|
PR RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT
|
Professional
|
Both
|
$1,212.23
|
|
|
Service Code
|
HCPCS 36585
|
| Min. Negotiated Rate |
$253.81 |
| Max. Negotiated Rate |
$815.80 |
| Rate for Payer: Cash Price |
$319.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$362.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$326.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$326.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$344.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$362.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$344.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$362.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$362.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$271.94
|
| Rate for Payer: Healthfirst Commercial |
$362.58
|
| Rate for Payer: Healthfirst Essential Plan |
$815.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$344.45
|
| Rate for Payer: Healthfirst QHP |
$362.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$253.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$362.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$308.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$253.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$362.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$271.94
|
| Rate for Payer: SOMOS Essential |
$271.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$362.58
|
|
|
PR RPLCMT COMPL TUN CTR VAD W/SUBQ PMP
|
Professional
|
Both
|
$1,474.83
|
|
|
Service Code
|
HCPCS 36583
|
| Min. Negotiated Rate |
$274.90 |
| Max. Negotiated Rate |
$883.60 |
| Rate for Payer: Cash Price |
$394.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$392.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$353.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$353.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$373.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$392.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$373.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$392.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$392.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$294.53
|
| Rate for Payer: Healthfirst Commercial |
$392.71
|
| Rate for Payer: Healthfirst Essential Plan |
$883.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$373.07
|
| Rate for Payer: Healthfirst QHP |
$392.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$274.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$392.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$333.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$274.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$392.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$294.53
|
| Rate for Payer: SOMOS Essential |
$294.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$392.71
|
|
|
PR RPLCMT COMPL TUN CTR VAD W/SUBQ PORT
|
Professional
|
Both
|
$1,234.31
|
|
|
Service Code
|
HCPCS 36582
|
| Min. Negotiated Rate |
$229.45 |
| Max. Negotiated Rate |
$737.50 |
| Rate for Payer: Cash Price |
$331.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$327.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$295.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$295.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$311.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$327.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$311.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$327.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$327.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$245.84
|
| Rate for Payer: Healthfirst Commercial |
$327.78
|
| Rate for Payer: Healthfirst Essential Plan |
$737.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$311.39
|
| Rate for Payer: Healthfirst QHP |
$327.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$229.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$327.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$278.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$229.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$327.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$245.84
|
| Rate for Payer: SOMOS Essential |
$245.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$327.78
|
|
|
PR RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$766.85
|
|
|
Service Code
|
HCPCS 36581
|
| Min. Negotiated Rate |
$144.32 |
| Max. Negotiated Rate |
$463.88 |
| Rate for Payer: Cash Price |
$206.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$206.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$185.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$185.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$195.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$206.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$195.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$206.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$206.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$154.63
|
| Rate for Payer: Healthfirst Commercial |
$206.17
|
| Rate for Payer: Healthfirst Essential Plan |
$463.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$195.86
|
| Rate for Payer: Healthfirst QHP |
$206.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$144.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$206.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$175.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$144.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$206.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$154.63
|
| Rate for Payer: SOMOS Essential |
$154.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$206.17
|
|
|
PR RPLCMT/IRRG SUBARACHNOID/SUBDURAL CATHETER
|
Professional
|
Both
|
$2,360.26
|
|
|
Service Code
|
HCPCS 62194
|
| Min. Negotiated Rate |
$436.90 |
| Max. Negotiated Rate |
$1,404.34 |
| Rate for Payer: Cash Price |
$627.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$624.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$561.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$561.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$592.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$624.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$592.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$624.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$624.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$468.11
|
| Rate for Payer: Healthfirst Commercial |
$624.15
|
| Rate for Payer: Healthfirst Essential Plan |
$1,404.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$592.94
|
| Rate for Payer: Healthfirst QHP |
$624.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$436.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$624.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$530.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$436.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$624.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$468.11
|
| Rate for Payer: SOMOS Essential |
$468.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$624.15
|
|
|
PR RPLCMT IRRIGATION/REVJ LUMBOSARACH SHUNT
|
Professional
|
Both
|
$3,231.45
|
|
|
Service Code
|
HCPCS 63744
|
| Min. Negotiated Rate |
$629.52 |
| Max. Negotiated Rate |
$2,023.45 |
| Rate for Payer: Cash Price |
$864.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$899.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$809.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$809.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$854.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$899.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$854.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$899.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$899.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$674.48
|
| Rate for Payer: Healthfirst Commercial |
$899.31
|
| Rate for Payer: Healthfirst Essential Plan |
$2,023.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$854.34
|
| Rate for Payer: Healthfirst QHP |
$899.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$629.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$899.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$764.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$629.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$899.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$674.48
|
| Rate for Payer: SOMOS Essential |
$674.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$899.31
|
|
|
PR RPLCMT/IRRIGATION VENTRICULAR CATHETER
|
Professional
|
Both
|
$2,543.77
|
|
|
Service Code
|
HCPCS 62225
|
| Min. Negotiated Rate |
$474.16 |
| Max. Negotiated Rate |
$1,524.08 |
| Rate for Payer: Cash Price |
$679.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$677.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$609.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$609.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$643.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$677.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$643.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$677.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$677.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$508.03
|
| Rate for Payer: Healthfirst Commercial |
$677.37
|
| Rate for Payer: Healthfirst Essential Plan |
$1,524.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$643.50
|
| Rate for Payer: Healthfirst QHP |
$677.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$474.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$677.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$575.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$474.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$677.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$508.03
|
| Rate for Payer: SOMOS Essential |
$508.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$677.37
|
|
|
PR RPLCMT OI IMPLT SKULL MAG TC ATTACHMENT ESP<100
|
Professional
|
Both
|
$2,773.51
|
|
|
Service Code
|
HCPCS 69719
|
| Min. Negotiated Rate |
$520.25 |
| Max. Negotiated Rate |
$1,672.24 |
| Rate for Payer: Cash Price |
$752.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$743.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$668.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$668.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$706.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$743.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$706.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$743.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$743.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$557.41
|
| Rate for Payer: Healthfirst Commercial |
$743.22
|
| Rate for Payer: Healthfirst Essential Plan |
$1,672.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$706.06
|
| Rate for Payer: Healthfirst QHP |
$743.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$520.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$743.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$631.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$520.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$743.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$557.41
|
| Rate for Payer: SOMOS Essential |
$557.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$743.22
|
|
|
PR RPLCMT OI IMPLT SKULL MAG TC ATTACHMENT ESP>=100
|
Professional
|
Both
|
$2,972.17
|
|
|
Service Code
|
HCPCS 69730
|
| Min. Negotiated Rate |
$553.96 |
| Max. Negotiated Rate |
$1,780.58 |
| Rate for Payer: Cash Price |
$819.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$791.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$712.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$712.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$751.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$791.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$751.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$791.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$791.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$593.53
|
| Rate for Payer: Healthfirst Commercial |
$791.37
|
| Rate for Payer: Healthfirst Essential Plan |
$1,780.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$751.80
|
| Rate for Payer: Healthfirst QHP |
$791.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$553.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$791.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$672.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$553.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$791.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$593.53
|
| Rate for Payer: SOMOS Essential |
$593.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$791.37
|
|
|
PR RPLCMT OI IMPLT SKULL PERQ ATTACHMENT ESP
|
Professional
|
Both
|
$2,419.69
|
|
|
Service Code
|
HCPCS 69717
|
| Min. Negotiated Rate |
$453.52 |
| Max. Negotiated Rate |
$1,457.75 |
| Rate for Payer: Cash Price |
$656.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$647.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$583.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$583.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$615.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$647.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$615.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$647.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$647.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$485.92
|
| Rate for Payer: Healthfirst Commercial |
$647.89
|
| Rate for Payer: Healthfirst Essential Plan |
$1,457.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$615.50
|
| Rate for Payer: Healthfirst QHP |
$647.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$453.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$647.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$550.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$453.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$647.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$485.92
|
| Rate for Payer: SOMOS Essential |
$485.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$647.89
|
|
|
PR RPLCMT PROST AORTIC VALVE OPEN XCP HOMOGRF/STENT
|
Professional
|
Both
|
$10,048.50
|
|
|
Service Code
|
HCPCS 33405
|
| Min. Negotiated Rate |
$1,851.06 |
| Max. Negotiated Rate |
$5,949.83 |
| Rate for Payer: Cash Price |
$2,671.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,644.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,379.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,379.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,512.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,644.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,512.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,644.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,644.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,983.28
|
| Rate for Payer: Healthfirst Commercial |
$2,644.37
|
| Rate for Payer: Healthfirst Essential Plan |
$5,949.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,512.15
|
| Rate for Payer: Healthfirst QHP |
$2,644.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,851.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,644.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,247.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,851.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,644.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,983.28
|
| Rate for Payer: SOMOS Essential |
$1,983.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,644.37
|
|
|
PR RPLCMT/REVJ CSF SHUNT VALVE/CATH SHUNT SYS
|
Professional
|
Both
|
$4,014.78
|
|
|
Service Code
|
HCPCS 62230
|
| Min. Negotiated Rate |
$737.18 |
| Max. Negotiated Rate |
$2,369.52 |
| Rate for Payer: Cash Price |
$1,063.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,053.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$947.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$947.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,000.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,053.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,000.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,053.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,053.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$789.84
|
| Rate for Payer: Healthfirst Commercial |
$1,053.12
|
| Rate for Payer: Healthfirst Essential Plan |
$2,369.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,000.46
|
| Rate for Payer: Healthfirst QHP |
$1,053.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$737.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,053.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$895.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$737.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,053.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$789.84
|
| Rate for Payer: SOMOS Essential |
$789.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,053.12
|
|
|
PR RPLCMT VAD PMP IMPLTBL ICORP 1 VNTR W/BYPASS
|
Professional
|
Both
|
$10,234.00
|
|
|
Service Code
|
HCPCS 33983
|
| Min. Negotiated Rate |
$1,846.46 |
| Max. Negotiated Rate |
$5,935.05 |
| Rate for Payer: Cash Price |
$2,666.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,637.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,374.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,374.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,505.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,637.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,505.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,637.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,637.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,978.35
|
| Rate for Payer: Healthfirst Commercial |
$2,637.80
|
| Rate for Payer: Healthfirst Essential Plan |
$5,935.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,505.91
|
| Rate for Payer: Healthfirst QHP |
$2,637.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,846.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,637.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,242.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,846.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,637.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,978.35
|
| Rate for Payer: SOMOS Essential |
$1,978.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,637.80
|
|
|
PR RPLCMT XTRCORP VAD 1/BIVENTR PUMP 1/EA PUMP
|
Professional
|
Both
|
$3,646.34
|
|
|
Service Code
|
HCPCS 33981
|
| Min. Negotiated Rate |
$667.54 |
| Max. Negotiated Rate |
$2,145.67 |
| Rate for Payer: Cash Price |
$963.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$953.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$858.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$858.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$905.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$953.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$905.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$953.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$953.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$715.22
|
| Rate for Payer: Healthfirst Commercial |
$953.63
|
| Rate for Payer: Healthfirst Essential Plan |
$2,145.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$905.95
|
| Rate for Payer: Healthfirst QHP |
$953.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$667.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$953.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$810.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$667.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$953.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$715.22
|
| Rate for Payer: SOMOS Essential |
$715.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$953.63
|
|
|
PR RPLJ DGT EXCEPT THMB MTCARPHLNGL JT COMPL AMP
|
Professional
|
Both
|
$9,044.14
|
|
|
Service Code
|
HCPCS 20816
|
| Min. Negotiated Rate |
$1,691.10 |
| Max. Negotiated Rate |
$5,435.66 |
| Rate for Payer: Cash Price |
$2,430.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,415.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,174.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,174.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,295.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,415.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,295.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,415.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,415.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,811.89
|
| Rate for Payer: Healthfirst Commercial |
$2,415.85
|
| Rate for Payer: Healthfirst Essential Plan |
$5,435.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,295.06
|
| Rate for Payer: Healthfirst QHP |
$2,415.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,691.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,415.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,053.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,691.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,415.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,811.89
|
| Rate for Payer: SOMOS Essential |
$1,811.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,415.85
|
|
|
PR RPLJ DGT EXCLUDING THMB SUBLIMIS TDN COMPL AMP
|
Professional
|
Both
|
$7,804.44
|
|
|
Service Code
|
HCPCS 20822
|
| Min. Negotiated Rate |
$1,462.84 |
| Max. Negotiated Rate |
$4,701.98 |
| Rate for Payer: Cash Price |
$2,102.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,089.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,880.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,880.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,985.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,089.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,985.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,089.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,089.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,567.33
|
| Rate for Payer: Healthfirst Commercial |
$2,089.77
|
| Rate for Payer: Healthfirst Essential Plan |
$4,701.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,985.28
|
| Rate for Payer: Healthfirst QHP |
$2,089.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,462.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,089.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,776.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,462.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,089.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,567.33
|
| Rate for Payer: SOMOS Essential |
$1,567.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,089.77
|
|
|
PR RPLJ THMB CARP/MTCRPL JT MP JT COMPL AMPUTATION
|
Professional
|
Both
|
$9,059.96
|
|
|
Service Code
|
HCPCS 20824
|
| Min. Negotiated Rate |
$1,694.62 |
| Max. Negotiated Rate |
$5,447.00 |
| Rate for Payer: Cash Price |
$2,435.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,420.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,178.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,178.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,299.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,420.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,299.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,420.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,420.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,815.67
|
| Rate for Payer: Healthfirst Commercial |
$2,420.89
|
| Rate for Payer: Healthfirst Essential Plan |
$5,447.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,299.85
|
| Rate for Payer: Healthfirst QHP |
$2,420.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,694.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,420.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,057.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,694.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,420.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,815.67
|
| Rate for Payer: SOMOS Essential |
$1,815.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,420.89
|
|
|
PR RPLJ THUMB DISTAL TIP MP JOINT COMPL AMPUTATION
|
Professional
|
Both
|
$8,019.52
|
|
|
Service Code
|
HCPCS 20827
|
| Min. Negotiated Rate |
$1,502.79 |
| Max. Negotiated Rate |
$4,830.39 |
| Rate for Payer: Cash Price |
$2,158.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,146.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,932.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,932.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,039.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,146.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,039.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,146.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,146.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,610.13
|
| Rate for Payer: Healthfirst Commercial |
$2,146.84
|
| Rate for Payer: Healthfirst Essential Plan |
$4,830.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,039.50
|
| Rate for Payer: Healthfirst QHP |
$2,146.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,502.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,146.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,824.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,502.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,146.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,610.13
|
| Rate for Payer: SOMOS Essential |
$1,610.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,146.84
|
|
|
PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED
|
Professional
|
Both
|
$2,864.58
|
|
|
Service Code
|
HCPCS 49553
|
| Min. Negotiated Rate |
$531.89 |
| Max. Negotiated Rate |
$1,709.64 |
| Rate for Payer: Cash Price |
$764.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$759.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$683.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$683.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$721.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$759.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$721.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$759.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$759.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$569.88
|
| Rate for Payer: Healthfirst Commercial |
$759.84
|
| Rate for Payer: Healthfirst Essential Plan |
$1,709.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$721.85
|
| Rate for Payer: Healthfirst QHP |
$759.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$531.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$759.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$645.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$531.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$759.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$569.88
|
| Rate for Payer: SOMOS Essential |
$569.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$759.84
|
|
|
PR RPR 1ST FEM HRNA ANY AGE REDUCIBLE
|
Professional
|
Both
|
$2,618.77
|
|
|
Service Code
|
HCPCS 49550
|
| Min. Negotiated Rate |
$487.49 |
| Max. Negotiated Rate |
$1,566.94 |
| Rate for Payer: Cash Price |
$699.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$696.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$626.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$626.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$661.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$696.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$661.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$696.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$696.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$522.32
|
| Rate for Payer: Healthfirst Commercial |
$696.42
|
| Rate for Payer: Healthfirst Essential Plan |
$1,566.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$661.60
|
| Rate for Payer: Healthfirst QHP |
$696.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$487.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$696.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$591.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$487.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$696.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$522.32
|
| Rate for Payer: SOMOS Essential |
$522.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$696.42
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED
|
Professional
|
Both
|
$2,661.33
|
|
|
Service Code
|
HCPCS 49507
|
| Min. Negotiated Rate |
$494.53 |
| Max. Negotiated Rate |
$1,589.56 |
| Rate for Payer: Cash Price |
$711.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$706.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$635.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$635.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$671.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$706.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$671.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$706.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$706.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$529.85
|
| Rate for Payer: Healthfirst Commercial |
$706.47
|
| Rate for Payer: Healthfirst Essential Plan |
$1,589.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$671.15
|
| Rate for Payer: Healthfirst QHP |
$706.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$494.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$706.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$600.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$494.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$706.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$529.85
|
| Rate for Payer: SOMOS Essential |
$529.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$706.47
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE
|
Professional
|
Both
|
$2,366.88
|
|
|
Service Code
|
HCPCS 49505
|
| Min. Negotiated Rate |
$440.81 |
| Max. Negotiated Rate |
$1,416.89 |
| Rate for Payer: Cash Price |
$633.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$629.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$566.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$566.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$598.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$629.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$598.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$629.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$629.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$472.30
|
| Rate for Payer: Healthfirst Commercial |
$629.73
|
| Rate for Payer: Healthfirst Essential Plan |
$1,416.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$598.24
|
| Rate for Payer: Healthfirst QHP |
$629.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$440.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$629.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$535.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$440.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$629.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$472.30
|
| Rate for Payer: SOMOS Essential |
$472.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$629.73
|
|
|
PR RPR 1ST INGUN HRNA AGE 6 MO-5 YRS INCARCERATED
|
Professional
|
Both
|
$2,752.58
|
|
|
Service Code
|
HCPCS 49501
|
| Min. Negotiated Rate |
$512.26 |
| Max. Negotiated Rate |
$1,646.55 |
| Rate for Payer: Cash Price |
$735.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$731.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$658.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$658.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$695.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$731.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$695.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$731.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$731.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$548.85
|
| Rate for Payer: Healthfirst Commercial |
$731.80
|
| Rate for Payer: Healthfirst Essential Plan |
$1,646.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$695.21
|
| Rate for Payer: Healthfirst QHP |
$731.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$512.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$731.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$622.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$512.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$731.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$548.85
|
| Rate for Payer: SOMOS Essential |
$548.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$731.80
|
|
|
PR RPR 1ST INGUN HRNA AGE 6 MO-5 YRS REDUCIBLE
|
Professional
|
Both
|
$1,885.35
|
|
|
Service Code
|
HCPCS 49500
|
| Min. Negotiated Rate |
$351.43 |
| Max. Negotiated Rate |
$1,129.59 |
| Rate for Payer: Cash Price |
$506.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$502.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$451.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$451.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$476.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$502.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$476.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$502.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$502.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$376.53
|
| Rate for Payer: Healthfirst Commercial |
$502.04
|
| Rate for Payer: Healthfirst Essential Plan |
$1,129.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$476.94
|
| Rate for Payer: Healthfirst QHP |
$502.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$351.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$502.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$426.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$351.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$502.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$376.53
|
| Rate for Payer: SOMOS Essential |
$376.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$502.04
|
|
|
PR RPR 1ST INGUN HRNA FULL TERM INFT <6 MO INCARCER
|
Professional
|
Both
|
$2,788.70
|
|
|
Service Code
|
HCPCS 49496
|
| Min. Negotiated Rate |
$519.41 |
| Max. Negotiated Rate |
$1,669.55 |
| Rate for Payer: Cash Price |
$746.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$742.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$667.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$667.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$704.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$742.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$704.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$742.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$742.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$556.51
|
| Rate for Payer: Healthfirst Commercial |
$742.02
|
| Rate for Payer: Healthfirst Essential Plan |
$1,669.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$704.92
|
| Rate for Payer: Healthfirst QHP |
$742.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$519.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$742.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$630.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$519.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$742.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$556.51
|
| Rate for Payer: SOMOS Essential |
$556.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$742.02
|
|
