|
PR TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT
|
Professional
|
Both
|
$348.99
|
|
|
Service Code
|
HCPCS 95924 26
|
| Min. Negotiated Rate |
$64.74 |
| Max. Negotiated Rate |
$208.10 |
| Rate for Payer: Amida Care Medicaid |
$93.40
|
| Rate for Payer: Cash Price |
$94.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.37
|
| Rate for Payer: Healthfirst Commercial |
$92.49
|
| Rate for Payer: Healthfirst Essential Plan |
$208.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.87
|
| Rate for Payer: Healthfirst QHP |
$92.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.37
|
| Rate for Payer: SOMOS Essential |
$69.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.49
|
|
|
PR TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT
|
Professional
|
Both
|
$285.78
|
|
|
Service Code
|
HCPCS 95924 TC
|
| Min. Negotiated Rate |
$51.40 |
| Max. Negotiated Rate |
$165.22 |
| Rate for Payer: Amida Care Medicaid |
$93.40
|
| Rate for Payer: Cash Price |
$78.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$66.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$66.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$69.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.07
|
| Rate for Payer: Healthfirst Commercial |
$73.43
|
| Rate for Payer: Healthfirst Essential Plan |
$165.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.76
|
| Rate for Payer: Healthfirst QHP |
$73.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$73.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$55.07
|
| Rate for Payer: SOMOS Essential |
$55.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.43
|
|
|
PR TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT
|
Professional
|
Both
|
$634.76
|
|
|
Service Code
|
HCPCS 95924
|
| Min. Negotiated Rate |
$93.40 |
| Max. Negotiated Rate |
$373.32 |
| Rate for Payer: Amida Care Medicaid |
$93.40
|
| Rate for Payer: Cash Price |
$172.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$165.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$149.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$149.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$157.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$165.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$157.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$124.44
|
| Rate for Payer: Healthfirst Commercial |
$165.92
|
| Rate for Payer: Healthfirst Essential Plan |
$373.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$157.62
|
| Rate for Payer: Healthfirst QHP |
$165.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$116.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$165.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$141.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$116.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$165.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$124.44
|
| Rate for Payer: SOMOS Essential |
$124.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$165.92
|
|
|
PR TSTG ANS FUNCJ VASOMOTOR ADRENERGIC INNERVAJ
|
Professional
|
Both
|
$181.51
|
|
|
Service Code
|
HCPCS 95922 26
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$109.67 |
| Rate for Payer: Amida Care Medicaid |
$63.83
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$48.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.55
|
| Rate for Payer: Healthfirst Commercial |
$48.74
|
| Rate for Payer: Healthfirst Essential Plan |
$109.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.30
|
| Rate for Payer: Healthfirst QHP |
$48.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.55
|
| Rate for Payer: SOMOS Essential |
$36.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.74
|
|
|
PR TSTG ANS FUNCJ VASOMOTOR ADRENERGIC INNERVAJ
|
Professional
|
Both
|
$223.97
|
|
|
Service Code
|
HCPCS 95922 TC
|
| Min. Negotiated Rate |
$36.19 |
| Max. Negotiated Rate |
$116.33 |
| Rate for Payer: Amida Care Medicaid |
$63.83
|
| Rate for Payer: Cash Price |
$59.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$51.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.77
|
| Rate for Payer: Healthfirst Commercial |
$51.70
|
| Rate for Payer: Healthfirst Essential Plan |
$116.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.12
|
| Rate for Payer: Healthfirst QHP |
$51.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$51.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.77
|
| Rate for Payer: SOMOS Essential |
$38.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.70
|
|
|
PR TSTG ANS FUNCJ VASOMOTOR ADRENERGIC INNERVAJ
|
Professional
|
Both
|
$405.48
|
|
|
Service Code
|
HCPCS 95922
|
| Min. Negotiated Rate |
$63.83 |
| Max. Negotiated Rate |
$225.99 |
| Rate for Payer: Amida Care Medicaid |
$63.83
|
| Rate for Payer: Cash Price |
$108.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$100.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$90.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$90.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$95.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$100.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$95.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.33
|
| Rate for Payer: Healthfirst Commercial |
$100.44
|
| Rate for Payer: Healthfirst Essential Plan |
$225.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$95.42
|
| Rate for Payer: Healthfirst QHP |
$100.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$70.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$100.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$85.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$70.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$100.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$75.33
|
| Rate for Payer: SOMOS Essential |
$75.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$100.44
|
|
|
PR TTRACH INTRO NDL WIRE DIL/STENT/TUBE O2 THER
|
Professional
|
Both
|
$656.39
|
|
|
Service Code
|
HCPCS 31730
|
| Min. Negotiated Rate |
$121.86 |
| Max. Negotiated Rate |
$391.68 |
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$174.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$156.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$156.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$165.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$174.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$165.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$130.56
|
| Rate for Payer: Healthfirst Commercial |
$174.08
|
| Rate for Payer: Healthfirst Essential Plan |
$391.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$165.38
|
| Rate for Payer: Healthfirst QHP |
$174.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$121.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$174.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$147.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$121.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$174.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$130.56
|
| Rate for Payer: SOMOS Essential |
$130.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$174.08
|
|
|
PR TUBE/NEEDLE CATH JEJUNOSTOMY ANY METHOD
|
Professional
|
Both
|
$641.13
|
|
|
Service Code
|
HCPCS 44015
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$373.66 |
| Rate for Payer: Cash Price |
$167.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$166.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$149.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$149.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$157.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$166.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$157.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$166.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$166.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$124.55
|
| Rate for Payer: Healthfirst Commercial |
$166.07
|
| Rate for Payer: Healthfirst Essential Plan |
$373.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$157.77
|
| Rate for Payer: Healthfirst QHP |
$166.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$116.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$166.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$141.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$116.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$166.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$124.55
|
| Rate for Payer: SOMOS Essential |
$124.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$166.07
|
|
|
PR TUBE THORACOSTOMY INCLUDES WATER SEAL
|
Professional
|
Both
|
$670.95
|
|
|
Service Code
|
HCPCS 32551
|
| Min. Negotiated Rate |
$124.50 |
| Max. Negotiated Rate |
$400.16 |
| Rate for Payer: Cash Price |
$179.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$177.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$160.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$160.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$168.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$177.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$168.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$133.39
|
| Rate for Payer: Healthfirst Commercial |
$177.85
|
| Rate for Payer: Healthfirst Essential Plan |
$400.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$168.96
|
| Rate for Payer: Healthfirst QHP |
$177.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$124.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$177.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$151.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$124.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$177.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$133.39
|
| Rate for Payer: SOMOS Essential |
$133.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$177.85
|
|
|
PR TUBOTUBAL ANASTATOMOSIS
|
Professional
|
Both
|
$3,967.46
|
|
|
Service Code
|
HCPCS 58750
|
| Min. Negotiated Rate |
$738.21 |
| Max. Negotiated Rate |
$2,372.80 |
| Rate for Payer: Cash Price |
$1,069.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,054.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$949.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$949.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,001.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,054.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,001.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,054.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,054.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$790.93
|
| Rate for Payer: Healthfirst Commercial |
$1,054.58
|
| Rate for Payer: Healthfirst Essential Plan |
$2,372.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,001.85
|
| Rate for Payer: Healthfirst QHP |
$1,054.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$738.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,054.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$896.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$738.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,054.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$790.93
|
| Rate for Payer: SOMOS Essential |
$790.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,054.58
|
|
|
PR TUBOUTERINE IMPLANTATION
|
Professional
|
Both
|
$3,957.38
|
|
|
Service Code
|
HCPCS 58752
|
| Min. Negotiated Rate |
$736.03 |
| Max. Negotiated Rate |
$2,365.81 |
| Rate for Payer: Cash Price |
$1,067.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,051.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$946.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$946.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$998.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,051.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$998.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,051.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,051.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$788.60
|
| Rate for Payer: Healthfirst Commercial |
$1,051.47
|
| Rate for Payer: Healthfirst Essential Plan |
$2,365.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$998.90
|
| Rate for Payer: Healthfirst QHP |
$1,051.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$736.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,051.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$893.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$736.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,051.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$788.60
|
| Rate for Payer: SOMOS Essential |
$788.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,051.47
|
|
|
PR TWIST/BURR HOLE IMPLTJ NSTIM ELTRD CORTICAL
|
Professional
|
Both
|
$4,751.29
|
|
|
Service Code
|
HCPCS 61850
|
| Min. Negotiated Rate |
$872.79 |
| Max. Negotiated Rate |
$2,805.39 |
| Rate for Payer: Cash Price |
$1,257.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,246.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,122.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,122.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,184.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,246.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,184.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,246.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,246.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$935.13
|
| Rate for Payer: Healthfirst Commercial |
$1,246.84
|
| Rate for Payer: Healthfirst Essential Plan |
$2,805.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,184.50
|
| Rate for Payer: Healthfirst QHP |
$1,246.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$872.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,246.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,059.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$872.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,246.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$935.13
|
| Rate for Payer: SOMOS Essential |
$935.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,246.84
|
|
|
PR TWIST DRILL HOLE EVAC&/DRG SUBDURAL HEMATOMA
|
Professional
|
Both
|
$4,324.36
|
|
|
Service Code
|
HCPCS 61108
|
| Min. Negotiated Rate |
$796.77 |
| Max. Negotiated Rate |
$2,561.04 |
| Rate for Payer: Cash Price |
$1,146.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,138.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,024.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,024.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,081.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,138.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,081.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,138.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,138.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$853.68
|
| Rate for Payer: Healthfirst Commercial |
$1,138.24
|
| Rate for Payer: Healthfirst Essential Plan |
$2,561.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,081.33
|
| Rate for Payer: Healthfirst QHP |
$1,138.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$796.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,138.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$967.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$796.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,138.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$853.68
|
| Rate for Payer: SOMOS Essential |
$853.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,138.24
|
|
|
PR TWIST DRILL HOLE IMPLT VENTRICULAR CATH/DEVICE
|
Professional
|
Both
|
$1,507.59
|
|
|
Service Code
|
HCPCS 61107
|
| Min. Negotiated Rate |
$273.76 |
| Max. Negotiated Rate |
$879.95 |
| Rate for Payer: Cash Price |
$395.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$391.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$351.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$351.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$371.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$391.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$371.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$391.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$391.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$293.32
|
| Rate for Payer: Healthfirst Commercial |
$391.09
|
| Rate for Payer: Healthfirst Essential Plan |
$879.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$371.54
|
| Rate for Payer: Healthfirst QHP |
$391.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$273.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$391.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$332.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$273.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$391.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$293.32
|
| Rate for Payer: SOMOS Essential |
$293.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$391.09
|
|
|
PR TWIST DRILL HOLE SUBDURAL/VENTRICULAR PUNCTURE
|
Professional
|
Both
|
$2,218.51
|
|
|
Service Code
|
HCPCS 61105
|
| Min. Negotiated Rate |
$411.21 |
| Max. Negotiated Rate |
$1,321.74 |
| Rate for Payer: Cash Price |
$589.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$587.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$528.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$528.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$558.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$587.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$558.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$587.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$587.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$440.58
|
| Rate for Payer: Healthfirst Commercial |
$587.44
|
| Rate for Payer: Healthfirst Essential Plan |
$1,321.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$558.07
|
| Rate for Payer: Healthfirst QHP |
$587.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$411.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$587.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$499.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$411.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$587.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$440.58
|
| Rate for Payer: SOMOS Essential |
$440.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$587.44
|
|
|
PR TX ADDUXOR SUBQ OPN W/OBTURATOR NEURECTOMY
|
Professional
|
Both
|
$2,664.13
|
|
|
Service Code
|
HCPCS 27003
|
| Min. Negotiated Rate |
$503.30 |
| Max. Negotiated Rate |
$1,617.75 |
| Rate for Payer: Cash Price |
$722.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$719.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$647.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$647.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$683.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$719.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$683.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$719.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$719.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$539.25
|
| Rate for Payer: Healthfirst Commercial |
$719.00
|
| Rate for Payer: Healthfirst Essential Plan |
$1,617.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$683.05
|
| Rate for Payer: Healthfirst QHP |
$719.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$503.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$719.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$611.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$503.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$719.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$539.25
|
| Rate for Payer: SOMOS Essential |
$539.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$719.00
|
|
|
PR TX ANAL FSTL TRANS/SUPRA/XTRASPHNCTRC INCL SETON
|
Professional
|
Both
|
$2,103.12
|
|
|
Service Code
|
HCPCS 46280
|
| Min. Negotiated Rate |
$397.26 |
| Max. Negotiated Rate |
$1,276.90 |
| Rate for Payer: Cash Price |
$568.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$567.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$510.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$510.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$539.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$567.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$539.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$567.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$567.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$425.63
|
| Rate for Payer: Healthfirst Commercial |
$567.51
|
| Rate for Payer: Healthfirst Essential Plan |
$1,276.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$539.13
|
| Rate for Payer: Healthfirst QHP |
$567.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$397.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$567.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$482.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$397.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$567.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$425.63
|
| Rate for Payer: SOMOS Essential |
$425.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$567.51
|
|
|
PR TX ECTOPIC PREGNANCY ABDL PREGNANCY
|
Professional
|
Both
|
$4,416.51
|
|
|
Service Code
|
HCPCS 59130
|
| Min. Negotiated Rate |
$805.50 |
| Max. Negotiated Rate |
$2,589.10 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,150.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,035.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,035.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,093.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,150.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,093.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,150.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,150.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$863.03
|
| Rate for Payer: Healthfirst Commercial |
$1,150.71
|
| Rate for Payer: Healthfirst Essential Plan |
$2,589.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,093.17
|
| Rate for Payer: Healthfirst QHP |
$1,150.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$805.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,150.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$978.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$805.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,150.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$863.03
|
| Rate for Payer: SOMOS Essential |
$863.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,150.71
|
|
|
PR TX ECTOPIC PREGNANCY ABDOMINAL/VAGINAL APPR
|
Professional
|
Both
|
$3,795.61
|
|
|
Service Code
|
HCPCS 59120
|
| Min. Negotiated Rate |
$693.67 |
| Max. Negotiated Rate |
$2,229.66 |
| Rate for Payer: Cash Price |
$1,007.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$990.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$891.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$941.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$990.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$941.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$990.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$990.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$743.22
|
| Rate for Payer: Healthfirst Commercial |
$990.96
|
| Rate for Payer: Healthfirst Essential Plan |
$2,229.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$941.41
|
| Rate for Payer: Healthfirst QHP |
$990.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$693.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$990.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$842.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$693.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$990.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$743.22
|
| Rate for Payer: SOMOS Essential |
$743.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$990.96
|
|
|
PR TX ECTOPIC PREGNANCY CERVICAL W/EVACUATION
|
Professional
|
Both
|
$1,931.37
|
|
|
Service Code
|
HCPCS 59140
|
| Min. Negotiated Rate |
$354.26 |
| Max. Negotiated Rate |
$1,138.70 |
| Rate for Payer: Cash Price |
$514.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$506.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$455.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$455.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$480.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$506.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$480.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$506.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$506.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$379.57
|
| Rate for Payer: Healthfirst Commercial |
$506.09
|
| Rate for Payer: Healthfirst Essential Plan |
$1,138.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$480.79
|
| Rate for Payer: Healthfirst QHP |
$506.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$354.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$506.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$430.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$354.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$506.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$379.57
|
| Rate for Payer: SOMOS Essential |
$379.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$506.09
|
|
|
PR TX ECTOPIC PREGNANCY NTRSTL PRTL RESCJ UTER
|
Professional
|
Both
|
$4,185.34
|
|
|
Service Code
|
HCPCS 59136
|
| Min. Negotiated Rate |
$765.09 |
| Max. Negotiated Rate |
$2,459.23 |
| Rate for Payer: Cash Price |
$1,109.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,092.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$983.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$983.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,038.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,092.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,038.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,092.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,092.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$819.74
|
| Rate for Payer: Healthfirst Commercial |
$1,092.99
|
| Rate for Payer: Healthfirst Essential Plan |
$2,459.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,038.34
|
| Rate for Payer: Healthfirst QHP |
$1,092.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$765.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,092.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$929.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$765.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,092.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$819.74
|
| Rate for Payer: SOMOS Essential |
$819.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,092.99
|
|
|
PR TX ECTOPIC PREGNANCY W/O SALPING&/OOPHORECTOMY
|
Professional
|
Both
|
$3,794.32
|
|
|
Service Code
|
HCPCS 59121
|
| Min. Negotiated Rate |
$694.05 |
| Max. Negotiated Rate |
$2,230.88 |
| Rate for Payer: Cash Price |
$1,007.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$991.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$892.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$892.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$941.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$991.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$941.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$991.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$991.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$743.62
|
| Rate for Payer: Healthfirst Commercial |
$991.50
|
| Rate for Payer: Healthfirst Essential Plan |
$2,230.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$941.92
|
| Rate for Payer: Healthfirst QHP |
$991.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$694.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$991.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$842.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$694.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$991.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$743.62
|
| Rate for Payer: SOMOS Essential |
$743.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$991.50
|
|
|
PR TX HUMRAL SHAFT FX W/INSJ IMED IMPLT W/W CERCLGE
|
Professional
|
Both
|
$3,804.68
|
|
|
Service Code
|
HCPCS 24516
|
| Min. Negotiated Rate |
$714.71 |
| Max. Negotiated Rate |
$2,297.30 |
| Rate for Payer: Cash Price |
$1,026.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,021.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$918.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$918.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$969.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,021.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$969.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,021.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,021.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$765.76
|
| Rate for Payer: Healthfirst Commercial |
$1,021.02
|
| Rate for Payer: Healthfirst Essential Plan |
$2,297.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$969.97
|
| Rate for Payer: Healthfirst QHP |
$1,021.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$714.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,021.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$867.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$714.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,021.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$765.76
|
| Rate for Payer: SOMOS Essential |
$765.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,021.02
|
|
|
PR TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL
|
Professional
|
Both
|
$1,419.25
|
|
|
Service Code
|
HCPCS 59812
|
| Min. Negotiated Rate |
$261.51 |
| Max. Negotiated Rate |
$840.55 |
| Rate for Payer: Cash Price |
$379.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$373.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$336.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$336.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$354.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$373.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$354.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$373.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$373.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$280.19
|
| Rate for Payer: Healthfirst Commercial |
$373.58
|
| Rate for Payer: Healthfirst Essential Plan |
$840.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$354.90
|
| Rate for Payer: Healthfirst QHP |
$373.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$261.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$373.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$317.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$261.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$373.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$280.19
|
| Rate for Payer: SOMOS Essential |
$280.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$373.58
|
|
|
PR TX INTER/PR/SUBTRCHNTRIC FEM FX IMED IMPLTSCREW
|
Professional
|
Both
|
$5,405.33
|
|
|
Service Code
|
HCPCS 27245
|
| Min. Negotiated Rate |
$1,015.47 |
| Max. Negotiated Rate |
$3,264.01 |
| Rate for Payer: Cash Price |
$1,457.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,450.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,305.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,305.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,378.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,450.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,378.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,450.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,450.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,088.00
|
| Rate for Payer: Healthfirst Commercial |
$1,450.67
|
| Rate for Payer: Healthfirst Essential Plan |
$3,264.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,378.14
|
| Rate for Payer: Healthfirst QHP |
$1,450.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,015.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,450.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,233.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,015.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,450.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,088.00
|
| Rate for Payer: SOMOS Essential |
$1,088.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,450.67
|
|
