price |
$45.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.92
|
| Rate for Payer: Healthfirst Commercial |
$43.89
|
| Rate for Payer: Healthfirst Essential Plan |
$98.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.70
|
| Rate for Payer: Healthfirst QHP |
$43.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.92
|
| Rate for Payer: SOMOS Essential |
$32.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.89
|
|
|
PR RHINECTOMY PARTIAL
|
Professional
|
Both
|
$3,515.82
|
|
|
Service Code
|
HCPCS 30150
|
| Min. Negotiated Rate |
$644.68 |
| Max. Negotiated Rate |
$2,072.18 |
| Rate for Payer: Cash Price |
$942.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$920.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$828.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$828.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$874.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$920.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$874.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$920.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$920.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$690.73
|
| Rate for Payer: Healthfirst Commercial |
$920.97
|
| Rate for Payer: Healthfirst Essential Plan |
$2,072.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$874.92
|
| Rate for Payer: Healthfirst QHP |
$920.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$644.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$920.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$782.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$644.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$920.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$690.73
|
| Rate for Payer: SOMOS Essential |
$690.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$920.97
|
|
|
PR RHINECTOMY TOTAL
|
Professional
|
Both
|
$3,544.73
|
|
|
Service Code
|
HCPCS 30160
|
| Min. Negotiated Rate |
$656.75 |
| Max. Negotiated Rate |
$2,110.99 |
| Rate for Payer: Cash Price |
$958.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$938.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$844.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$844.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$891.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$938.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$891.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$938.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$938.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$703.66
|
| Rate for Payer: Healthfirst Commercial |
$938.22
|
| Rate for Payer: Healthfirst Essential Plan |
$2,110.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.31
|
| Rate for Payer: Healthfirst QHP |
$938.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$656.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$938.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$797.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$656.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$938.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$703.66
|
| Rate for Payer: SOMOS Essential |
$703.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$938.22
|
|
|
PR RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR
|
Professional
|
Both
|
$6,333.08
|
|
|
Service Code
|
HCPCS 30420
|
| Min. Negotiated Rate |
$1,163.53 |
| Max. Negotiated Rate |
$3,739.91 |
| Rate for Payer: Cash Price |
$1,704.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,662.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,495.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,495.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,579.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,662.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,579.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,662.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,662.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,246.63
|
| Rate for Payer: Healthfirst Commercial |
$1,662.18
|
| Rate for Payer: Healthfirst Essential Plan |
$3,739.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,579.07
|
| Rate for Payer: Healthfirst QHP |
$1,662.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,163.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,662.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,412.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,163.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,662.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,246.63
|
| Rate for Payer: SOMOS Essential |
$1,246.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,662.18
|
|
|
PR RHINOPLASTY SECONDARY INTERMEDIATE REVISION
|
Professional
|
Both
|
$5,895.23
|
|
|
Service Code
|
HCPCS 30435
|
| Min. Negotiated Rate |
$1,089.79 |
| Max. Negotiated Rate |
$3,502.89 |
| Rate for Payer: Cash Price |
$1,583.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,556.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,401.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,401.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,479.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,556.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,479.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,556.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,556.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,167.63
|
| Rate for Payer: Healthfirst Commercial |
$1,556.84
|
| Rate for Payer: Healthfirst Essential Plan |
$3,502.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,479.00
|
| Rate for Payer: Healthfirst QHP |
$1,556.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,089.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,556.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,323.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,089.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,556.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,167.63
|
| Rate for Payer: SOMOS Essential |
$1,167.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,556.84
|
|
