|
PR TREATMENT CLOSED ELBOW DISLOCATION W/O ANES
|
Professional
|
Both
|
$1,545.53
|
|
|
Service Code
|
HCPCS 24600
|
| Min. Negotiated Rate |
$293.87 |
| Max. Negotiated Rate |
$944.60 |
| Rate for Payer: Cash Price |
$420.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$419.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$377.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$377.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$398.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$419.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$398.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$419.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$419.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$314.87
|
| Rate for Payer: Healthfirst Commercial |
$419.82
|
| Rate for Payer: Healthfirst Essential Plan |
$944.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$398.83
|
| Rate for Payer: Healthfirst QHP |
$419.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$293.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$419.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$356.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$293.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$419.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$314.87
|
| Rate for Payer: SOMOS Essential |
$314.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$419.82
|
|
|
PR TREATMENT EXTENSIVE RETINOPATHY PHOTOCOAGULATION
|
Professional
|
Both
|
$1,245.06
|
|
|
Service Code
|
HCPCS 67228
|
| Min. Negotiated Rate |
$236.75 |
| Max. Negotiated Rate |
$761.00 |
| Rate for Payer: Cash Price |
$341.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$338.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$304.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$304.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$321.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$338.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$321.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$338.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$338.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$253.66
|
| Rate for Payer: Healthfirst Commercial |
$338.22
|
| Rate for Payer: Healthfirst Essential Plan |
$761.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$321.31
|
| Rate for Payer: Healthfirst QHP |
$338.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$236.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$338.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$287.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$236.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$338.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$253.66
|
| Rate for Payer: SOMOS Essential |
$253.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$338.22
|
|
|
PR TR FNGR AXH POS W/O MVASC ANAST
|
Professional
|
Both
|
$6,156.71
|
|
|
Service Code
|
HCPCS 26555
|
| Min. Negotiated Rate |
$1,141.08 |
| Max. Negotiated Rate |
$3,667.77 |
| Rate for Payer: Cash Price |
$1,653.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,630.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,467.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,467.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,548.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,630.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,548.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,630.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,630.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,222.59
|
| Rate for Payer: Healthfirst Commercial |
$1,630.12
|
| Rate for Payer: Healthfirst Essential Plan |
$3,667.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,548.61
|
| Rate for Payer: Healthfirst QHP |
$1,630.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,141.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,630.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,385.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,141.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,630.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,222.59
|
| Rate for Payer: SOMOS Essential |
$1,222.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,630.12
|
|
|
PR TRIAMCINOLONE ACETONIDE INJ
|
Professional
|
Both
|
$30.31
|
|
|
Service Code
|
HCPCS J3301
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.89 |
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.63
|
| Rate for Payer: Healthfirst Commercial |
$0.84
|
| Rate for Payer: Healthfirst Essential Plan |
$1.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.80
|
| Rate for Payer: Healthfirst QHP |
$0.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.63
|
| Rate for Payer: SOMOS Essential |
$0.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.84
|
|
|
PR TRICUSPID VALVE RPSG&PLCTJ EBSTEIN ANOMALY
|
Professional
|
Both
|
$10,902.22
|
|
|
Service Code
|
HCPCS 33468
|
| Min. Negotiated Rate |
$2,001.64 |
| Max. Negotiated Rate |
$6,433.85 |
| Rate for Payer: Cash Price |
$2,892.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,859.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,573.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,573.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,716.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,859.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,716.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,859.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,859.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,144.62
|
| Rate for Payer: Healthfirst Commercial |
$2,859.49
|
| Rate for Payer: Healthfirst Essential Plan |
$6,433.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,716.52
|
| Rate for Payer: Healthfirst QHP |
$2,859.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,001.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,859.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,430.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,001.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,859.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,144.62
|
| Rate for Payer: SOMOS Essential |
$2,144.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,859.49
|
|
|
PR TRIMMING NONDYSTROPHIC NAILS ANY NUMBER
|
Professional
|
Both
|
$29.79
|
|
|
Service Code
|
HCPCS 11719
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$18.07 |
| Rate for Payer: Cash Price |
$8.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.02
|
| Rate for Payer: Healthfirst Commercial |
$8.03
|
| Rate for Payer: Healthfirst Essential Plan |
$18.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.63
|
| Rate for Payer: Healthfirst QHP |
$8.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$6.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.02
|
| Rate for Payer: SOMOS Essential |
$6.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.03
|
|
|
PR TRIM NAIL(S)
|
Professional
|
Both
|
$29.79
|
|
|
Service Code
|
HCPCS G0127
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$18.07 |
| Rate for Payer: Cash Price |
$8.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.02
|
| Rate for Payer: Healthfirst Commercial |
$8.03
|
| Rate for Payer: Healthfirst Essential Plan |
$18.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.63
|
| Rate for Payer: Healthfirst QHP |
$8.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$6.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.02
|
| Rate for Payer: SOMOS Essential |
$6.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.03
|
|
|
PR TRLML BALO ANGIOP OPEN/PERQ IMG S&I 1ST ART
|
Professional
|
Both
|
$1,488.87
|
|
|
Service Code
|
HCPCS 37246
|
| Min. Negotiated Rate |
$277.32 |
| Max. Negotiated Rate |
$891.38 |
| Rate for Payer: Cash Price |
$397.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$396.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$356.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$356.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$376.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$396.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$376.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$396.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$297.13
|
| Rate for Payer: Healthfirst Commercial |
$396.17
|
| Rate for Payer: Healthfirst Essential Plan |
$891.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$376.36
|
| Rate for Payer: Healthfirst QHP |
$396.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$277.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$396.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$336.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$277.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$396.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$297.13
|
| Rate for Payer: SOMOS Essential |
$297.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$396.17
|
|
|
PR TRLML BALO ANGIOP OPEN/PERQ IMG S&I EA ADDL ART
|
Professional
|
Both
|
$747.64
|
|
|
Service Code
|
HCPCS 37247
|
| Min. Negotiated Rate |
$137.75 |
| Max. Negotiated Rate |
$442.75 |
| Rate for Payer: Cash Price |
$198.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$196.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$177.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$177.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$186.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$196.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$186.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$196.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$147.59
|
| Rate for Payer: Healthfirst Commercial |
$196.78
|
| Rate for Payer: Healthfirst Essential Plan |
$442.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$186.94
|
| Rate for Payer: Healthfirst QHP |
$196.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$137.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$196.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$167.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$137.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$196.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$147.59
|
| Rate for Payer: SOMOS Essential |
$147.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$196.78
|
|
|
PR TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I 1ST VEIN
|
Professional
|
Both
|
$1,239.95
|
|
|
Service Code
|
HCPCS 37248
|
| Min. Negotiated Rate |
$231.99 |
| Max. Negotiated Rate |
$745.70 |
| Rate for Payer: Cash Price |
$334.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$331.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$298.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$298.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$314.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$331.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$314.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$331.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$331.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$248.56
|
| Rate for Payer: Healthfirst Commercial |
$331.42
|
| Rate for Payer: Healthfirst Essential Plan |
$745.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$314.85
|
| Rate for Payer: Healthfirst QHP |
$331.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$231.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$331.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$281.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$231.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$331.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$248.56
|
| Rate for Payer: SOMOS Essential |
$248.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$331.42
|
|
|
PR TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I ADDL VEIN
|
Professional
|
Both
|
$619.36
|
|
|
Service Code
|
HCPCS 37249
|
| Min. Negotiated Rate |
$116.18 |
| Max. Negotiated Rate |
$373.43 |
| Rate for Payer: Cash Price |
$165.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$165.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$149.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$149.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$157.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$165.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$157.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$124.48
|
| Rate for Payer: Healthfirst Commercial |
$165.97
|
| Rate for Payer: Healthfirst Essential Plan |
$373.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$157.67
|
| Rate for Payer: Healthfirst QHP |
$165.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$116.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$165.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$141.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$116.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$165.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$124.48
|
| Rate for Payer: SOMOS Essential |
$124.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$165.97
|
|
|
PR TRLUML BALO ANGIOP CTR DIALYSIS SEG W/IMG S&I
|
Professional
|
Both
|
$614.01
|
|
|
Service Code
|
HCPCS 36907
|
| Min. Negotiated Rate |
$115.39 |
| Max. Negotiated Rate |
$370.91 |
| Rate for Payer: Cash Price |
$164.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$164.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$148.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$148.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$156.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$164.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$156.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$164.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$164.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$123.64
|
| Rate for Payer: Healthfirst Commercial |
$164.85
|
| Rate for Payer: Healthfirst Essential Plan |
$370.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.61
|
| Rate for Payer: Healthfirst QHP |
$164.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$115.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$164.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$140.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$115.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$164.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$123.64
|
| Rate for Payer: SOMOS Essential |
$123.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$164.85
|
|
|
PR TRLUML DILAT AQUEOUS O/F CAN WO RETENTION DEV/ST
|
Professional
|
Both
|
$2,573.59
|
|
|
Service Code
|
HCPCS 66174
|
| Min. Negotiated Rate |
$490.12 |
| Max. Negotiated Rate |
$1,575.38 |
| Rate for Payer: Cash Price |
$709.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$700.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$630.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$630.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$665.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$700.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$665.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$700.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$700.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$525.13
|
| Rate for Payer: Healthfirst Commercial |
$700.17
|
| Rate for Payer: Healthfirst Essential Plan |
$1,575.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$665.16
|
| Rate for Payer: Healthfirst QHP |
$700.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$490.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$700.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$595.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$490.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$700.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$525.13
|
| Rate for Payer: SOMOS Essential |
$525.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$700.17
|
|
|
PR TRLUML DILAT AQUEOUS O/F CAN W/RETENTION DEV/ST
|
Professional
|
Both
|
$2,985.43
|
|
|
Service Code
|
HCPCS 66175
|
| Min. Negotiated Rate |
$566.68 |
| Max. Negotiated Rate |
$1,821.46 |
| Rate for Payer: Cash Price |
$823.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$809.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$728.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$728.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$769.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$809.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$769.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$809.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$809.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$607.15
|
| Rate for Payer: Healthfirst Commercial |
$809.54
|
| Rate for Payer: Healthfirst Essential Plan |
$1,821.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$769.06
|
| Rate for Payer: Healthfirst QHP |
$809.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$566.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$809.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$688.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$566.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$809.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$607.15
|
| Rate for Payer: SOMOS Essential |
$607.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$809.54
|
|
|
PR TRNSCONDLR POST CRNL FOSSA DCOMPR ART W/WO MOBIL
|
Professional
|
Both
|
$14,077.77
|
|
|
Service Code
|
HCPCS 61597
|
| Min. Negotiated Rate |
$2,527.99 |
| Max. Negotiated Rate |
$8,125.67 |
| Rate for Payer: Cash Price |
$3,727.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,611.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,250.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,250.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,430.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,611.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,430.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,611.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,611.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,708.56
|
| Rate for Payer: Healthfirst Commercial |
$3,611.41
|
| Rate for Payer: Healthfirst Essential Plan |
$8,125.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,430.84
|
| Rate for Payer: Healthfirst QHP |
$3,611.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,527.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,611.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,069.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,527.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,611.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,708.56
|
| Rate for Payer: SOMOS Essential |
$2,708.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,611.41
|
|
|
PR TRNSPLJ ALLOGENEIC HEMATOPOIETIC CELLS PER DONOR
|
Professional
|
Both
|
$976.08
|
|
|
Service Code
|
HCPCS 38240
|
| Min. Negotiated Rate |
$188.02 |
| Max. Negotiated Rate |
$604.35 |
| Rate for Payer: Cash Price |
$269.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$268.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$241.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$241.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$255.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$268.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$255.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$268.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$268.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$201.45
|
| Rate for Payer: Healthfirst Commercial |
$268.60
|
| Rate for Payer: Healthfirst Essential Plan |
$604.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$255.17
|
| Rate for Payer: Healthfirst QHP |
$268.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$188.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$268.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$228.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$188.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$268.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$201.45
|
| Rate for Payer: SOMOS Essential |
$201.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$268.60
|
|
|
PR TRNSPLJ AUTOLOGOUS HEMATOPOIETIC CELLS PER DONOR
|
Professional
|
Both
|
$719.53
|
|
|
Service Code
|
HCPCS 38241
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$445.50 |
| Rate for Payer: Cash Price |
$199.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$198.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$178.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$178.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$188.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$198.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$188.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$198.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$148.50
|
| Rate for Payer: Healthfirst Commercial |
$198.00
|
| Rate for Payer: Healthfirst Essential Plan |
$445.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$188.10
|
| Rate for Payer: Healthfirst QHP |
$198.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$138.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$198.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$168.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$138.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$198.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$148.50
|
| Rate for Payer: SOMOS Essential |
$148.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$198.00
|
|
|
PR TRNSPLJ HEMATOPOIETIC CELL BOOST
|
Professional
|
Both
|
$499.14
|
|
|
Service Code
|
HCPCS 38243
|
| Min. Negotiated Rate |
$96.44 |
| Max. Negotiated Rate |
$309.98 |
| Rate for Payer: Cash Price |
$138.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$137.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$123.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$130.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$137.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$130.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.33
|
| Rate for Payer: Healthfirst Commercial |
$137.77
|
| Rate for Payer: Healthfirst Essential Plan |
$309.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.88
|
| Rate for Payer: Healthfirst QHP |
$137.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$96.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$137.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$117.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$96.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$137.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$103.33
|
| Rate for Payer: SOMOS Essential |
$103.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.77
|
|
|
PR TRNSRAL SKULL BSE/BR STEM/CORD BX/DCOMPR/EXC LES
|
Professional
|
Both
|
$12,102.93
|
|
|
Service Code
|
HCPCS 61575
|
| Min. Negotiated Rate |
$2,207.49 |
| Max. Negotiated Rate |
$7,095.51 |
| Rate for Payer: Cash Price |
$3,183.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,153.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,838.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,838.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,995.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,153.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,995.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,153.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,153.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,365.17
|
| Rate for Payer: Healthfirst Commercial |
$3,153.56
|
| Rate for Payer: Healthfirst Essential Plan |
$7,095.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,995.88
|
| Rate for Payer: Healthfirst QHP |
$3,153.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,207.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,153.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,680.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,207.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,153.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,365.17
|
| Rate for Payer: SOMOS Essential |
$2,365.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,153.56
|
|
|
PR TRNSRL SKUL BSE/BR STM/CORD BX/DCMP/ SPLT TONGUE
|
Professional
|
Both
|
$19,979.54
|
|
|
Service Code
|
HCPCS 61576
|
| Min. Negotiated Rate |
$3,655.74 |
| Max. Negotiated Rate |
$11,750.58 |
| Rate for Payer: Cash Price |
$5,262.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,222.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,700.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,700.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,961.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,222.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,961.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,222.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,222.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,916.86
|
| Rate for Payer: Healthfirst Commercial |
$5,222.48
|
| Rate for Payer: Healthfirst Essential Plan |
$11,750.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,961.36
|
| Rate for Payer: Healthfirst QHP |
$5,222.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,655.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5,222.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4,439.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3,655.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,222.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,916.86
|
| Rate for Payer: SOMOS Essential |
$3,916.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,222.48
|
|
|
PR TRNSXJ/AVLSN OBTURAT NRV INPELV W/WO TENOTOMY
|
Professional
|
Both
|
$2,880.92
|
|
|
Service Code
|
HCPCS 64766
|
| Min. Negotiated Rate |
$535.72 |
| Max. Negotiated Rate |
$1,721.97 |
| Rate for Payer: Cash Price |
$770.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$765.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$688.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$688.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$727.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$765.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$727.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$765.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$765.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$573.99
|
| Rate for Payer: Healthfirst Commercial |
$765.32
|
| Rate for Payer: Healthfirst Essential Plan |
$1,721.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$727.05
|
| Rate for Payer: Healthfirst QHP |
$765.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$535.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$765.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$650.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$535.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$765.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$573.99
|
| Rate for Payer: SOMOS Essential |
$573.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$765.32
|
|
|
PR TRNSXJ/AVLSN OBTURAT NRV XPELV W/WO TENOTOMY
|
Professional
|
Both
|
$2,336.29
|
|
|
Service Code
|
HCPCS 64763
|
| Min. Negotiated Rate |
$434.93 |
| Max. Negotiated Rate |
$1,397.99 |
| Rate for Payer: Cash Price |
$624.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$621.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$559.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$559.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$590.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$621.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$590.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$621.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$621.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$466.00
|
| Rate for Payer: Healthfirst Commercial |
$621.33
|
| Rate for Payer: Healthfirst Essential Plan |
$1,397.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$590.26
|
| Rate for Payer: Healthfirst QHP |
$621.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$434.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$621.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$528.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$434.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$621.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$466.00
|
| Rate for Payer: SOMOS Essential |
$466.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$621.33
|
|
|
PR TRNSXJ/LIG CAROTID ARTERY PETROUS CANAL W/O RPR
|
Professional
|
Both
|
$2,262.12
|
|
|
Service Code
|
HCPCS 61611
|
| Min. Negotiated Rate |
$409.13 |
| Max. Negotiated Rate |
$1,315.06 |
| Rate for Payer: Cash Price |
$590.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$584.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$526.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$526.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$555.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$584.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$555.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$584.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$584.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$438.35
|
| Rate for Payer: Healthfirst Commercial |
$584.47
|
| Rate for Payer: Healthfirst Essential Plan |
$1,315.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$555.25
|
| Rate for Payer: Healthfirst QHP |
$584.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$409.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$584.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$496.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$409.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$584.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$438.35
|
| Rate for Payer: SOMOS Essential |
$438.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$584.47
|
|
|
PR TRNSXJ/REPOSITIONING ABERRANT RENAL VESSEL SPX
|
Professional
|
Both
|
$4,894.96
|
|
|
Service Code
|
HCPCS 50100
|
| Min. Negotiated Rate |
$907.12 |
| Max. Negotiated Rate |
$2,915.75 |
| Rate for Payer: Cash Price |
$1,305.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,295.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,166.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,166.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,231.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,295.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,231.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,295.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,295.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$971.92
|
| Rate for Payer: Healthfirst Commercial |
$1,295.89
|
| Rate for Payer: Healthfirst Essential Plan |
$2,915.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,231.10
|
| Rate for Payer: Healthfirst QHP |
$1,295.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$907.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,295.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,101.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$907.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,295.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$971.92
|
| Rate for Payer: SOMOS Essential |
$971.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,295.89
|
|
|
PR TR PARASPI MUSC HIP FASC/TDN XTN GRF
|
Professional
|
Both
|
$3,857.77
|
|
|
Service Code
|
HCPCS 27105
|
| Min. Negotiated Rate |
$726.04 |
| Max. Negotiated Rate |
$2,333.70 |
| Rate for Payer: Cash Price |
$1,042.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,037.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$933.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$933.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$985.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,037.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$985.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,037.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,037.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$777.90
|
| Rate for Payer: Healthfirst Commercial |
$1,037.20
|
| Rate for Payer: Healthfirst Essential Plan |
$2,333.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$985.34
|
| Rate for Payer: Healthfirst QHP |
$1,037.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$726.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,037.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$881.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$726.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,037.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$777.90
|
| Rate for Payer: SOMOS Essential |
$777.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,037.20
|
|
