|
PR ASPIRATION AND/OR INJECTION THYROID CYST
|
Professional
|
Both
|
$200.59
|
|
|
Service Code
|
HCPCS 60300
|
| Min. Negotiated Rate |
$37.77 |
| Max. Negotiated Rate |
$121.41 |
| Rate for Payer: Cash Price |
$54.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.47
|
| Rate for Payer: Healthfirst Commercial |
$53.96
|
| Rate for Payer: Healthfirst Essential Plan |
$121.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.26
|
| Rate for Payer: Healthfirst QHP |
$53.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.47
|
| Rate for Payer: SOMOS Essential |
$40.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.96
|
|
|
PR ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER
|
Professional
|
Both
|
$595.63
|
|
|
Service Code
|
HCPCS 51102
|
| Min. Negotiated Rate |
$110.80 |
| Max. Negotiated Rate |
$356.15 |
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$158.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$142.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$142.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$150.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$158.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$150.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$158.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$158.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$118.72
|
| Rate for Payer: Healthfirst Commercial |
$158.29
|
| Rate for Payer: Healthfirst Essential Plan |
$356.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$150.38
|
| Rate for Payer: Healthfirst QHP |
$158.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$110.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$158.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$134.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$110.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$158.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$118.72
|
| Rate for Payer: SOMOS Essential |
$118.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$158.29
|
|
|
PR ASPIRATION BLADDER NEEDLE
|
Professional
|
Both
|
$163.87
|
|
|
Service Code
|
HCPCS 51100
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$98.82 |
| Rate for Payer: Cash Price |
$44.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.94
|
| Rate for Payer: Healthfirst Commercial |
$43.92
|
| Rate for Payer: Healthfirst Essential Plan |
$98.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.72
|
| Rate for Payer: Healthfirst QHP |
$43.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.94
|
| Rate for Payer: SOMOS Essential |
$32.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.92
|
|
|
PR ASPIRATION BLADDER TROCAR/INTRACATHETER
|
Professional
|
Both
|
$210.91
|
|
|
Service Code
|
HCPCS 51101
|
| Min. Negotiated Rate |
$40.28 |
| Max. Negotiated Rate |
$129.47 |
| Rate for Payer: Cash Price |
$57.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$57.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$51.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$54.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$57.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$54.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.16
|
| Rate for Payer: Healthfirst Commercial |
$57.54
|
| Rate for Payer: Healthfirst Essential Plan |
$129.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$54.66
|
| Rate for Payer: Healthfirst QHP |
$57.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$57.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$43.16
|
| Rate for Payer: SOMOS Essential |
$43.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57.54
|
|
|
PR ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ
|
Professional
|
Both
|
$175.42
|
|
|
Service Code
|
HCPCS 20612
|
| Min. Negotiated Rate |
$33.16 |
| Max. Negotiated Rate |
$106.58 |
| Rate for Payer: Cash Price |
$47.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.53
|
| Rate for Payer: Healthfirst Commercial |
$47.37
|
| Rate for Payer: Healthfirst Essential Plan |
$106.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.00
|
| Rate for Payer: Healthfirst QHP |
$47.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.53
|
| Rate for Payer: SOMOS Essential |
$35.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.37
|
|
|
PR ASPIRATION & INJECTION TREATMENT BONE CYST
|
Professional
|
Both
|
$688.73
|
|
|
Service Code
|
HCPCS 20615
|
| Min. Negotiated Rate |
$129.05 |
| Max. Negotiated Rate |
$414.81 |
| Rate for Payer: Cash Price |
$189.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$165.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$165.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$184.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$138.27
|
| Rate for Payer: Healthfirst Commercial |
$184.36
|
| Rate for Payer: Healthfirst Essential Plan |
$414.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$175.14
|
| Rate for Payer: Healthfirst QHP |
$184.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$129.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$184.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$156.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$129.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.27
|
| Rate for Payer: SOMOS Essential |
$138.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.36
|
|
|
PR ASPIRATION/RELEASE VITREOUS SUBRETINAL/CHOROIDAL
|
Professional
|
Both
|
$2,508.14
|
|
|
Service Code
|
HCPCS 67015
|
| Min. Negotiated Rate |
$473.01 |
| Max. Negotiated Rate |
$1,520.39 |
| Rate for Payer: Cash Price |
$688.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$675.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$608.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$608.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$641.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$675.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$641.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$675.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$675.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$506.80
|
| Rate for Payer: Healthfirst Commercial |
$675.73
|
| Rate for Payer: Healthfirst Essential Plan |
$1,520.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$641.94
|
| Rate for Payer: Healthfirst QHP |
$675.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$473.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$675.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$574.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$473.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$675.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$506.80
|
| Rate for Payer: SOMOS Essential |
$506.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$675.73
|
|
|
PR ASPIR &/NJX RENAL CYST/PELVIS NEEDLE PRQ
|
Professional
|
Both
|
$386.61
|
|
|
Service Code
|
HCPCS 50390
|
| Min. Negotiated Rate |
$72.77 |
| Max. Negotiated Rate |
$233.89 |
| Rate for Payer: Cash Price |
$104.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$103.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$93.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$93.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$98.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$98.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.96
|
| Rate for Payer: Healthfirst Commercial |
$103.95
|
| Rate for Payer: Healthfirst Essential Plan |
$233.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$98.75
|
| Rate for Payer: Healthfirst QHP |
$103.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$103.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$88.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.96
|
| Rate for Payer: SOMOS Essential |
$77.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.95
|
|
|
PR ASSESSMENT APHASIA W/INTERP & REPORT PER HOUR
|
Professional
|
Both
|
$397.50
|
|
|
Service Code
|
HCPCS 96105
|
| Min. Negotiated Rate |
$38.82 |
| Max. Negotiated Rate |
$239.18 |
| Rate for Payer: Amida Care Medicaid |
$38.82
|
| Rate for Payer: Cash Price |
$107.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$106.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$95.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$95.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$100.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$106.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$100.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.72
|
| Rate for Payer: Healthfirst Commercial |
$106.30
|
| Rate for Payer: Healthfirst Essential Plan |
$239.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$100.98
|
| Rate for Payer: Healthfirst QHP |
$106.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$106.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$90.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$74.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$106.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$79.72
|
| Rate for Payer: SOMOS Essential |
$79.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$106.30
|
|
|
PR ASSESSMENT TINNITUS
|
Professional
|
Both
|
$244.09
|
|
|
Service Code
|
HCPCS 92625
|
| Min. Negotiated Rate |
$46.30 |
| Max. Negotiated Rate |
$148.84 |
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$66.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$66.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.61
|
| Rate for Payer: Healthfirst Commercial |
$66.15
|
| Rate for Payer: Healthfirst Essential Plan |
$148.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.84
|
| Rate for Payer: Healthfirst QHP |
$66.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$66.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$56.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$66.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$49.61
|
| Rate for Payer: SOMOS Essential |
$49.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.15
|
|
|
PR ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT
|
Professional
|
Both
|
$786.42
|
|
|
Service Code
|
HCPCS 99483
|
| Min. Negotiated Rate |
$148.84 |
| Max. Negotiated Rate |
$478.42 |
| Rate for Payer: Cash Price |
$214.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$212.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$191.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$191.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$202.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$212.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$202.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$212.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$159.47
|
| Rate for Payer: Healthfirst Commercial |
$212.63
|
| Rate for Payer: Healthfirst Essential Plan |
$478.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$202.00
|
| Rate for Payer: Healthfirst QHP |
$212.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$148.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$212.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$180.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$148.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$212.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$159.47
|
| Rate for Payer: SOMOS Essential |
$159.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$212.63
|
|
|
PR ASSTV TECHNOL ASSMT DIR CNTCT W/REPRT EA 15 MIN
|
Professional
|
Both
|
$156.45
|
|
|
Service Code
|
HCPCS 97755
|
| Min. Negotiated Rate |
$29.95 |
| Max. Negotiated Rate |
$96.25 |
| Rate for Payer: Cash Price |
$42.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.09
|
| Rate for Payer: Healthfirst Commercial |
$42.78
|
| Rate for Payer: Healthfirst Essential Plan |
$96.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.64
|
| Rate for Payer: Healthfirst QHP |
$42.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$42.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.09
|
| Rate for Payer: SOMOS Essential |
$32.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.78
|
|
|
PRASUGREL HCL 10 MG PO TABS
|
Facility
|
IP
|
$16.51
|
|
|
Service Code
|
NDC 6586283030
|
| Hospital Charge Code |
6586283030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$8.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.25
|
|
|
PRASUGREL HCL 10 MG PO TABS
|
Facility
|
OP
|
$16.51
|
|
|
Service Code
|
NDC 6586283030
|
| Hospital Charge Code |
6586283030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$13.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.25
|
| Rate for Payer: Aetna Government |
$8.25
|
| Rate for Payer: Brighton Health Commercial |
$12.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.22
|
| Rate for Payer: EmblemHealth Commercial |
$8.25
|
| Rate for Payer: Group Health Inc Commercial |
$8.25
|
| Rate for Payer: Group Health Inc Medicare |
$5.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.73
|
|
|
PRASUGREL HCL 10 MG PO TABS
|
Facility
|
IP
|
$16.51
|
|
|
Service Code
|
NDC 1672927310
|
| Hospital Charge Code |
1672927310
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$8.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.25
|
|
|
PRASUGREL HCL 10 MG PO TABS
|
Facility
|
OP
|
$16.51
|
|
|
Service Code
|
NDC 6050546433
|
| Hospital Charge Code |
6050546433
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$13.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.25
|
| Rate for Payer: Aetna Government |
$8.25
|
| Rate for Payer: Brighton Health Commercial |
$12.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.22
|
| Rate for Payer: EmblemHealth Commercial |
$8.25
|
| Rate for Payer: Group Health Inc Commercial |
$8.25
|
| Rate for Payer: Group Health Inc Medicare |
$5.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.73
|
|
|
PRASUGREL HCL 10 MG PO TABS
|
Facility
|
IP
|
$16.51
|
|
|
Service Code
|
NDC 6050546433
|
| Hospital Charge Code |
6050546433
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$8.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.25
|
|
|
PRASUGREL HCL 10 MG PO TABS
|
Facility
|
OP
|
$16.51
|
|
|
Service Code
|
NDC 1672927310
|
| Hospital Charge Code |
1672927310
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$13.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.25
|
| Rate for Payer: Aetna Government |
$8.25
|
| Rate for Payer: Brighton Health Commercial |
$12.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.22
|
| Rate for Payer: EmblemHealth Commercial |
$8.25
|
| Rate for Payer: Group Health Inc Commercial |
$8.25
|
| Rate for Payer: Group Health Inc Medicare |
$5.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.73
|
|
|
PRASUGREL HCL 5 MG PO TABS
|
Facility
|
OP
|
$16.51
|
|
|
Service Code
|
NDC 6050546423
|
| Hospital Charge Code |
6050546423
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$13.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.25
|
| Rate for Payer: Aetna Government |
$8.25
|
| Rate for Payer: Brighton Health Commercial |
$12.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.22
|
| Rate for Payer: EmblemHealth Commercial |
$8.25
|
| Rate for Payer: Group Health Inc Commercial |
$8.25
|
| Rate for Payer: Group Health Inc Medicare |
$5.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.73
|
|
|
PRASUGREL HCL 5 MG PO TABS
|
Facility
|
IP
|
$16.51
|
|
|
Service Code
|
NDC 6050546423
|
| Hospital Charge Code |
6050546423
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$8.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.25
|
|
|
PRASUGREL HCL 5 MG PO TABS
|
Facility
|
IP
|
$16.51
|
|
|
Service Code
|
NDC 0378518593
|
| Hospital Charge Code |
0378518593
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$8.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.25
|
|
|
PRASUGREL HCL 5 MG PO TABS
|
Facility
|
OP
|
$16.51
|
|
|
Service Code
|
NDC 0378518593
|
| Hospital Charge Code |
0378518593
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$13.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.25
|
| Rate for Payer: Aetna Government |
$8.25
|
| Rate for Payer: Brighton Health Commercial |
$12.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.22
|
| Rate for Payer: EmblemHealth Commercial |
$8.25
|
| Rate for Payer: Group Health Inc Commercial |
$8.25
|
| Rate for Payer: Group Health Inc Medicare |
$5.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.73
|
|
|
PR ATRIA ABLATE & RCNSTJ W/OTHER PROCEDURE LIMITE
|
Professional
|
Both
|
$2,582.09
|
|
|
Service Code
|
HCPCS 33257
|
| Min. Negotiated Rate |
$478.96 |
| Max. Negotiated Rate |
$1,539.52 |
| Rate for Payer: Cash Price |
$688.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$684.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$615.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$615.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$650.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$684.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$650.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$684.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$684.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$513.17
|
| Rate for Payer: Healthfirst Commercial |
$684.23
|
| Rate for Payer: Healthfirst Essential Plan |
$1,539.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$650.02
|
| Rate for Payer: Healthfirst QHP |
$684.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$478.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$684.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$581.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$478.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$684.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$513.17
|
| Rate for Payer: SOMOS Essential |
$513.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$684.23
|
|
|
PR ATRIA ABLTJ & RCNSTJ W/OTHER PX EXTENSIV W/O BYP
|
Professional
|
Both
|
$2,864.19
|
|
|
Service Code
|
HCPCS 33258
|
| Min. Negotiated Rate |
$530.21 |
| Max. Negotiated Rate |
$1,704.24 |
| Rate for Payer: Cash Price |
$763.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$757.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$681.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$681.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$719.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$757.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$719.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$757.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$757.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$568.08
|
| Rate for Payer: Healthfirst Commercial |
$757.44
|
| Rate for Payer: Healthfirst Essential Plan |
$1,704.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$719.57
|
| Rate for Payer: Healthfirst QHP |
$757.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$530.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$757.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$643.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$530.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$757.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$568.08
|
| Rate for Payer: SOMOS Essential |
$568.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$757.44
|
|
|
PR ATRIA ABLTJ & RCNSTJ W/OTHER PX EXTEN W/BYPASS
|
Professional
|
Both
|
$3,738.39
|
|
|
Service Code
|
HCPCS 33259
|
| Min. Negotiated Rate |
$694.78 |
| Max. Negotiated Rate |
$2,233.22 |
| Rate for Payer: Cash Price |
$1,000.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$992.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$893.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$893.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$942.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$992.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$942.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$992.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$992.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$744.40
|
| Rate for Payer: Healthfirst Commercial |
$992.54
|
| Rate for Payer: Healthfirst Essential Plan |
$2,233.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$942.91
|
| Rate for Payer: Healthfirst QHP |
$992.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$694.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$992.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$843.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$694.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$992.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$744.40
|
| Rate for Payer: SOMOS Essential |
$744.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$992.54
|
|
