|
PR VESTIBULOPLASTY POSTERIOR UNILATERAL
|
Professional
|
Both
|
$2,965.97
|
|
|
Service Code
|
HCPCS 40842
|
| Min. Negotiated Rate |
$498.34 |
| Max. Negotiated Rate |
$1,601.82 |
| Rate for Payer: Cash Price |
$801.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$711.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$640.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$640.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$676.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$711.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$676.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$711.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$711.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$533.94
|
| Rate for Payer: Healthfirst Commercial |
$711.92
|
| Rate for Payer: Healthfirst Essential Plan |
$1,601.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$676.32
|
| Rate for Payer: Healthfirst QHP |
$711.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$498.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$711.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$605.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$498.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$711.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$533.94
|
| Rate for Payer: SOMOS Essential |
$533.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$711.92
|
|
|
PR VGTMY W/PYLOROPLASTY W/WO GASTROST PARIETAL CELL
|
Professional
|
Both
|
$5,456.78
|
|
|
Service Code
|
HCPCS 43641
|
| Min. Negotiated Rate |
$1,010.59 |
| Max. Negotiated Rate |
$3,248.32 |
| Rate for Payer: Cash Price |
$1,454.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,443.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,299.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,299.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,371.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,443.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,371.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,443.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,443.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,082.78
|
| Rate for Payer: Healthfirst Commercial |
$1,443.70
|
| Rate for Payer: Healthfirst Essential Plan |
$3,248.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,371.52
|
| Rate for Payer: Healthfirst QHP |
$1,443.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,010.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,443.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,227.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,010.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,443.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,082.78
|
| Rate for Payer: SOMOS Essential |
$1,082.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,443.70
|
|
|
PR VGTMY W/PYLORPLSTY W/WO GASTROST TRUNCAL/SLCTV
|
Professional
|
Both
|
$5,396.13
|
|
|
Service Code
|
HCPCS 43640
|
| Min. Negotiated Rate |
$999.68 |
| Max. Negotiated Rate |
$3,213.25 |
| Rate for Payer: Cash Price |
$1,437.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,428.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,285.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,285.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,356.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,428.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,356.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,428.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,428.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,071.08
|
| Rate for Payer: Healthfirst Commercial |
$1,428.11
|
| Rate for Payer: Healthfirst Essential Plan |
$3,213.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,356.70
|
| Rate for Payer: Healthfirst QHP |
$1,428.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$999.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,428.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,213.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$999.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,428.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,071.08
|
| Rate for Payer: SOMOS Essential |
$1,071.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,428.11
|
|
|
PR VISIT ESKETAMINE, > 56M
|
Professional
|
Both
|
$145.64
|
|
|
Service Code
|
HCPCS G2083
|
| Min. Negotiated Rate |
$17.18 |
| Max. Negotiated Rate |
$87.57 |
| Rate for Payer: Amida Care Medicaid |
$17.18
|
| Rate for Payer: Cash Price |
$40.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.19
|
| Rate for Payer: Healthfirst Commercial |
$38.92
|
| Rate for Payer: Healthfirst Essential Plan |
$87.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.97
|
| Rate for Payer: Healthfirst QHP |
$38.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.19
|
| Rate for Payer: SOMOS Essential |
$29.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.92
|
|
|
PR VISIT ESKETAMINE 56M OR LESS
|
Professional
|
Both
|
$145.64
|
|
|
Service Code
|
HCPCS G2082
|
| Min. Negotiated Rate |
$17.18 |
| Max. Negotiated Rate |
$87.57 |
| Rate for Payer: Amida Care Medicaid |
$17.18
|
| Rate for Payer: Cash Price |
$40.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.19
|
| Rate for Payer: Healthfirst Commercial |
$38.92
|
| Rate for Payer: Healthfirst Essential Plan |
$87.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.97
|
| Rate for Payer: Healthfirst QHP |
$38.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.19
|
| Rate for Payer: SOMOS Essential |
$29.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.92
|
|
|
PR VISIT TO DETERM LDCT ELIG
|
Professional
|
Both
|
$104.83
|
|
|
Service Code
|
HCPCS G0296
|
| Min. Negotiated Rate |
$19.27 |
| Max. Negotiated Rate |
$61.94 |
| Rate for Payer: Cash Price |
$27.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.65
|
| Rate for Payer: Healthfirst Commercial |
$27.53
|
| Rate for Payer: Healthfirst Essential Plan |
$61.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.15
|
| Rate for Payer: Healthfirst QHP |
$27.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.65
|
| Rate for Payer: SOMOS Essential |
$20.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.53
|
|
|
PR VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R
|
Professional
|
Both
|
$72.45
|
|
|
Service Code
|
HCPCS 95930 26
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$86.04 |
| Rate for Payer: Amida Care Medicaid |
$86.04
|
| Rate for Payer: Cash Price |
$19.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.74
|
| Rate for Payer: Healthfirst Commercial |
$19.66
|
| Rate for Payer: Healthfirst Essential Plan |
$44.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.68
|
| Rate for Payer: Healthfirst QHP |
$19.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.74
|
| Rate for Payer: SOMOS Essential |
$14.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.66
|
|
|
PR VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R
|
Professional
|
Both
|
$208.29
|
|
|
Service Code
|
HCPCS 95930 TC
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$126.27 |
| Rate for Payer: Amida Care Medicaid |
$86.04
|
| Rate for Payer: Cash Price |
$58.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$53.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.09
|
| Rate for Payer: Healthfirst Commercial |
$56.12
|
| Rate for Payer: Healthfirst Essential Plan |
$126.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$53.31
|
| Rate for Payer: Healthfirst QHP |
$56.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$56.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.09
|
| Rate for Payer: SOMOS Essential |
$42.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.12
|
|
|
PR VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R
|
Professional
|
Both
|
$280.74
|
|
|
Service Code
|
HCPCS 95930
|
| Min. Negotiated Rate |
$53.05 |
| Max. Negotiated Rate |
$170.53 |
| Rate for Payer: Amida Care Medicaid |
$86.04
|
| Rate for Payer: Cash Price |
$78.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$75.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$68.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$75.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.84
|
| Rate for Payer: Healthfirst Commercial |
$75.79
|
| Rate for Payer: Healthfirst Essential Plan |
$170.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.00
|
| Rate for Payer: Healthfirst QHP |
$75.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$75.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$64.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$75.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56.84
|
| Rate for Payer: SOMOS Essential |
$56.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.79
|
|
|
PR VISUAL REINFORCEMENT AUDIOMETRY
|
Professional
|
Both
|
$147.77
|
|
|
Service Code
|
HCPCS 92579
|
| Min. Negotiated Rate |
$28.07 |
| Max. Negotiated Rate |
$90.22 |
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.07
|
| Rate for Payer: Healthfirst Commercial |
$40.10
|
| Rate for Payer: Healthfirst Essential Plan |
$90.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.09
|
| Rate for Payer: Healthfirst QHP |
$40.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.07
|
| Rate for Payer: SOMOS Essential |
$30.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.10
|
|
|
PR VITAMIN B12 INJECTION
|
Professional
|
Both
|
$9.52
|
|
|
Service Code
|
HCPCS J3420
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.76
|
| Rate for Payer: Healthfirst Commercial |
$1.01
|
| Rate for Payer: Healthfirst Essential Plan |
$2.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.96
|
| Rate for Payer: Healthfirst QHP |
$1.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.76
|
| Rate for Payer: SOMOS Essential |
$0.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.01
|
|
|
PR VITRECTOMY MCHNL PARS PLNA FOCAL ENDOLASER PC
|
Professional
|
Both
|
$3,934.91
|
|
|
Service Code
|
HCPCS 67039
|
| Min. Negotiated Rate |
$747.62 |
| Max. Negotiated Rate |
$2,403.07 |
| Rate for Payer: Cash Price |
$1,083.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,068.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$961.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$961.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,014.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,068.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,014.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,068.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,068.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$801.02
|
| Rate for Payer: Healthfirst Commercial |
$1,068.03
|
| Rate for Payer: Healthfirst Essential Plan |
$2,403.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,014.63
|
| Rate for Payer: Healthfirst QHP |
$1,068.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$747.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,068.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$907.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$747.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,068.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$801.02
|
| Rate for Payer: SOMOS Essential |
$801.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,068.03
|
|
|
PR VITRECTOMY MECHANICAL PARS PLANA
|
Professional
|
Both
|
$3,674.37
|
|
|
Service Code
|
HCPCS 67036
|
| Min. Negotiated Rate |
$698.90 |
| Max. Negotiated Rate |
$2,246.47 |
| Rate for Payer: Cash Price |
$1,013.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$998.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$898.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$898.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$948.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$998.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$948.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$998.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$998.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$748.82
|
| Rate for Payer: Healthfirst Commercial |
$998.43
|
| Rate for Payer: Healthfirst Essential Plan |
$2,246.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$948.51
|
| Rate for Payer: Healthfirst QHP |
$998.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$698.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$998.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$848.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$698.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$998.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$748.82
|
| Rate for Payer: SOMOS Essential |
$748.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$998.43
|
|
|
PR VITRECTOMY PARS PLANA REMOVE INT MEMB RETINA
|
Professional
|
Both
|
$4,679.99
|
|
|
Service Code
|
HCPCS 67042
|
| Min. Negotiated Rate |
$888.37 |
| Max. Negotiated Rate |
$2,855.47 |
| Rate for Payer: Cash Price |
$1,286.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,269.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,142.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,142.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,205.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,269.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,205.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,269.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,269.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$951.83
|
| Rate for Payer: Healthfirst Commercial |
$1,269.10
|
| Rate for Payer: Healthfirst Essential Plan |
$2,855.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,205.64
|
| Rate for Payer: Healthfirst QHP |
$1,269.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$888.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,269.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,078.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$888.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,269.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$951.83
|
| Rate for Payer: SOMOS Essential |
$951.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,269.10
|
|
|
PR VITRECTOMY PARS PLANA REMOVE PRERETINAL MEMBRANE
|
Professional
|
Both
|
$4,681.43
|
|
|
Service Code
|
HCPCS 67041
|
| Min. Negotiated Rate |
$888.37 |
| Max. Negotiated Rate |
$2,855.47 |
| Rate for Payer: Cash Price |
$1,286.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,269.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,142.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,142.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,205.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,269.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,205.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,269.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,269.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$951.83
|
| Rate for Payer: Healthfirst Commercial |
$1,269.10
|
| Rate for Payer: Healthfirst Essential Plan |
$2,855.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,205.64
|
| Rate for Payer: Healthfirst QHP |
$1,269.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$888.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,269.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,078.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$888.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,269.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$951.83
|
| Rate for Payer: SOMOS Essential |
$951.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,269.10
|
|
|
PR VITRECTOMY PARS PLANA REMOVE SUBRETINAL MEMBRANE
|
Professional
|
Both
|
$4,928.18
|
|
|
Service Code
|
HCPCS 67043
|
| Min. Negotiated Rate |
$937.52 |
| Max. Negotiated Rate |
$3,013.45 |
| Rate for Payer: Cash Price |
$1,355.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,339.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,205.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,205.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,272.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,339.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,272.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,339.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,339.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,004.48
|
| Rate for Payer: Healthfirst Commercial |
$1,339.31
|
| Rate for Payer: Healthfirst Essential Plan |
$3,013.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,272.34
|
| Rate for Payer: Healthfirst QHP |
$1,339.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$937.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,339.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,138.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$937.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,339.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,004.48
|
| Rate for Payer: SOMOS Essential |
$1,004.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,339.31
|
|
|
PR VLVP MITRAL VALVE W/BYPASS RAD RCNSTJ W/WO RING
|
Professional
|
Both
|
$10,742.94
|
|
|
Service Code
|
HCPCS 33427
|
| Min. Negotiated Rate |
$1,982.27 |
| Max. Negotiated Rate |
$6,371.60 |
| Rate for Payer: Cash Price |
$2,861.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,831.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,548.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,548.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,690.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,831.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,690.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,831.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,831.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,123.86
|
| Rate for Payer: Healthfirst Commercial |
$2,831.82
|
| Rate for Payer: Healthfirst Essential Plan |
$6,371.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,690.23
|
| Rate for Payer: Healthfirst QHP |
$2,831.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,982.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,831.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,407.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,982.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,831.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,123.86
|
| Rate for Payer: SOMOS Essential |
$2,123.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,831.82
|
|
|
PR VLVP MITRAL VALVE W/CARD BYP W/PROSTC RING
|
Professional
|
Both
|
$10,539.31
|
|
|
Service Code
|
HCPCS 33426
|
| Min. Negotiated Rate |
$1,944.57 |
| Max. Negotiated Rate |
$6,250.41 |
| Rate for Payer: Cash Price |
$2,804.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,777.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,500.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,500.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,639.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,777.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,639.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,777.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,777.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,083.47
|
| Rate for Payer: Healthfirst Commercial |
$2,777.96
|
| Rate for Payer: Healthfirst Essential Plan |
$6,250.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,639.06
|
| Rate for Payer: Healthfirst QHP |
$2,777.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,944.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,777.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,361.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,944.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,777.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,083.47
|
| Rate for Payer: SOMOS Essential |
$2,083.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,777.96
|
|
|
PR VNPNXR <3 YEARS PHY/QHP SKILL FEMRAL/JUGLAR VEIN
|
Professional
|
Both
|
$78.68
|
|
|
Service Code
|
HCPCS 36400
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$45.85 |
| Rate for Payer: Cash Price |
$20.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.29
|
| Rate for Payer: Healthfirst Commercial |
$20.38
|
| Rate for Payer: Healthfirst Essential Plan |
$45.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.36
|
| Rate for Payer: Healthfirst QHP |
$20.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.29
|
| Rate for Payer: SOMOS Essential |
$15.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.38
|
|
|
PR VNPNXR 3 YEARS/> PHYS/QHP SKILL
|
Professional
|
Both
|
$38.08
|
|
|
Service Code
|
HCPCS 36410
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$22.84 |
| Rate for Payer: Cash Price |
$10.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.61
|
| Rate for Payer: Healthfirst Commercial |
$10.15
|
| Rate for Payer: Healthfirst Essential Plan |
$22.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.64
|
| Rate for Payer: Healthfirst QHP |
$10.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.61
|
| Rate for Payer: SOMOS Essential |
$7.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.15
|
|
|
PR VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN
|
Professional
|
Both
|
$35.35
|
|
|
Service Code
|
HCPCS 36406
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$21.46 |
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.16
|
| Rate for Payer: Healthfirst Commercial |
$9.54
|
| Rate for Payer: Healthfirst Essential Plan |
$21.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.06
|
| Rate for Payer: Healthfirst QHP |
$9.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.16
|
| Rate for Payer: SOMOS Essential |
$7.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.54
|
|
|
PR VNPNXR <3 YEARS PHYS/QHP SKILL SCALP VEIN
|
Professional
|
Both
|
$60.10
|
|
|
Service Code
|
HCPCS 36405
|
| Min. Negotiated Rate |
$11.33 |
| Max. Negotiated Rate |
$36.43 |
| Rate for Payer: Cash Price |
$16.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.14
|
| Rate for Payer: Healthfirst Commercial |
$16.19
|
| Rate for Payer: Healthfirst Essential Plan |
$36.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.38
|
| Rate for Payer: Healthfirst QHP |
$16.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.14
|
| Rate for Payer: SOMOS Essential |
$12.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.19
|
|
|
PR VOID PRESSURE STUDIES INTRAABDOMINAL
|
Professional
|
Both
|
$163.77
|
|
|
Service Code
|
HCPCS 51797 26
|
| Min. Negotiated Rate |
$30.47 |
| Max. Negotiated Rate |
$97.94 |
| Rate for Payer: Cash Price |
$44.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.65
|
| Rate for Payer: Healthfirst Commercial |
$43.53
|
| Rate for Payer: Healthfirst Essential Plan |
$97.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.35
|
| Rate for Payer: Healthfirst QHP |
$43.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.65
|
| Rate for Payer: SOMOS Essential |
$32.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.53
|
|
|
PR VOID PRESSURE STUDIES INTRAABDOMINAL
|
Professional
|
Both
|
$662.69
|
|
|
Service Code
|
HCPCS 51797 TC
|
| Min. Negotiated Rate |
$103.52 |
| Max. Negotiated Rate |
$332.75 |
| Rate for Payer: Cash Price |
$176.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$133.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$110.92
|
| Rate for Payer: Healthfirst Commercial |
$147.89
|
| Rate for Payer: Healthfirst Essential Plan |
$332.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$140.50
|
| Rate for Payer: Healthfirst QHP |
$147.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$103.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$125.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$103.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$110.92
|
| Rate for Payer: SOMOS Essential |
$110.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.89
|
|
|
PR VOID PRESSURE STUDIES INTRAABDOMINAL
|
Professional
|
Both
|
$826.46
|
|
|
Service Code
|
HCPCS 51797
|
| Min. Negotiated Rate |
$133.99 |
| Max. Negotiated Rate |
$430.69 |
| Rate for Payer: Cash Price |
$221.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$191.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$172.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$181.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$191.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$181.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$143.56
|
| Rate for Payer: Healthfirst Commercial |
$191.42
|
| Rate for Payer: Healthfirst Essential Plan |
$430.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$181.85
|
| Rate for Payer: Healthfirst QHP |
$191.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$133.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$191.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$162.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$133.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$191.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$143.56
|
| Rate for Payer: SOMOS Essential |
$143.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.42
|
|
