|
PR RPR BLOOD VSL GRF OTH/THN VEIN UPPER EXTREMITY
|
Professional
|
Both
|
$3,823.40
|
|
|
Service Code
|
HCPCS 35266
|
| Min. Negotiated Rate |
$706.41 |
| Max. Negotiated Rate |
$2,270.61 |
| Rate for Payer: Cash Price |
$1,019.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,009.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$908.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$908.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$958.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,009.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$958.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,009.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,009.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$756.87
|
| Rate for Payer: Healthfirst Commercial |
$1,009.16
|
| Rate for Payer: Healthfirst Essential Plan |
$2,270.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$958.70
|
| Rate for Payer: Healthfirst QHP |
$1,009.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$706.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,009.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$857.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$706.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,009.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$756.87
|
| Rate for Payer: SOMOS Essential |
$756.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,009.16
|
|
|
PR RPR BLPOS CONJUNCTIVO-TARSO-MUSC-LEVATOR RESCJ
|
Professional
|
Both
|
$1,785.11
|
|
|
Service Code
|
HCPCS 67908
|
| Min. Negotiated Rate |
$339.98 |
| Max. Negotiated Rate |
$1,092.80 |
| Rate for Payer: Cash Price |
$491.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$485.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$437.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$437.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$461.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$485.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$461.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$485.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$485.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$364.27
|
| Rate for Payer: Healthfirst Commercial |
$485.69
|
| Rate for Payer: Healthfirst Essential Plan |
$1,092.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$461.41
|
| Rate for Payer: Healthfirst QHP |
$485.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$339.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$485.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$412.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$339.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$485.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$364.27
|
| Rate for Payer: SOMOS Essential |
$364.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$485.69
|
|
|
PR RPR BLVSL W/GRF OTHER/THAN VEIN LOWER EXTREMITY
|
Professional
|
Both
|
$4,128.32
|
|
|
Service Code
|
HCPCS 35286
|
| Min. Negotiated Rate |
$756.24 |
| Max. Negotiated Rate |
$2,430.76 |
| Rate for Payer: Cash Price |
$1,091.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,080.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$972.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$972.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,026.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,080.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,026.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,080.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,080.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$810.25
|
| Rate for Payer: Healthfirst Commercial |
$1,080.34
|
| Rate for Payer: Healthfirst Essential Plan |
$2,430.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,026.32
|
| Rate for Payer: Healthfirst QHP |
$1,080.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$756.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,080.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$918.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$756.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,080.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$810.25
|
| Rate for Payer: SOMOS Essential |
$810.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,080.34
|
|
|
PR RPR BLVSL W/GRFT OTHER/THAN VEIN INTRA-ABDOMINAL
|
Professional
|
Both
|
$7,213.36
|
|
|
Service Code
|
HCPCS 35281
|
| Min. Negotiated Rate |
$1,337.53 |
| Max. Negotiated Rate |
$4,299.19 |
| Rate for Payer: Cash Price |
$1,913.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,910.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,719.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,719.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,815.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,910.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,815.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,910.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,910.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,433.06
|
| Rate for Payer: Healthfirst Commercial |
$1,910.75
|
| Rate for Payer: Healthfirst Essential Plan |
$4,299.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,815.21
|
| Rate for Payer: Healthfirst QHP |
$1,910.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,337.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,910.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,624.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,337.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,910.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,433.06
|
| Rate for Payer: SOMOS Essential |
$1,433.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,910.75
|
|
|
PR RPR CAR ANOMAL CLSR SEPTL DFCT SMPL FONTAN PX
|
Professional
|
Both
|
$8,884.93
|
|
|
Service Code
|
HCPCS 33615
|
| Min. Negotiated Rate |
$1,636.91 |
| Max. Negotiated Rate |
$5,261.49 |
| Rate for Payer: Cash Price |
$2,362.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,338.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,104.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,104.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,221.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,338.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,221.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,338.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,338.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,753.83
|
| Rate for Payer: Healthfirst Commercial |
$2,338.44
|
| Rate for Payer: Healthfirst Essential Plan |
$5,261.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,221.52
|
| Rate for Payer: Healthfirst QHP |
$2,338.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,636.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,338.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,987.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,636.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,338.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,753.83
|
| Rate for Payer: SOMOS Essential |
$1,753.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,338.44
|
|
|
PR RPR CAR ANOMAL SURG ENLGMENT VENTR SEPTL DFCT
|
Professional
|
Both
|
$7,906.01
|
|
|
Service Code
|
HCPCS 33610
|
| Min. Negotiated Rate |
$1,458.37 |
| Max. Negotiated Rate |
$4,687.63 |
| Rate for Payer: Cash Price |
$2,103.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,083.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,875.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,875.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,979.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,083.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,979.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,083.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,083.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,562.54
|
| Rate for Payer: Healthfirst Commercial |
$2,083.39
|
| Rate for Payer: Healthfirst Essential Plan |
$4,687.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,979.22
|
| Rate for Payer: Healthfirst QHP |
$2,083.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,458.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,083.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,770.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,458.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,083.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,562.54
|
| Rate for Payer: SOMOS Essential |
$1,562.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,083.39
|
|
|
PR RPR CAR ANOMAL XCP PULM ATRESIA VENTR SEPTL DFCT
|
Professional
|
Both
|
$8,012.20
|
|
|
Service Code
|
HCPCS 33608
|
| Min. Negotiated Rate |
$1,478.51 |
| Max. Negotiated Rate |
$4,752.36 |
| Rate for Payer: Cash Price |
$2,132.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,112.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,900.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,900.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,006.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,112.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,006.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,112.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,112.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,584.12
|
| Rate for Payer: Healthfirst Commercial |
$2,112.16
|
| Rate for Payer: Healthfirst Essential Plan |
$4,752.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,006.55
|
| Rate for Payer: Healthfirst QHP |
$2,112.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,478.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,112.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,795.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,478.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,112.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,584.12
|
| Rate for Payer: SOMOS Essential |
$1,584.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,112.16
|
|
|
PR RPR CLOACAL ANOMALY CMBN ABDL&SACROPRNL
|
Professional
|
Both
|
$17,605.42
|
|
|
Service Code
|
HCPCS 46746
|
| Min. Negotiated Rate |
$3,253.05 |
| Max. Negotiated Rate |
$10,456.25 |
| Rate for Payer: Cash Price |
$4,683.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,647.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,182.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,182.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,414.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,647.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,414.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,647.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,647.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,485.41
|
| Rate for Payer: Healthfirst Commercial |
$4,647.22
|
| Rate for Payer: Healthfirst Essential Plan |
$10,456.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,414.86
|
| Rate for Payer: Healthfirst QHP |
$4,647.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,253.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,647.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,950.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3,253.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,647.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,485.41
|
| Rate for Payer: SOMOS Essential |
$3,485.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,647.22
|
|
|
PR RPR CLOACAL ANOMALY CMBN ABDL & SACROPRNL W/GRF
|
Professional
|
Both
|
$19,079.80
|
|
|
Service Code
|
HCPCS 46748
|
| Min. Negotiated Rate |
$3,523.89 |
| Max. Negotiated Rate |
$11,326.79 |
| Rate for Payer: Cash Price |
$5,074.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,034.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,530.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,530.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,782.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,034.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,782.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,034.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,034.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,775.60
|
| Rate for Payer: Healthfirst Commercial |
$5,034.13
|
| Rate for Payer: Healthfirst Essential Plan |
$11,326.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,782.42
|
| Rate for Payer: Healthfirst QHP |
$5,034.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,523.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5,034.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4,279.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3,523.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,034.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,775.60
|
| Rate for Payer: SOMOS Essential |
$3,775.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,034.13
|
|
|
PR RPR CLOACAL ANOMALY SACROPERINEAL
|
Professional
|
Both
|
$15,981.49
|
|
|
Service Code
|
HCPCS 46744
|
| Min. Negotiated Rate |
$2,955.25 |
| Max. Negotiated Rate |
$9,499.00 |
| Rate for Payer: Cash Price |
$4,253.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,221.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,799.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,799.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,010.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,221.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,010.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,221.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,221.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,166.34
|
| Rate for Payer: Healthfirst Commercial |
$4,221.78
|
| Rate for Payer: Healthfirst Essential Plan |
$9,499.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,010.69
|
| Rate for Payer: Healthfirst QHP |
$4,221.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,955.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,221.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,588.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,955.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,221.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,166.34
|
| Rate for Payer: SOMOS Essential |
$3,166.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,221.78
|
|
|
PR RPR COLTRL LIGM MTCARPHLNGL/IPHAL JT
|
Professional
|
Both
|
$3,099.78
|
|
|
Service Code
|
HCPCS 26540
|
| Min. Negotiated Rate |
$576.79 |
| Max. Negotiated Rate |
$1,853.98 |
| Rate for Payer: Cash Price |
$836.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$823.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$741.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$741.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$782.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$823.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$782.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$823.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$823.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$617.99
|
| Rate for Payer: Healthfirst Commercial |
$823.99
|
| Rate for Payer: Healthfirst Essential Plan |
$1,853.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$782.79
|
| Rate for Payer: Healthfirst QHP |
$823.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$576.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$823.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$700.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$576.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$823.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$617.99
|
| Rate for Payer: SOMOS Essential |
$617.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$823.99
|
|
|
PR RPR COMPL AV CANAL W/WO PROSTC VALVE
|
Professional
|
Both
|
$8,765.09
|
|
|
Service Code
|
HCPCS 33670
|
| Min. Negotiated Rate |
$1,607.88 |
| Max. Negotiated Rate |
$5,168.18 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,296.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,067.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,067.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,182.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,296.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,182.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,296.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,296.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,722.73
|
| Rate for Payer: Healthfirst Commercial |
$2,296.97
|
| Rate for Payer: Healthfirst Essential Plan |
$5,168.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,182.12
|
| Rate for Payer: Healthfirst QHP |
$2,296.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,607.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,296.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,952.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,607.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,296.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,722.73
|
| Rate for Payer: SOMOS Essential |
$1,722.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,296.97
|
|
|
PR RPR COMPLEX CARDIAC ANOMALY MODIFIED FONTAN PX
|
Professional
|
Both
|
$9,628.36
|
|
|
Service Code
|
HCPCS 33617
|
| Min. Negotiated Rate |
$1,771.41 |
| Max. Negotiated Rate |
$5,693.83 |
| Rate for Payer: Cash Price |
$2,559.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,530.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,277.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,277.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,404.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,530.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,404.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,530.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,530.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,897.94
|
| Rate for Payer: Healthfirst Commercial |
$2,530.59
|
| Rate for Payer: Healthfirst Essential Plan |
$5,693.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,404.06
|
| Rate for Payer: Healthfirst QHP |
$2,530.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,771.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,530.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,151.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,771.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,530.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,897.94
|
| Rate for Payer: SOMOS Essential |
$1,897.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,530.59
|
|
|
PR RPR COMPLEX RETINA DETACH VITRECT &MEMBRANE PEEL
|
Professional
|
Both
|
$5,446.91
|
|
|
Service Code
|
HCPCS 67113
|
| Min. Negotiated Rate |
$1,032.60 |
| Max. Negotiated Rate |
$3,319.07 |
| Rate for Payer: Cash Price |
$1,496.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,475.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,327.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,327.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,401.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,475.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,401.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,475.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,475.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,106.36
|
| Rate for Payer: Healthfirst Commercial |
$1,475.14
|
| Rate for Payer: Healthfirst Essential Plan |
$3,319.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,401.38
|
| Rate for Payer: Healthfirst QHP |
$1,475.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,032.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,475.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,253.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,032.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,475.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,106.36
|
| Rate for Payer: SOMOS Essential |
$1,106.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,475.14
|
|
|
PR RPR COMPONENT INFLATABLE PENILE PROSTHESIS
|
Professional
|
Both
|
$3,313.49
|
|
|
Service Code
|
HCPCS 54408
|
| Min. Negotiated Rate |
$632.18 |
| Max. Negotiated Rate |
$2,032.00 |
| Rate for Payer: Cash Price |
$907.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$903.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$812.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$812.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$857.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$903.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$857.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$903.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$903.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$677.33
|
| Rate for Payer: Healthfirst Commercial |
$903.11
|
| Rate for Payer: Healthfirst Essential Plan |
$2,032.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$857.95
|
| Rate for Payer: Healthfirst QHP |
$903.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$632.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$903.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$767.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$632.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$903.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$677.33
|
| Rate for Payer: SOMOS Essential |
$677.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$903.11
|
|
|
PR RPR CONGENITAL AV FISTULA EXTREMITIES
|
Professional
|
Both
|
$4,293.42
|
|
|
Service Code
|
HCPCS 35184
|
| Min. Negotiated Rate |
$788.12 |
| Max. Negotiated Rate |
$2,533.25 |
| Rate for Payer: Cash Price |
$1,137.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,125.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,013.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,013.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,069.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,125.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,069.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,125.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,125.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$844.42
|
| Rate for Payer: Healthfirst Commercial |
$1,125.89
|
| Rate for Payer: Healthfirst Essential Plan |
$2,533.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,069.60
|
| Rate for Payer: Healthfirst QHP |
$1,125.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$788.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,125.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$957.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$788.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,125.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$844.42
|
| Rate for Payer: SOMOS Essential |
$844.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,125.89
|
|
|
PR RPR CONGENITAL AV FISTULA THORAX & ABDOMEN
|
Professional
|
Both
|
$7,972.76
|
|
|
Service Code
|
HCPCS 35182
|
| Min. Negotiated Rate |
$1,470.51 |
| Max. Negotiated Rate |
$4,726.64 |
| Rate for Payer: Cash Price |
$2,121.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,100.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,890.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,890.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,995.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,100.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,995.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,100.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,100.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,575.55
|
| Rate for Payer: Healthfirst Commercial |
$2,100.73
|
| Rate for Payer: Healthfirst Essential Plan |
$4,726.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,995.69
|
| Rate for Payer: Healthfirst QHP |
$2,100.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,470.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,100.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,785.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,470.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,100.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,575.55
|
| Rate for Payer: SOMOS Essential |
$1,575.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,100.73
|
|
|
PR RPR CORONARY AV/ARTERIOCAR CHMBR FSTL W/BYPASS
|
Professional
|
Both
|
$6,879.08
|
|
|
Service Code
|
HCPCS 33500
|
| Min. Negotiated Rate |
$1,269.40 |
| Max. Negotiated Rate |
$4,080.22 |
| Rate for Payer: Cash Price |
$1,827.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,813.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,632.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,632.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,722.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,813.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,722.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,813.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,813.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,360.07
|
| Rate for Payer: Healthfirst Commercial |
$1,813.43
|
| Rate for Payer: Healthfirst Essential Plan |
$4,080.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,722.76
|
| Rate for Payer: Healthfirst QHP |
$1,813.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,269.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,813.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,541.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,269.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,813.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,360.07
|
| Rate for Payer: SOMOS Essential |
$1,360.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,813.43
|
|
|
PR RPR CORONARY AV/ARTERIOCAR CHMBR FSTL W/O BYPASS
|
Professional
|
Both
|
$4,912.92
|
|
|
Service Code
|
HCPCS 33501
|
| Min. Negotiated Rate |
$910.06 |
| Max. Negotiated Rate |
$2,925.18 |
| Rate for Payer: Cash Price |
$1,308.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,300.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,170.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,170.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,235.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,300.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,235.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,300.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,300.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$975.06
|
| Rate for Payer: Healthfirst Commercial |
$1,300.08
|
| Rate for Payer: Healthfirst Essential Plan |
$2,925.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,235.08
|
| Rate for Payer: Healthfirst QHP |
$1,300.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$910.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,300.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,105.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$910.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,300.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$975.06
|
| Rate for Payer: SOMOS Essential |
$975.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,300.08
|
|
|
PR RPR COR TRIATM/SUPVALVR RING RESCJ L ATRIAL MEMB
|
Professional
|
Both
|
$7,339.78
|
|
|
Service Code
|
HCPCS 33732
|
| Min. Negotiated Rate |
$1,353.80 |
| Max. Negotiated Rate |
$4,351.50 |
| Rate for Payer: Cash Price |
$1,954.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,934.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,740.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,740.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,837.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,934.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,837.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,934.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,934.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,450.50
|
| Rate for Payer: Healthfirst Commercial |
$1,934.00
|
| Rate for Payer: Healthfirst Essential Plan |
$4,351.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,837.30
|
| Rate for Payer: Healthfirst QHP |
$1,934.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,353.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,934.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,643.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,353.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,934.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,450.50
|
| Rate for Payer: SOMOS Essential |
$1,450.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,934.00
|
|
|
PR RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT
|
Professional
|
Both
|
$795.24
|
|
|
Service Code
|
HCPCS 36576
|
| Min. Negotiated Rate |
$147.53 |
| Max. Negotiated Rate |
$474.19 |
| Rate for Payer: Cash Price |
$213.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$210.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$189.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$189.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$200.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$200.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$210.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$210.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$158.06
|
| Rate for Payer: Healthfirst Commercial |
$210.75
|
| Rate for Payer: Healthfirst Essential Plan |
$474.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$200.21
|
| Rate for Payer: Healthfirst QHP |
$210.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$147.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$210.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$179.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$147.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$210.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$158.06
|
| Rate for Payer: SOMOS Essential |
$158.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$210.75
|
|
|
PR RPR DIPHRG HRNA OTH/THN NEONATAL TRAUMTC AQT
|
Professional
|
Both
|
$3,881.05
|
|
|
Service Code
|
HCPCS 39540
|
| Min. Negotiated Rate |
$716.41 |
| Max. Negotiated Rate |
$2,302.74 |
| Rate for Payer: Cash Price |
$1,037.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,023.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$921.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$921.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$972.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,023.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$972.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,023.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,023.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$767.58
|
| Rate for Payer: Healthfirst Commercial |
$1,023.44
|
| Rate for Payer: Healthfirst Essential Plan |
$2,302.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$972.27
|
| Rate for Payer: Healthfirst QHP |
$1,023.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$716.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,023.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$869.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$716.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,023.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$767.58
|
| Rate for Payer: SOMOS Essential |
$767.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,023.44
|
|
|
PR RPR DIPHRG HRNA OTH/THN NEONATAL TRAUMTC CHRNC
|
Professional
|
Both
|
$4,188.70
|
|
|
Service Code
|
HCPCS 39541
|
| Min. Negotiated Rate |
$778.86 |
| Max. Negotiated Rate |
$2,503.49 |
| Rate for Payer: Cash Price |
$1,115.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,112.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,001.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,001.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,057.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,112.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,057.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,112.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,112.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$834.50
|
| Rate for Payer: Healthfirst Commercial |
$1,112.66
|
| Rate for Payer: Healthfirst Essential Plan |
$2,503.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,057.03
|
| Rate for Payer: Healthfirst QHP |
$1,112.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$778.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,112.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$945.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$778.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,112.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$834.50
|
| Rate for Payer: SOMOS Essential |
$834.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,112.66
|
|
|
PR RPR DISLOC PERONEAL TENDON W/O FIBULAR OSTEOTOMY
|
Professional
|
Both
|
$2,144.10
|
|
|
Service Code
|
HCPCS 27675
|
| Min. Negotiated Rate |
$407.11 |
| Max. Negotiated Rate |
$1,308.58 |
| Rate for Payer: Cash Price |
$583.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$581.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$523.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$523.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$552.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$581.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$552.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$581.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$581.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$436.19
|
| Rate for Payer: Healthfirst Commercial |
$581.59
|
| Rate for Payer: Healthfirst Essential Plan |
$1,308.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$552.51
|
| Rate for Payer: Healthfirst QHP |
$581.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$407.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$581.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$494.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$407.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$581.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$436.19
|
| Rate for Payer: SOMOS Essential |
$436.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$581.59
|
|
|
PR RPR & DIV SYMBLEPHARON W/WO CONFORM/CONTACT LE
|
Professional
|
Both
|
$1,648.64
|
|
|
Service Code
|
HCPCS 68340
|
| Min. Negotiated Rate |
$315.21 |
| Max. Negotiated Rate |
$1,013.17 |
| Rate for Payer: Cash Price |
$453.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$450.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$405.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$405.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$427.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$450.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$427.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$450.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$450.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$337.73
|
| Rate for Payer: Healthfirst Commercial |
$450.30
|
| Rate for Payer: Healthfirst Essential Plan |
$1,013.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$427.79
|
| Rate for Payer: Healthfirst QHP |
$450.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$315.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$450.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$382.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$315.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$450.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$337.73
|
| Rate for Payer: SOMOS Essential |
$337.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$450.30
|
|
