|
PR RMVL VENTR ASSIST DEV IMPLTABLE ICORP 1 VNTRC
|
Professional
|
Both
|
$7,868.00
|
|
|
Service Code
|
HCPCS 33980
|
| Min. Negotiated Rate |
$1,443.88 |
| Max. Negotiated Rate |
$4,641.05 |
| Rate for Payer: Cash Price |
$2,092.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,062.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,856.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,856.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,959.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,062.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,959.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,062.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,062.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,547.02
|
| Rate for Payer: Healthfirst Commercial |
$2,062.69
|
| Rate for Payer: Healthfirst Essential Plan |
$4,641.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,959.56
|
| Rate for Payer: Healthfirst QHP |
$2,062.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,443.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,062.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,753.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,443.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,062.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,547.02
|
| Rate for Payer: SOMOS Essential |
$1,547.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,062.69
|
|
|
PR RMVL VITREOUS ANT APPR PARTIAL REMOVAL
|
Professional
|
Both
|
$1,960.67
|
|
|
Service Code
|
HCPCS 67005
|
| Min. Negotiated Rate |
$376.37 |
| Max. Negotiated Rate |
$1,209.76 |
| Rate for Payer: Cash Price |
$542.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$537.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$483.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$483.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$510.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$537.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$510.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$537.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$537.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$403.25
|
| Rate for Payer: Healthfirst Commercial |
$537.67
|
| Rate for Payer: Healthfirst Essential Plan |
$1,209.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$510.79
|
| Rate for Payer: Healthfirst QHP |
$537.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$376.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$537.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$457.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$376.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$537.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$403.25
|
| Rate for Payer: SOMOS Essential |
$403.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$537.67
|
|
|
PR RMVL VITREOUS ANT APPR SUBTOT RMVL MECH VITRECT
|
Professional
|
Both
|
$2,245.11
|
|
|
Service Code
|
HCPCS 67010
|
| Min. Negotiated Rate |
$428.26 |
| Max. Negotiated Rate |
$1,376.55 |
| Rate for Payer: Cash Price |
$619.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$611.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$550.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$550.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$581.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$611.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$581.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$611.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$611.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$458.85
|
| Rate for Payer: Healthfirst Commercial |
$611.80
|
| Rate for Payer: Healthfirst Essential Plan |
$1,376.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$581.21
|
| Rate for Payer: Healthfirst QHP |
$611.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$428.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$611.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$520.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$428.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$611.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$458.85
|
| Rate for Payer: SOMOS Essential |
$458.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$611.80
|
|
|
PR RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT
|
Professional
|
Both
|
$451.57
|
|
|
Service Code
|
HCPCS 11983
|
| Min. Negotiated Rate |
$83.87 |
| Max. Negotiated Rate |
$269.57 |
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$119.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$107.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$107.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$119.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.86
|
| Rate for Payer: Healthfirst Commercial |
$119.81
|
| Rate for Payer: Healthfirst Essential Plan |
$269.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$113.82
|
| Rate for Payer: Healthfirst QHP |
$119.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$83.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$119.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$101.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$83.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$119.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$89.86
|
| Rate for Payer: SOMOS Essential |
$89.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$119.81
|
|
|
PR RNL EXPL X NECESSITATING OTH SPEC PX
|
Professional
|
Both
|
$3,250.49
|
|
|
Service Code
|
HCPCS 50010
|
| Min. Negotiated Rate |
$562.97 |
| Max. Negotiated Rate |
$1,809.54 |
| Rate for Payer: Cash Price |
$810.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$804.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$723.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$723.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$764.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$804.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$764.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$804.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$804.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$603.18
|
| Rate for Payer: Healthfirst Commercial |
$804.24
|
| Rate for Payer: Healthfirst Essential Plan |
$1,809.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$764.03
|
| Rate for Payer: Healthfirst QHP |
$804.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$562.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$804.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$683.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$562.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$804.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$603.18
|
| Rate for Payer: SOMOS Essential |
$603.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$804.24
|
|
|
PR RNL NDSC NFROT FULGURATION &/INCISION W/WO BX
|
Professional
|
Both
|
$2,326.24
|
|
|
Service Code
|
HCPCS 50576
|
| Min. Negotiated Rate |
$441.25 |
| Max. Negotiated Rate |
$1,418.31 |
| Rate for Payer: Cash Price |
$633.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$630.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$567.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$567.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$598.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$630.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$598.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$630.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$630.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$472.77
|
| Rate for Payer: Healthfirst Commercial |
$630.36
|
| Rate for Payer: Healthfirst Essential Plan |
$1,418.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$598.84
|
| Rate for Payer: Healthfirst QHP |
$630.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$441.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$630.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$535.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$441.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$630.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$472.77
|
| Rate for Payer: SOMOS Essential |
$472.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$630.36
|
|
|
PR RNL NDSC NFROT/PLOT W/ENDOPYELOTOMY
|
Professional
|
Both
|
$2,948.58
|
|
|
Service Code
|
HCPCS 50575
|
| Min. Negotiated Rate |
$558.28 |
| Max. Negotiated Rate |
$1,794.46 |
| Rate for Payer: Cash Price |
$801.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$797.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$717.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$717.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$757.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$797.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$757.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$797.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$797.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$598.15
|
| Rate for Payer: Healthfirst Commercial |
$797.54
|
| Rate for Payer: Healthfirst Essential Plan |
$1,794.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$757.66
|
| Rate for Payer: Healthfirst QHP |
$797.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$558.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$797.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$677.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$558.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$797.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$598.15
|
| Rate for Payer: SOMOS Essential |
$598.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$797.54
|
|
|
PR RNL NDSC NFROT/PLOT W/RMVL FB/CALCULUS
|
Professional
|
Both
|
$2,502.96
|
|
|
Service Code
|
HCPCS 50580
|
| Min. Negotiated Rate |
$474.55 |
| Max. Negotiated Rate |
$1,525.34 |
| Rate for Payer: Cash Price |
$682.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$677.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$610.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$610.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$644.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$677.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$644.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$677.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$677.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$508.45
|
| Rate for Payer: Healthfirst Commercial |
$677.93
|
| Rate for Payer: Healthfirst Essential Plan |
$1,525.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$644.03
|
| Rate for Payer: Healthfirst QHP |
$677.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$474.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$677.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$576.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$474.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$677.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$508.45
|
| Rate for Payer: SOMOS Essential |
$508.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$677.93
|
|
|
PR RNL NDSC NFROT W/URTRL CATHJ W/WO DILAT URETER
|
Professional
|
Both
|
$2,189.81
|
|
|
Service Code
|
HCPCS 50572
|
| Min. Negotiated Rate |
$416.38 |
| Max. Negotiated Rate |
$1,338.37 |
| Rate for Payer: Cash Price |
$597.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$594.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$535.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$535.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$565.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$594.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$565.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$594.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$594.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$446.12
|
| Rate for Payer: Healthfirst Commercial |
$594.83
|
| Rate for Payer: Healthfirst Essential Plan |
$1,338.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$565.09
|
| Rate for Payer: Healthfirst QHP |
$594.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$416.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$594.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$505.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$416.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$594.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$446.12
|
| Rate for Payer: SOMOS Essential |
$446.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$594.83
|
|
|
PR ROM MEAS&REPRT EA XTR EX HAND/EA TRNK SCTJ SPI
|
Professional
|
Both
|
$31.40
|
|
|
Service Code
|
HCPCS 95851
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Amida Care Medicaid |
$4.16
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.34
|
| Rate for Payer: Healthfirst Commercial |
$8.46
|
| Rate for Payer: Healthfirst Essential Plan |
$19.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.04
|
| Rate for Payer: Healthfirst QHP |
$8.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.34
|
| Rate for Payer: SOMOS Essential |
$6.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.46
|
|
|
PR ROM MEAS&REPRT HAND W/WO COMPARISON NORMAL SID
|
Professional
|
Both
|
$22.26
|
|
|
Service Code
|
HCPCS 95852
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$14.29 |
| Rate for Payer: Amida Care Medicaid |
$2.97
|
| Rate for Payer: Cash Price |
$6.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.76
|
| Rate for Payer: Healthfirst Commercial |
$6.35
|
| Rate for Payer: Healthfirst Essential Plan |
$14.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.03
|
| Rate for Payer: Healthfirst QHP |
$6.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$4.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$6.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$5.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$4.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.76
|
| Rate for Payer: SOMOS Essential |
$4.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.35
|
|
|
PR ROPRTJ > 1 MO AFTER ORIGINAL OPRATION
|
Professional
|
Both
|
$673.05
|
|
|
Service Code
|
HCPCS 35700
|
| Min. Negotiated Rate |
$123.19 |
| Max. Negotiated Rate |
$395.95 |
| Rate for Payer: Cash Price |
$177.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$175.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$158.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$158.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$167.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$175.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$167.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$131.99
|
| Rate for Payer: Healthfirst Commercial |
$175.98
|
| Rate for Payer: Healthfirst Essential Plan |
$395.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$167.18
|
| Rate for Payer: Healthfirst QHP |
$175.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$123.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$175.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$149.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$123.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$175.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$131.99
|
| Rate for Payer: SOMOS Essential |
$131.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$175.98
|
|
|
PR ROPRTJ CAB/VALVE PX > 1 MO AFTER ORIGINAL OPERJ
|
Professional
|
Both
|
$2,321.31
|
|
|
Service Code
|
HCPCS 33530
|
| Min. Negotiated Rate |
$424.86 |
| Max. Negotiated Rate |
$1,365.62 |
| Rate for Payer: Cash Price |
$613.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$606.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$546.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$546.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$576.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$606.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$576.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$606.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$606.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$455.20
|
| Rate for Payer: Healthfirst Commercial |
$606.94
|
| Rate for Payer: Healthfirst Essential Plan |
$1,365.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$576.59
|
| Rate for Payer: Healthfirst QHP |
$606.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$424.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$606.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$515.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$424.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$606.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$455.20
|
| Rate for Payer: SOMOS Essential |
$455.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$606.94
|
|
|
PR ROPRTJ CRTD TEAEC > 1 MO AFTER ORIGINAL OPRATIO
|
Professional
|
Both
|
$702.52
|
|
|
Service Code
|
HCPCS 35390
|
| Min. Negotiated Rate |
$129.58 |
| Max. Negotiated Rate |
$416.52 |
| Rate for Payer: Cash Price |
$185.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$185.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$166.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$166.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$185.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$185.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$138.84
|
| Rate for Payer: Healthfirst Commercial |
$185.12
|
| Rate for Payer: Healthfirst Essential Plan |
$416.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$175.86
|
| Rate for Payer: Healthfirst QHP |
$185.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$129.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$185.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$157.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$129.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$185.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.84
|
| Rate for Payer: SOMOS Essential |
$138.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$185.12
|
|
|
PR ROUTINE FOOTCARE PT W LOPS
|
Professional
|
Both
|
$85.33
|
|
|
Service Code
|
HCPCS G0247
|
| Min. Negotiated Rate |
$16.18 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$23.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.34
|
| Rate for Payer: Healthfirst Commercial |
$23.12
|
| Rate for Payer: Healthfirst Essential Plan |
$52.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.96
|
| Rate for Payer: Healthfirst QHP |
$23.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.34
|
| Rate for Payer: SOMOS Essential |
$17.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.12
|
|
|
PR ROUTINE OB CARE VAG DLVRY & POSTPARTUM CARE VB
|
Professional
|
Both
|
$11,597.60
|
|
|
Service Code
|
HCPCS 59610
|
| Min. Negotiated Rate |
$2,143.28 |
| Max. Negotiated Rate |
$6,889.12 |
| Rate for Payer: Cash Price |
$3,113.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,061.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,755.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,755.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,908.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,061.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,908.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,061.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,061.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,296.37
|
| Rate for Payer: Healthfirst Commercial |
$3,061.83
|
| Rate for Payer: Healthfirst Essential Plan |
$6,889.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,908.74
|
| Rate for Payer: Healthfirst QHP |
$3,061.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,143.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,061.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,602.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,143.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,061.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,296.37
|
| Rate for Payer: SOMOS Essential |
$2,296.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,061.83
|
|
|
PR ROUTINE OBSTETRICAL CARE ATTEMPTED VBAC
|
Professional
|
Both
|
$12,384.68
|
|
|
Service Code
|
HCPCS 59618
|
| Min. Negotiated Rate |
$2,296.85 |
| Max. Negotiated Rate |
$7,382.72 |
| Rate for Payer: Cash Price |
$3,337.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,281.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,953.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,953.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,117.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,281.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,117.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,281.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,281.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,460.91
|
| Rate for Payer: Healthfirst Commercial |
$3,281.21
|
| Rate for Payer: Healthfirst Essential Plan |
$7,382.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,117.15
|
| Rate for Payer: Healthfirst QHP |
$3,281.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,296.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,281.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,789.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,296.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,281.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,460.91
|
| Rate for Payer: SOMOS Essential |
$2,460.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,281.21
|
|
|
PR RPLCMT ALL/PART URETER INTESTINE SGM W/ANAST
|
Professional
|
Both
|
$5,139.09
|
|
|
Service Code
|
HCPCS 50840
|
| Min. Negotiated Rate |
$977.69 |
| Max. Negotiated Rate |
$3,142.57 |
| Rate for Payer: Cash Price |
$1,403.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,396.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,257.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,257.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,326.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,396.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,326.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,396.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,396.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,047.53
|
| Rate for Payer: Healthfirst Commercial |
$1,396.70
|
| Rate for Payer: Healthfirst Essential Plan |
$3,142.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,326.87
|
| Rate for Payer: Healthfirst QHP |
$1,396.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$977.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,396.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,187.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$977.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,396.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,047.53
|
| Rate for Payer: SOMOS Essential |
$1,047.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,396.70
|
|
|
PR RPLCMT AORTIC VALVE ANNULUS ENLGMENT NONC SINUS
|
Professional
|
Both
|
$14,815.89
|
|
|
Service Code
|
HCPCS 33411
|
| Min. Negotiated Rate |
$2,728.93 |
| Max. Negotiated Rate |
$8,771.56 |
| Rate for Payer: Cash Price |
$3,937.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,898.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,508.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,508.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,703.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,898.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,703.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,898.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,898.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,923.85
|
| Rate for Payer: Healthfirst Commercial |
$3,898.47
|
| Rate for Payer: Healthfirst Essential Plan |
$8,771.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,703.55
|
| Rate for Payer: Healthfirst QHP |
$3,898.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,728.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,898.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,313.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,728.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,898.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,923.85
|
| Rate for Payer: SOMOS Essential |
$2,923.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,898.47
|
|
|
PR RPLCMT AORTIC VALVE BY TLCJ AUTOL PULM VALVE
|
Professional
|
Both
|
$14,973.14
|
|
|
Service Code
|
HCPCS 33440
|
| Min. Negotiated Rate |
$2,752.27 |
| Max. Negotiated Rate |
$8,846.59 |
| Rate for Payer: Cash Price |
$3,968.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,931.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,538.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,538.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,735.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,931.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,735.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,931.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,931.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,948.86
|
| Rate for Payer: Healthfirst Commercial |
$3,931.82
|
| Rate for Payer: Healthfirst Essential Plan |
$8,846.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,735.23
|
| Rate for Payer: Healthfirst QHP |
$3,931.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,752.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,931.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,342.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,752.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,931.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,948.86
|
| Rate for Payer: SOMOS Essential |
$2,948.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,931.82
|
|
|
PR RPLCMT AORTIC VALVE OPN ALLOGRAFT VALVE FREEHAND
|
Professional
|
Both
|
$12,814.73
|
|
|
Service Code
|
HCPCS 33406
|
| Min. Negotiated Rate |
$2,357.00 |
| Max. Negotiated Rate |
$7,576.06 |
| Rate for Payer: Cash Price |
$3,403.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,367.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,030.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,030.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,198.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,367.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,198.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,367.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,367.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,525.36
|
| Rate for Payer: Healthfirst Commercial |
$3,367.14
|
| Rate for Payer: Healthfirst Essential Plan |
$7,576.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,198.78
|
| Rate for Payer: Healthfirst QHP |
$3,367.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,357.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,367.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,862.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,357.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,367.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,525.36
|
| Rate for Payer: SOMOS Essential |
$2,525.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,367.14
|
|
|
PR RPLCMT AORTIC VALVE OPN W/STENTLESS TISSUE VALVE
|
Professional
|
Both
|
$11,255.44
|
|
|
Service Code
|
HCPCS 33410
|
| Min. Negotiated Rate |
$2,077.70 |
| Max. Negotiated Rate |
$6,678.34 |
| Rate for Payer: Cash Price |
$2,990.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,968.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,671.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,671.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,819.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,968.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,819.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,968.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,968.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,226.11
|
| Rate for Payer: Healthfirst Commercial |
$2,968.15
|
| Rate for Payer: Healthfirst Essential Plan |
$6,678.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,819.74
|
| Rate for Payer: Healthfirst QHP |
$2,968.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,077.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,968.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,522.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,077.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,968.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,226.11
|
| Rate for Payer: SOMOS Essential |
$2,226.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,968.15
|
|
|
PR RPLCMT BONE FLAP/PROSTHETIC PLATE SKULL
|
Professional
|
Both
|
$5,014.14
|
|
|
Service Code
|
HCPCS 62143
|
| Min. Negotiated Rate |
$921.96 |
| Max. Negotiated Rate |
$2,963.45 |
| Rate for Payer: Cash Price |
$1,323.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,317.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,185.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,185.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,251.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,317.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,251.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,317.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,317.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$987.82
|
| Rate for Payer: Healthfirst Commercial |
$1,317.09
|
| Rate for Payer: Healthfirst Essential Plan |
$2,963.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,251.24
|
| Rate for Payer: Healthfirst QHP |
$1,317.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$921.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,317.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,119.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$921.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,317.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$987.82
|
| Rate for Payer: SOMOS Essential |
$987.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,317.09
|
|
|
PR RPLCMT CATH CTR VAD SUBQ PORT/PMP
|
Professional
|
Both
|
$888.93
|
|
|
Service Code
|
HCPCS 36578
|
| Min. Negotiated Rate |
$162.84 |
| Max. Negotiated Rate |
$523.42 |
| Rate for Payer: Cash Price |
$238.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$232.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$209.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$221.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$232.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$221.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$232.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$232.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$174.47
|
| Rate for Payer: Healthfirst Commercial |
$232.63
|
| Rate for Payer: Healthfirst Essential Plan |
$523.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$221.00
|
| Rate for Payer: Healthfirst QHP |
$232.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$162.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$232.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$197.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$162.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$232.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$174.47
|
| Rate for Payer: SOMOS Essential |
$174.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$232.63
|
|
|
PR RPLCMT COMPL NON-TUN CVC W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$276.57
|
|
|
Service Code
|
HCPCS 36580
|
| Min. Negotiated Rate |
$50.47 |
| Max. Negotiated Rate |
$162.22 |
| Rate for Payer: Cash Price |
$73.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$64.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$68.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$68.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.08
|
| Rate for Payer: Healthfirst Commercial |
$72.10
|
| Rate for Payer: Healthfirst Essential Plan |
$162.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.50
|
| Rate for Payer: Healthfirst QHP |
$72.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$50.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$72.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$61.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.08
|
| Rate for Payer: SOMOS Essential |
$54.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.10
|
|
