|
PR TRANSPEDICULAR DCMPRN 1 SEG EA THORACIC/LUMBAR
|
Professional
|
Both
|
$1,505.95
|
|
|
Service Code
|
HCPCS 63057
|
| Min. Negotiated Rate |
$276.22 |
| Max. Negotiated Rate |
$887.85 |
| Rate for Payer: Cash Price |
$396.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$394.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$355.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$355.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$374.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$394.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$374.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$394.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$394.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$295.95
|
| Rate for Payer: Healthfirst Commercial |
$394.60
|
| Rate for Payer: Healthfirst Essential Plan |
$887.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$374.87
|
| Rate for Payer: Healthfirst QHP |
$394.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$276.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$394.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$335.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$276.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$394.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$295.95
|
| Rate for Payer: SOMOS Essential |
$295.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$394.60
|
|
|
PR TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG LUMBAR
|
Professional
|
Both
|
$6,972.00
|
|
|
Service Code
|
HCPCS 63056
|
| Min. Negotiated Rate |
$1,279.14 |
| Max. Negotiated Rate |
$4,111.54 |
| Rate for Payer: Cash Price |
$1,847.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,827.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,644.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,644.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,735.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,827.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,735.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,827.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,827.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,370.51
|
| Rate for Payer: Healthfirst Commercial |
$1,827.35
|
| Rate for Payer: Healthfirst Essential Plan |
$4,111.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,735.98
|
| Rate for Payer: Healthfirst QHP |
$1,827.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,279.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,827.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,553.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,279.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,827.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,370.51
|
| Rate for Payer: SOMOS Essential |
$1,370.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,827.35
|
|
|
PR TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG THORACIC
|
Professional
|
Both
|
$7,708.02
|
|
|
Service Code
|
HCPCS 63055
|
| Min. Negotiated Rate |
$1,413.07 |
| Max. Negotiated Rate |
$4,542.01 |
| Rate for Payer: Cash Price |
$2,038.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,018.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,816.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,816.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,917.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,018.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,917.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,018.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,018.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,514.00
|
| Rate for Payer: Healthfirst Commercial |
$2,018.67
|
| Rate for Payer: Healthfirst Essential Plan |
$4,542.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,917.74
|
| Rate for Payer: Healthfirst QHP |
$2,018.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,413.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,018.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,715.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,413.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,018.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,514.00
|
| Rate for Payer: SOMOS Essential |
$1,514.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,018.67
|
|
|
PR TRANSPERINEAL PLMT BIODEGRADABLE MATRL 1/MLT NJX
|
Professional
|
Both
|
$677.22
|
|
|
Service Code
|
HCPCS 55874
|
| Min. Negotiated Rate |
$128.97 |
| Max. Negotiated Rate |
$414.56 |
| Rate for Payer: Cash Price |
$185.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$165.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$165.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$184.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$138.19
|
| Rate for Payer: Healthfirst Commercial |
$184.25
|
| Rate for Payer: Healthfirst Essential Plan |
$414.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$175.04
|
| Rate for Payer: Healthfirst QHP |
$184.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$128.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$184.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$156.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$128.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.19
|
| Rate for Payer: SOMOS Essential |
$138.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.25
|
|
|
PR TRANSPERINEAL PLMT NDL/CATHS PROSTATE RADJ INSJ
|
Professional
|
Both
|
$3,240.58
|
|
|
Service Code
|
HCPCS 55875
|
| Min. Negotiated Rate |
$622.52 |
| Max. Negotiated Rate |
$2,000.97 |
| Rate for Payer: Cash Price |
$889.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$889.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$800.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$800.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$844.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$889.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$844.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$889.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$889.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$666.99
|
| Rate for Payer: Healthfirst Commercial |
$889.32
|
| Rate for Payer: Healthfirst Essential Plan |
$2,000.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$844.85
|
| Rate for Payer: Healthfirst QHP |
$889.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$622.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$889.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$755.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$622.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$889.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$666.99
|
| Rate for Payer: SOMOS Essential |
$666.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$889.32
|
|
|
PR TRANSPLANTATION PANCREATIC ALLOGRAFT
|
Professional
|
Both
|
$11,738.90
|
|
|
Service Code
|
HCPCS 48554
|
| Min. Negotiated Rate |
$2,208.25 |
| Max. Negotiated Rate |
$7,097.94 |
| Rate for Payer: Cash Price |
$3,165.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,154.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,839.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,839.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,996.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,154.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,996.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,154.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,154.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,365.98
|
| Rate for Payer: Healthfirst Commercial |
$3,154.64
|
| Rate for Payer: Healthfirst Essential Plan |
$7,097.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,996.91
|
| Rate for Payer: Healthfirst QHP |
$3,154.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,208.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,154.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,681.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,208.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,154.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,365.98
|
| Rate for Payer: SOMOS Essential |
$2,365.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,154.64
|
|
|
PR TRANSPLANTATION TESTIS TO THIGH
|
Professional
|
Both
|
$3,297.84
|
|
|
Service Code
|
HCPCS 54680
|
| Min. Negotiated Rate |
$628.03 |
| Max. Negotiated Rate |
$2,018.65 |
| Rate for Payer: Cash Price |
$901.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$897.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$807.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$807.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$852.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$897.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$852.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$897.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$897.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$672.88
|
| Rate for Payer: Healthfirst Commercial |
$897.18
|
| Rate for Payer: Healthfirst Essential Plan |
$2,018.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$852.32
|
| Rate for Payer: Healthfirst QHP |
$897.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$628.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$897.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$762.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$628.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$897.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$672.88
|
| Rate for Payer: SOMOS Essential |
$672.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$897.18
|
|
|
PR TRANSPLANT/TRANSFER THIGH XTNSR TO FLXR 1 TENDON
|
Professional
|
Both
|
$2,751.60
|
|
|
Service Code
|
HCPCS 27396
|
| Min. Negotiated Rate |
$519.86 |
| Max. Negotiated Rate |
$1,670.96 |
| Rate for Payer: Cash Price |
$744.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$742.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$668.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$668.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$705.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$742.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$705.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$742.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$742.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$556.99
|
| Rate for Payer: Healthfirst Commercial |
$742.65
|
| Rate for Payer: Healthfirst Essential Plan |
$1,670.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$705.52
|
| Rate for Payer: Healthfirst QHP |
$742.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$519.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$742.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$631.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$519.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$742.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$556.99
|
| Rate for Payer: SOMOS Essential |
$556.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$742.65
|
|
|
PR TRANSPLANT/TRANSFER THIGH XTNSR TO FLXR MULT TDN
|
Professional
|
Both
|
$4,051.50
|
|
|
Service Code
|
HCPCS 27397
|
| Min. Negotiated Rate |
$764.60 |
| Max. Negotiated Rate |
$2,457.65 |
| Rate for Payer: Cash Price |
$1,096.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,092.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$983.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$983.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,037.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,092.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,037.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,092.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,092.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$819.22
|
| Rate for Payer: Healthfirst Commercial |
$1,092.29
|
| Rate for Payer: Healthfirst Essential Plan |
$2,457.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,037.68
|
| Rate for Payer: Healthfirst QHP |
$1,092.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$764.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,092.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$928.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$764.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,092.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$819.22
|
| Rate for Payer: SOMOS Essential |
$819.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,092.29
|
|
|
PR TRANSPOSITION OVARY
|
Professional
|
Both
|
$3,100.16
|
|
|
Service Code
|
HCPCS 58825
|
| Min. Negotiated Rate |
$576.24 |
| Max. Negotiated Rate |
$1,852.20 |
| Rate for Payer: Cash Price |
$836.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$823.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$740.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$740.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$782.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$823.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$782.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$823.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$823.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$617.40
|
| Rate for Payer: Healthfirst Commercial |
$823.20
|
| Rate for Payer: Healthfirst Essential Plan |
$1,852.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$782.04
|
| Rate for Payer: Healthfirst QHP |
$823.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$576.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$823.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$699.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$576.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$823.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$617.40
|
| Rate for Payer: SOMOS Essential |
$617.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$823.20
|
|
|
PR TRANSPOSITION PROCEDURE EXTRAOCULAR MUSC
|
Professional
|
Both
|
$833.98
|
|
|
Service Code
|
HCPCS 67320
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$432.20 |
| Rate for Payer: Cash Price |
$194.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$192.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$172.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$182.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$192.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$182.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$192.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$192.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$144.07
|
| Rate for Payer: Healthfirst Commercial |
$192.09
|
| Rate for Payer: Healthfirst Essential Plan |
$432.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$182.49
|
| Rate for Payer: Healthfirst QHP |
$192.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$134.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$192.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$163.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$134.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$192.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$144.07
|
| Rate for Payer: SOMOS Essential |
$144.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$192.09
|
|
|
PR TRANSPTRSAL POST CRNL FOSSA CLIVUS/FORAMN MAGNUM
|
Professional
|
Both
|
$13,650.35
|
|
|
Service Code
|
HCPCS 61598
|
| Min. Negotiated Rate |
$2,479.67 |
| Max. Negotiated Rate |
$7,970.38 |
| Rate for Payer: Cash Price |
$3,594.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,542.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,188.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,188.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,365.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,542.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,365.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,542.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,542.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,656.79
|
| Rate for Payer: Healthfirst Commercial |
$3,542.39
|
| Rate for Payer: Healthfirst Essential Plan |
$7,970.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,365.27
|
| Rate for Payer: Healthfirst QHP |
$3,542.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,479.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,542.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,011.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,479.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,542.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,656.79
|
| Rate for Payer: SOMOS Essential |
$2,656.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,542.39
|
|
|
PR TRANSRECTAL ABLTJ MAL PRST8 TISSUE HIFU W/US
|
Professional
|
Both
|
$4,090.42
|
|
|
Service Code
|
HCPCS 55880
|
| Min. Negotiated Rate |
$779.36 |
| Max. Negotiated Rate |
$2,505.08 |
| Rate for Payer: Cash Price |
$1,119.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,113.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,002.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,002.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,057.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,113.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,057.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,113.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,113.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$835.03
|
| Rate for Payer: Healthfirst Commercial |
$1,113.37
|
| Rate for Payer: Healthfirst Essential Plan |
$2,505.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,057.70
|
| Rate for Payer: Healthfirst QHP |
$1,113.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$779.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,113.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$946.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$779.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,113.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$835.03
|
| Rate for Payer: SOMOS Essential |
$835.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,113.37
|
|
|
PR TRANSRECTAL DRAINAGE OF PELVIC ABSCESS
|
Professional
|
Both
|
$1,882.44
|
|
|
Service Code
|
HCPCS 45000
|
| Min. Negotiated Rate |
$352.43 |
| Max. Negotiated Rate |
$1,132.81 |
| Rate for Payer: Cash Price |
$508.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$503.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$453.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$453.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$478.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$503.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$478.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$503.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$503.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$377.60
|
| Rate for Payer: Healthfirst Commercial |
$503.47
|
| Rate for Payer: Healthfirst Essential Plan |
$1,132.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$478.30
|
| Rate for Payer: Healthfirst QHP |
$503.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$352.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$503.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$427.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$352.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$503.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$377.60
|
| Rate for Payer: SOMOS Essential |
$377.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$503.47
|
|
|
PR TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL
|
Professional
|
Both
|
$192.36
|
|
|
Service Code
|
HCPCS 93293
|
| Min. Negotiated Rate |
$33.07 |
| Max. Negotiated Rate |
$106.29 |
| Rate for Payer: Amida Care Medicaid |
$47.39
|
| Rate for Payer: Cash Price |
$50.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.43
|
| Rate for Payer: Healthfirst Commercial |
$47.24
|
| Rate for Payer: Healthfirst Essential Plan |
$106.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.88
|
| Rate for Payer: Healthfirst QHP |
$47.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.43
|
| Rate for Payer: SOMOS Essential |
$35.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.24
|
|
|
PR TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL
|
Professional
|
Both
|
$55.93
|
|
|
Service Code
|
HCPCS 93293 26
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$47.39 |
| Rate for Payer: Amida Care Medicaid |
$47.39
|
| Rate for Payer: Cash Price |
$15.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.09
|
| Rate for Payer: Healthfirst Commercial |
$14.79
|
| Rate for Payer: Healthfirst Essential Plan |
$33.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.05
|
| Rate for Payer: Healthfirst QHP |
$14.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.09
|
| Rate for Payer: SOMOS Essential |
$11.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.79
|
|
|
PR TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL
|
Professional
|
Both
|
$136.43
|
|
|
Service Code
|
HCPCS 93293 TC
|
| Min. Negotiated Rate |
$22.71 |
| Max. Negotiated Rate |
$73.01 |
| Rate for Payer: Amida Care Medicaid |
$47.39
|
| Rate for Payer: Cash Price |
$35.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.34
|
| Rate for Payer: Healthfirst Commercial |
$32.45
|
| Rate for Payer: Healthfirst Essential Plan |
$73.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.83
|
| Rate for Payer: Healthfirst QHP |
$32.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.34
|
| Rate for Payer: SOMOS Essential |
$24.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.45
|
|
|
PR TRANSTEMP APPR POST CRAN FOSSA DCOMPR SINUS/NRV
|
Professional
|
Both
|
$10,753.12
|
|
|
Service Code
|
HCPCS 61595
|
| Min. Negotiated Rate |
$1,995.53 |
| Max. Negotiated Rate |
$6,414.19 |
| Rate for Payer: Cash Price |
$2,887.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,850.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,565.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,565.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,708.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,850.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,708.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,850.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,850.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,138.06
|
| Rate for Payer: Healthfirst Commercial |
$2,850.75
|
| Rate for Payer: Healthfirst Essential Plan |
$6,414.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,708.21
|
| Rate for Payer: Healthfirst QHP |
$2,850.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,995.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,850.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,423.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,995.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,850.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,138.06
|
| Rate for Payer: SOMOS Essential |
$2,138.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,850.75
|
|
|
PR TRANSTHORACIC CATHETER INSERTION FOR STENT PLMT
|
Professional
|
Both
|
$4,133.22
|
|
|
Service Code
|
HCPCS 33621
|
| Min. Negotiated Rate |
$763.78 |
| Max. Negotiated Rate |
$2,455.02 |
| Rate for Payer: Cash Price |
$1,101.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,091.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$982.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$982.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,036.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,091.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,036.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,091.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,091.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$818.34
|
| Rate for Payer: Healthfirst Commercial |
$1,091.12
|
| Rate for Payer: Healthfirst Essential Plan |
$2,455.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,036.56
|
| Rate for Payer: Healthfirst QHP |
$1,091.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$763.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,091.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$927.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$763.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,091.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$818.34
|
| Rate for Payer: SOMOS Essential |
$818.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,091.12
|
|
|
PR TRANSURETEROURETEROSTOMY ANAST URETER CLAT URTR
|
Professional
|
Both
|
$4,803.58
|
|
|
Service Code
|
HCPCS 50770
|
| Min. Negotiated Rate |
$913.48 |
| Max. Negotiated Rate |
$2,936.18 |
| Rate for Payer: Cash Price |
$1,313.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,304.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,174.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,174.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,239.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,304.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,239.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,304.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,304.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$978.73
|
| Rate for Payer: Healthfirst Commercial |
$1,304.97
|
| Rate for Payer: Healthfirst Essential Plan |
$2,936.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,239.72
|
| Rate for Payer: Healthfirst QHP |
$1,304.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$913.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,304.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,109.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$913.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,304.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$978.73
|
| Rate for Payer: SOMOS Essential |
$978.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,304.97
|
|
|
PR TRANSURETHRAL INCISION PROSTATE
|
Professional
|
Both
|
$1,991.05
|
|
|
Service Code
|
HCPCS 52450
|
| Min. Negotiated Rate |
$382.34 |
| Max. Negotiated Rate |
$1,228.95 |
| Rate for Payer: Cash Price |
$548.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$546.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$491.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$491.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$518.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$546.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$518.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$546.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$546.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$409.65
|
| Rate for Payer: Healthfirst Commercial |
$546.20
|
| Rate for Payer: Healthfirst Essential Plan |
$1,228.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$518.89
|
| Rate for Payer: Healthfirst QHP |
$546.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$382.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$546.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$464.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$382.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$546.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$409.65
|
| Rate for Payer: SOMOS Essential |
$409.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$546.20
|
|
|
PR TRANSURETHRAL RESECTION BLADDER NECK
|
Professional
|
Both
|
$2,069.80
|
|
|
Service Code
|
HCPCS 52500
|
| Min. Negotiated Rate |
$396.72 |
| Max. Negotiated Rate |
$1,275.16 |
| Rate for Payer: Cash Price |
$569.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$566.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$510.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$510.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$538.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$566.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$538.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$566.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$566.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$425.06
|
| Rate for Payer: Healthfirst Commercial |
$566.74
|
| Rate for Payer: Healthfirst Essential Plan |
$1,275.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$538.40
|
| Rate for Payer: Healthfirst QHP |
$566.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$396.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$566.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$481.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$396.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$566.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$425.06
|
| Rate for Payer: SOMOS Essential |
$425.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$566.74
|
|
|
PR TRANSVESICAL URETROLITHOTOMY
|
Professional
|
Both
|
$2,450.14
|
|
|
Service Code
|
HCPCS 51060
|
| Min. Negotiated Rate |
$467.54 |
| Max. Negotiated Rate |
$1,502.82 |
| Rate for Payer: Cash Price |
$671.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$667.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$601.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$601.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$634.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$667.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$634.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$667.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$667.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$500.94
|
| Rate for Payer: Healthfirst Commercial |
$667.92
|
| Rate for Payer: Healthfirst Essential Plan |
$1,502.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$634.52
|
| Rate for Payer: Healthfirst QHP |
$667.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$467.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$667.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$567.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$467.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$667.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$500.94
|
| Rate for Payer: SOMOS Essential |
$500.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$667.92
|
|
|
PR TRANSVRS A-ARCH GRF W/CARD BYP PRFD HYPOTHERMIA
|
Professional
|
Both
|
$14,400.26
|
|
|
Service Code
|
HCPCS 33871
|
| Min. Negotiated Rate |
$2,645.17 |
| Max. Negotiated Rate |
$8,502.34 |
| Rate for Payer: Cash Price |
$3,820.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,778.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,400.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,400.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,589.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,778.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,589.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,778.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,778.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,834.11
|
| Rate for Payer: Healthfirst Commercial |
$3,778.82
|
| Rate for Payer: Healthfirst Essential Plan |
$8,502.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,589.88
|
| Rate for Payer: Healthfirst QHP |
$3,778.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,645.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,778.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,212.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,645.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,778.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,834.11
|
| Rate for Payer: SOMOS Essential |
$2,834.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,778.82
|
|
|
PR TREATMENT CLOSED ELBOW DISLOCATION REQ ANES
|
Professional
|
Both
|
$2,134.09
|
|
|
Service Code
|
HCPCS 24605
|
| Min. Negotiated Rate |
$403.68 |
| Max. Negotiated Rate |
$1,297.53 |
| Rate for Payer: Cash Price |
$581.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$576.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$519.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$519.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$547.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$576.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$547.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$576.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$576.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$432.51
|
| Rate for Payer: Healthfirst Commercial |
$576.68
|
| Rate for Payer: Healthfirst Essential Plan |
$1,297.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$547.85
|
| Rate for Payer: Healthfirst QHP |
$576.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$403.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$576.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$490.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$403.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$576.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$432.51
|
| Rate for Payer: SOMOS Essential |
$432.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$576.68
|
|
