|
PR R & L HRT CATH WINJX HRT ART& L VENTR IMG
|
Professional
|
Both
|
$5,394.31
|
|
|
Service Code
|
HCPCS 93460
|
| Min. Negotiated Rate |
$601.40 |
| Max. Negotiated Rate |
$3,107.81 |
| Rate for Payer: Amida Care Medicaid |
$601.40
|
| Rate for Payer: Cash Price |
$1,443.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,381.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,243.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,243.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,312.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,381.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,312.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,381.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,381.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,035.94
|
| Rate for Payer: Healthfirst Commercial |
$1,381.25
|
| Rate for Payer: Healthfirst Essential Plan |
$3,107.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,312.19
|
| Rate for Payer: Healthfirst QHP |
$1,381.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$966.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,381.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,174.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$966.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,381.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,035.94
|
| Rate for Payer: SOMOS Essential |
$1,035.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,381.25
|
|
|
PR R & L HRT CATH WINJX HRT ART& L VENTR IMG
|
Professional
|
Both
|
$1,599.89
|
|
|
Service Code
|
HCPCS 93460 26
|
| Min. Negotiated Rate |
$296.30 |
| Max. Negotiated Rate |
$952.40 |
| Rate for Payer: Amida Care Medicaid |
$601.40
|
| Rate for Payer: Cash Price |
$427.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$423.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$380.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$380.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$402.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$423.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$402.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$423.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$423.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$317.47
|
| Rate for Payer: Healthfirst Commercial |
$423.29
|
| Rate for Payer: Healthfirst Essential Plan |
$952.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$402.13
|
| Rate for Payer: Healthfirst QHP |
$423.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$296.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$423.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$359.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$296.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$423.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$317.47
|
| Rate for Payer: SOMOS Essential |
$317.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$423.29
|
|
|
PR R & L HRT CATH W/NJX L VENTRICULOG IMG S&I
|
Professional
|
Both
|
$3,621.94
|
|
|
Service Code
|
HCPCS 93453 TC
|
| Min. Negotiated Rate |
$535.45 |
| Max. Negotiated Rate |
$2,058.46 |
| Rate for Payer: Amida Care Medicaid |
$535.45
|
| Rate for Payer: Cash Price |
$969.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$914.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$823.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$823.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$869.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$914.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$869.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$914.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$914.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$686.15
|
| Rate for Payer: Healthfirst Commercial |
$914.87
|
| Rate for Payer: Healthfirst Essential Plan |
$2,058.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$869.13
|
| Rate for Payer: Healthfirst QHP |
$914.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$640.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$914.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$777.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$640.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$914.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$686.15
|
| Rate for Payer: SOMOS Essential |
$686.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$914.87
|
|
|
PR R & L HRT CATH W/NJX L VENTRICULOG IMG S&I
|
Professional
|
Both
|
$4,974.87
|
|
|
Service Code
|
HCPCS 93453
|
| Min. Negotiated Rate |
$535.45 |
| Max. Negotiated Rate |
$2,861.93 |
| Rate for Payer: Amida Care Medicaid |
$535.45
|
| Rate for Payer: Cash Price |
$1,330.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,271.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,144.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,144.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,208.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,271.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,208.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,271.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,271.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$953.98
|
| Rate for Payer: Healthfirst Commercial |
$1,271.97
|
| Rate for Payer: Healthfirst Essential Plan |
$2,861.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,208.37
|
| Rate for Payer: Healthfirst QHP |
$1,271.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$890.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,271.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,081.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$890.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,271.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$953.98
|
| Rate for Payer: SOMOS Essential |
$953.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,271.97
|
|
|
PR R & L HRT CATH W/NJX L VENTRICULOG IMG S&I
|
Professional
|
Both
|
$1,352.96
|
|
|
Service Code
|
HCPCS 93453 26
|
| Min. Negotiated Rate |
$249.96 |
| Max. Negotiated Rate |
$803.45 |
| Rate for Payer: Amida Care Medicaid |
$535.45
|
| Rate for Payer: Cash Price |
$361.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$357.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$321.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$321.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$339.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$357.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$339.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$357.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$357.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$267.82
|
| Rate for Payer: Healthfirst Commercial |
$357.09
|
| Rate for Payer: Healthfirst Essential Plan |
$803.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$339.24
|
| Rate for Payer: Healthfirst QHP |
$357.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$249.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$357.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$303.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$249.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$357.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$267.82
|
| Rate for Payer: SOMOS Essential |
$267.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$357.09
|
|
|
PR RLS XTNSV SCAR TISS W/O DETACHING EO MUSC SPX
|
Professional
|
Both
|
$2,773.40
|
|
|
Service Code
|
HCPCS 67343
|
| Min. Negotiated Rate |
$531.13 |
| Max. Negotiated Rate |
$1,707.21 |
| Rate for Payer: Cash Price |
$766.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$758.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$682.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$682.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$720.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$758.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$720.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$758.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$758.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$569.07
|
| Rate for Payer: Healthfirst Commercial |
$758.76
|
| Rate for Payer: Healthfirst Essential Plan |
$1,707.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$720.82
|
| Rate for Payer: Healthfirst QHP |
$758.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$531.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$758.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$644.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$531.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$758.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$569.07
|
| Rate for Payer: SOMOS Essential |
$569.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$758.76
|
|
|
PR RMVL 1/DUAL CHAMBER DEFIB ELECTRODE BY THORACOM
|
Professional
|
Both
|
$6,099.49
|
|
|
Service Code
|
HCPCS 33243
|
| Min. Negotiated Rate |
$1,125.92 |
| Max. Negotiated Rate |
$3,619.03 |
| Rate for Payer: Cash Price |
$1,625.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,608.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,447.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,447.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,528.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,608.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,528.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,608.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,608.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,206.35
|
| Rate for Payer: Healthfirst Commercial |
$1,608.46
|
| Rate for Payer: Healthfirst Essential Plan |
$3,619.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,528.04
|
| Rate for Payer: Healthfirst QHP |
$1,608.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,125.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,608.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,367.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,125.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,608.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,206.35
|
| Rate for Payer: SOMOS Essential |
$1,206.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,608.46
|
|
|
PR RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ
|
Professional
|
Both
|
$3,826.94
|
|
|
Service Code
|
HCPCS 33244
|
| Min. Negotiated Rate |
$700.55 |
| Max. Negotiated Rate |
$2,251.76 |
| Rate for Payer: Cash Price |
$1,012.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,000.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$900.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$900.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$950.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,000.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$950.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,000.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,000.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$750.59
|
| Rate for Payer: Healthfirst Commercial |
$1,000.78
|
| Rate for Payer: Healthfirst Essential Plan |
$2,251.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$950.74
|
| Rate for Payer: Healthfirst QHP |
$1,000.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$700.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,000.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$850.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$700.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,000.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$750.59
|
| Rate for Payer: SOMOS Essential |
$750.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,000.78
|
|
|
PR RMVL ASCENDING-AORTA BALO DEV W/RPR ASCEND-AORTA
|
Professional
|
Both
|
$3,929.84
|
|
|
Service Code
|
HCPCS 33974
|
| Min. Negotiated Rate |
$728.92 |
| Max. Negotiated Rate |
$2,342.97 |
| Rate for Payer: Cash Price |
$1,048.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,041.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$937.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$937.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$989.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,041.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$989.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,041.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,041.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$780.99
|
| Rate for Payer: Healthfirst Commercial |
$1,041.32
|
| Rate for Payer: Healthfirst Essential Plan |
$2,342.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$989.25
|
| Rate for Payer: Healthfirst QHP |
$1,041.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$728.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,041.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$885.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$728.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,041.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$780.99
|
| Rate for Payer: SOMOS Essential |
$780.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,041.32
|
|
|
PR RMVL/BIVALV SHO/HIP SPICA MINERVA/RISSER JACKET
|
Professional
|
Both
|
$362.46
|
|
|
Service Code
|
HCPCS 29710
|
| Min. Negotiated Rate |
$68.07 |
| Max. Negotiated Rate |
$218.79 |
| Rate for Payer: Cash Price |
$97.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$97.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$87.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$92.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$97.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$92.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.93
|
| Rate for Payer: Healthfirst Commercial |
$97.24
|
| Rate for Payer: Healthfirst Essential Plan |
$218.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$92.38
|
| Rate for Payer: Healthfirst QHP |
$97.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$97.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$82.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$97.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.93
|
| Rate for Payer: SOMOS Essential |
$72.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$97.24
|
|
|
PR RMVL BLOOD CLOT ANTERIOR SEGMENT EYE
|
Professional
|
Both
|
$2,650.38
|
|
|
Service Code
|
HCPCS 65930
|
| Min. Negotiated Rate |
$501.18 |
| Max. Negotiated Rate |
$1,610.93 |
| Rate for Payer: Cash Price |
$728.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$715.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$644.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$644.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$680.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$715.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$680.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$715.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$715.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$536.98
|
| Rate for Payer: Healthfirst Commercial |
$715.97
|
| Rate for Payer: Healthfirst Essential Plan |
$1,610.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$680.17
|
| Rate for Payer: Healthfirst QHP |
$715.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$501.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$715.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$608.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$501.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$715.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$536.98
|
| Rate for Payer: SOMOS Essential |
$536.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$715.97
|
|
|
PR RMVL BONE FLAP/PROSTHETIC PLATE SKULL
|
Professional
|
Both
|
$4,248.23
|
|
|
Service Code
|
HCPCS 62142
|
| Min. Negotiated Rate |
$786.94 |
| Max. Negotiated Rate |
$2,529.45 |
| Rate for Payer: Cash Price |
$1,128.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,124.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,011.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,011.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,067.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,124.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,067.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,124.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,124.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$843.15
|
| Rate for Payer: Healthfirst Commercial |
$1,124.20
|
| Rate for Payer: Healthfirst Essential Plan |
$2,529.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,067.99
|
| Rate for Payer: Healthfirst QHP |
$1,124.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$786.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,124.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$955.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$786.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,124.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$843.15
|
| Rate for Payer: SOMOS Essential |
$843.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,124.20
|
|
|
PR RMVL COMPL CSF SHUNT SYSTEM W/O RPLCMT SHUNT
|
Professional
|
Both
|
$2,908.96
|
|
|
Service Code
|
HCPCS 62256
|
| Min. Negotiated Rate |
$538.29 |
| Max. Negotiated Rate |
$1,730.23 |
| Rate for Payer: Cash Price |
$777.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$768.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$692.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$692.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$730.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$768.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$730.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$768.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$768.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$576.74
|
| Rate for Payer: Healthfirst Commercial |
$768.99
|
| Rate for Payer: Healthfirst Essential Plan |
$1,730.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$730.54
|
| Rate for Payer: Healthfirst QHP |
$768.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$538.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$768.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$653.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$538.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$768.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$576.74
|
| Rate for Payer: SOMOS Essential |
$576.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$768.99
|
|
|
PR RMVL COMPLETE CSF SHUNT SYSTEM W/RPLCMT SHUNT
|
Professional
|
Both
|
$5,319.51
|
|
|
Service Code
|
HCPCS 62258
|
| Min. Negotiated Rate |
$972.24 |
| Max. Negotiated Rate |
$3,125.05 |
| Rate for Payer: Cash Price |
$1,410.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,388.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,250.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,250.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,319.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,388.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,319.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,388.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,388.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,041.68
|
| Rate for Payer: Healthfirst Commercial |
$1,388.91
|
| Rate for Payer: Healthfirst Essential Plan |
$3,125.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,319.46
|
| Rate for Payer: Healthfirst QHP |
$1,388.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$972.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,388.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,180.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$972.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,388.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,041.68
|
| Rate for Payer: SOMOS Essential |
$1,041.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,388.91
|
|
|
PR RMVL CORNEAL EPITHELIUM W/APPL CHELATING AGENT
|
Professional
|
Both
|
$1,521.42
|
|
|
Service Code
|
HCPCS 65436
|
| Min. Negotiated Rate |
$291.24 |
| Max. Negotiated Rate |
$936.13 |
| Rate for Payer: Cash Price |
$419.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$416.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$374.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$374.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$395.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$416.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$395.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$416.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$416.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$312.05
|
| Rate for Payer: Healthfirst Commercial |
$416.06
|
| Rate for Payer: Healthfirst Essential Plan |
$936.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$395.26
|
| Rate for Payer: Healthfirst QHP |
$416.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$291.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$416.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$353.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$291.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$416.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$312.05
|
| Rate for Payer: SOMOS Essential |
$312.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$416.06
|
|
|
PR RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION
|
Professional
|
Both
|
$283.89
|
|
|
Service Code
|
HCPCS 65435
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$174.85 |
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$77.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$69.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$69.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$73.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$77.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$73.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.28
|
| Rate for Payer: Healthfirst Commercial |
$77.71
|
| Rate for Payer: Healthfirst Essential Plan |
$174.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.82
|
| Rate for Payer: Healthfirst QHP |
$77.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$54.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$77.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$66.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$54.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$77.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$58.28
|
| Rate for Payer: SOMOS Essential |
$58.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$77.71
|
|
|
PR RMVL DISC ARTHROPLASTY ANT 1 INTERSPACE CERVICAL
|
Professional
|
Both
|
$9,970.17
|
|
|
Service Code
|
HCPCS 22864
|
| Min. Negotiated Rate |
$1,823.44 |
| Max. Negotiated Rate |
$5,861.07 |
| Rate for Payer: Cash Price |
$2,629.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,604.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,344.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,344.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,474.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,604.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,474.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,604.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,604.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,953.69
|
| Rate for Payer: Healthfirst Commercial |
$2,604.92
|
| Rate for Payer: Healthfirst Essential Plan |
$5,861.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,474.67
|
| Rate for Payer: Healthfirst QHP |
$2,604.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,823.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,604.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,214.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,823.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,604.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,953.69
|
| Rate for Payer: SOMOS Essential |
$1,953.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,604.92
|
|
|
PR RMVL DISC ARTHROPLASTY ANT 1 INTERSPACE LUMBAR
|
Professional
|
Both
|
$10,886.58
|
|
|
Service Code
|
HCPCS 22865
|
| Min. Negotiated Rate |
$1,993.17 |
| Max. Negotiated Rate |
$6,406.60 |
| Rate for Payer: Cash Price |
$2,872.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,847.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,562.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,562.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,705.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,847.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,705.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,847.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,847.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,135.53
|
| Rate for Payer: Healthfirst Commercial |
$2,847.38
|
| Rate for Payer: Healthfirst Essential Plan |
$6,406.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,705.01
|
| Rate for Payer: Healthfirst QHP |
$2,847.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,993.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,847.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,420.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,993.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,847.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,135.53
|
| Rate for Payer: SOMOS Essential |
$2,135.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,847.38
|
|
|
PR RMVL EMBEDDED FB FROM DENTALVLR STRUXS SOFT TISS
|
Professional
|
Both
|
$844.38
|
|
|
Service Code
|
HCPCS 41805
|
| Min. Negotiated Rate |
$156.72 |
| Max. Negotiated Rate |
$503.75 |
| Rate for Payer: Cash Price |
$227.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$223.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$201.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$201.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$212.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$223.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$212.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$223.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$223.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$167.92
|
| Rate for Payer: Healthfirst Commercial |
$223.89
|
| Rate for Payer: Healthfirst Essential Plan |
$503.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$212.70
|
| Rate for Payer: Healthfirst QHP |
$223.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$156.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$223.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$190.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$156.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$223.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$167.92
|
| Rate for Payer: SOMOS Essential |
$167.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$223.89
|
|
|
PR RMVL EMBEDDED FB FROM DENTOALVEOLAR STRUXS BONE
|
Professional
|
Both
|
$1,182.30
|
|
|
Service Code
|
HCPCS 41806
|
| Min. Negotiated Rate |
$220.14 |
| Max. Negotiated Rate |
$707.60 |
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$314.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$283.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$283.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$298.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$314.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$298.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$314.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$314.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$235.87
|
| Rate for Payer: Healthfirst Commercial |
$314.49
|
| Rate for Payer: Healthfirst Essential Plan |
$707.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$298.77
|
| Rate for Payer: Healthfirst QHP |
$314.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$220.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$314.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$267.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$220.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$314.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$235.87
|
| Rate for Payer: SOMOS Essential |
$235.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$314.49
|
|
|
PR RMVL EMBEDDED FB VESTIBULE MOUTH COMP
|
Professional
|
Both
|
$827.40
|
|
|
Service Code
|
HCPCS 40805
|
| Min. Negotiated Rate |
$160.75 |
| Max. Negotiated Rate |
$516.69 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$229.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$206.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$206.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$218.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$229.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$218.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$229.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$229.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$172.23
|
| Rate for Payer: Healthfirst Commercial |
$229.64
|
| Rate for Payer: Healthfirst Essential Plan |
$516.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$218.16
|
| Rate for Payer: Healthfirst QHP |
$229.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$160.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$229.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$195.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$160.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$229.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$172.23
|
| Rate for Payer: SOMOS Essential |
$172.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$229.64
|
|
|
PR RMVL EMBEDDED FB VESTIBULE MOUTH SMPL
|
Professional
|
Both
|
$483.91
|
|
|
Service Code
|
HCPCS 40804
|
| Min. Negotiated Rate |
$96.31 |
| Max. Negotiated Rate |
$309.56 |
| Rate for Payer: Cash Price |
$132.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$137.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$123.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$130.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$137.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$130.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.19
|
| Rate for Payer: Healthfirst Commercial |
$137.58
|
| Rate for Payer: Healthfirst Essential Plan |
$309.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.70
|
| Rate for Payer: Healthfirst QHP |
$137.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$96.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$137.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$116.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$96.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$137.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$103.19
|
| Rate for Payer: SOMOS Essential |
$103.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.58
|
|
|
PR RMVL ENTIRE LUMBOSARACH SHUNT SYS W/O RPLCMT
|
Professional
|
Both
|
$2,918.23
|
|
|
Service Code
|
HCPCS 63746
|
| Min. Negotiated Rate |
$540.40 |
| Max. Negotiated Rate |
$1,737.00 |
| Rate for Payer: Cash Price |
$777.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$772.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$694.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$694.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$733.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$772.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$733.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$772.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$772.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$579.00
|
| Rate for Payer: Healthfirst Commercial |
$772.00
|
| Rate for Payer: Healthfirst Essential Plan |
$1,737.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$733.40
|
| Rate for Payer: Healthfirst QHP |
$772.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$540.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$772.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$656.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$540.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$772.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$579.00
|
| Rate for Payer: SOMOS Essential |
$579.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$772.00
|
|
|
PR RMVL ENTIRE OI IMPLT SKL MAG TC ATTCH ESP>=100
|
Professional
|
Both
|
$2,563.96
|
|
|
Service Code
|
HCPCS 69728
|
| Min. Negotiated Rate |
$479.25 |
| Max. Negotiated Rate |
$1,540.46 |
| Rate for Payer: Cash Price |
$707.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$684.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$616.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$616.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$650.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$684.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$650.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$684.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$684.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$513.49
|
| Rate for Payer: Healthfirst Commercial |
$684.65
|
| Rate for Payer: Healthfirst Essential Plan |
$1,540.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$650.42
|
| Rate for Payer: Healthfirst QHP |
$684.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$479.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$684.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$581.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$479.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$684.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$513.49
|
| Rate for Payer: SOMOS Essential |
$513.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$684.65
|
|
|
PR RMVL EPITHELIAL DOWNGROWTH ANT CHAMBER EYE
|
Professional
|
Both
|
$4,097.87
|
|
|
Service Code
|
HCPCS 65900
|
| Min. Negotiated Rate |
$773.37 |
| Max. Negotiated Rate |
$2,485.84 |
| Rate for Payer: Cash Price |
$1,125.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,104.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$994.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$994.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,049.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,104.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,049.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,104.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,104.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$828.62
|
| Rate for Payer: Healthfirst Commercial |
$1,104.82
|
| Rate for Payer: Healthfirst Essential Plan |
$2,485.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,049.58
|
| Rate for Payer: Healthfirst QHP |
$1,104.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$773.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,104.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$939.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$773.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,104.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$828.62
|
| Rate for Payer: SOMOS Essential |
$828.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,104.82
|
|
