|
PR CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG
|
Professional
|
Both
|
$436.03
|
|
|
Service Code
|
HCPCS 96409
|
| Min. Negotiated Rate |
$77.78 |
| Max. Negotiated Rate |
$250.02 |
| Rate for Payer: Cash Price |
$118.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$111.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$100.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$100.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$105.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$111.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$105.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.34
|
| Rate for Payer: Healthfirst Commercial |
$111.12
|
| Rate for Payer: Healthfirst Essential Plan |
$250.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$105.56
|
| Rate for Payer: Healthfirst QHP |
$111.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$77.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$111.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$94.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$77.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$111.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.34
|
| Rate for Payer: SOMOS Essential |
$83.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.12
|
|
|
PR CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG
|
Professional
|
Both
|
$238.67
|
|
|
Service Code
|
HCPCS 96411
|
| Min. Negotiated Rate |
$42.53 |
| Max. Negotiated Rate |
$136.71 |
| Rate for Payer: Cash Price |
$63.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$60.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$54.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$54.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$57.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$60.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$57.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.57
|
| Rate for Payer: Healthfirst Commercial |
$60.76
|
| Rate for Payer: Healthfirst Essential Plan |
$136.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$57.72
|
| Rate for Payer: Healthfirst QHP |
$60.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$42.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$60.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$51.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$42.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$60.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.57
|
| Rate for Payer: SOMOS Essential |
$45.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$60.76
|
|
|
PR CHEMOTX ADMN PERTL CAVITY IMPLANTED PORT/CATH
|
Professional
|
Both
|
$123.06
|
|
|
Service Code
|
HCPCS 96446
|
| Min. Negotiated Rate |
$16.19 |
| Max. Negotiated Rate |
$52.04 |
| Rate for Payer: Cash Price |
$24.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$23.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.35
|
| Rate for Payer: Healthfirst Commercial |
$23.13
|
| Rate for Payer: Healthfirst Essential Plan |
$52.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.97
|
| Rate for Payer: Healthfirst QHP |
$23.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.35
|
| Rate for Payer: SOMOS Essential |
$17.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.13
|
|
|
PR CHEMOTX ADMN PLEURAL CAVITY REQ&W/THORACNTS
|
Professional
|
Both
|
$545.34
|
|
|
Service Code
|
HCPCS 96440
|
| Min. Negotiated Rate |
$105.98 |
| Max. Negotiated Rate |
$340.65 |
| Rate for Payer: Cash Price |
$151.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$151.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$136.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$136.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$143.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$151.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$143.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$151.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$151.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.55
|
| Rate for Payer: Healthfirst Commercial |
$151.40
|
| Rate for Payer: Healthfirst Essential Plan |
$340.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$143.83
|
| Rate for Payer: Healthfirst QHP |
$151.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$151.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$128.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$151.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$113.55
|
| Rate for Payer: SOMOS Essential |
$113.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$151.40
|
|
|
PR CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO
|
Professional
|
Both
|
$144.27
|
|
|
Service Code
|
HCPCS 96402
|
| Min. Negotiated Rate |
$29.09 |
| Max. Negotiated Rate |
$93.49 |
| Rate for Payer: Cash Price |
$41.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.16
|
| Rate for Payer: Healthfirst Commercial |
$41.55
|
| Rate for Payer: Healthfirst Essential Plan |
$93.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.47
|
| Rate for Payer: Healthfirst QHP |
$41.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.16
|
| Rate for Payer: SOMOS Essential |
$31.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.55
|
|
|
PR CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO
|
Professional
|
Both
|
$313.25
|
|
|
Service Code
|
HCPCS 96401
|
| Min. Negotiated Rate |
$55.71 |
| Max. Negotiated Rate |
$179.06 |
| Rate for Payer: Cash Price |
$84.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$79.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.69
|
| Rate for Payer: Healthfirst Commercial |
$79.58
|
| Rate for Payer: Healthfirst Essential Plan |
$179.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$75.60
|
| Rate for Payer: Healthfirst QHP |
$79.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$79.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$67.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$59.69
|
| Rate for Payer: SOMOS Essential |
$59.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.58
|
|
|
PR CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP
|
Professional
|
Both
|
$555.77
|
|
|
Service Code
|
HCPCS 96416
|
| Min. Negotiated Rate |
$98.79 |
| Max. Negotiated Rate |
$317.54 |
| Rate for Payer: Cash Price |
$150.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$141.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$127.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$127.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$134.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$141.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$134.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$141.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$141.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.85
|
| Rate for Payer: Healthfirst Commercial |
$141.13
|
| Rate for Payer: Healthfirst Essential Plan |
$317.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$134.07
|
| Rate for Payer: Healthfirst QHP |
$141.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$141.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$119.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$141.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.85
|
| Rate for Payer: SOMOS Essential |
$105.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$141.13
|
|
|
PR CHEMOTX NJX SUBARACHND/INTRAVENTR RSVR 1/MULT
|
Professional
|
Both
|
$172.17
|
|
|
Service Code
|
HCPCS 96542
|
| Min. Negotiated Rate |
$31.93 |
| Max. Negotiated Rate |
$102.64 |
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.22
|
| Rate for Payer: Healthfirst Commercial |
$45.62
|
| Rate for Payer: Healthfirst Essential Plan |
$102.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.34
|
| Rate for Payer: Healthfirst QHP |
$45.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.22
|
| Rate for Payer: SOMOS Essential |
$34.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.62
|
|
|
PR CHIROPRACTIC MANIPULATIVE TX SPINAL 1-2 REGIONS
|
Professional
|
Both
|
$86.24
|
|
|
Service Code
|
HCPCS 98940
|
| Min. Negotiated Rate |
$16.69 |
| Max. Negotiated Rate |
$53.64 |
| Rate for Payer: Cash Price |
$23.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$23.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.88
|
| Rate for Payer: Healthfirst Commercial |
$23.84
|
| Rate for Payer: Healthfirst Essential Plan |
$53.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.65
|
| Rate for Payer: Healthfirst QHP |
$23.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.88
|
| Rate for Payer: SOMOS Essential |
$17.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.84
|
|
|
PR CHIROPRACTIC MANIPULATIVE TX SPINAL 3-4 REGIONS
|
Professional
|
Both
|
$131.92
|
|
|
Service Code
|
HCPCS 98941
|
| Min. Negotiated Rate |
$25.43 |
| Max. Negotiated Rate |
$81.74 |
| Rate for Payer: Cash Price |
$36.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.25
|
| Rate for Payer: Healthfirst Commercial |
$36.33
|
| Rate for Payer: Healthfirst Essential Plan |
$81.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.51
|
| Rate for Payer: Healthfirst QHP |
$36.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.25
|
| Rate for Payer: SOMOS Essential |
$27.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.33
|
|
|
PR CHIROPRACTIC MANIPULATIVE TX SPINAL 5 REGIONS
|
Professional
|
Both
|
$177.59
|
|
|
Service Code
|
HCPCS 98942
|
| Min. Negotiated Rate |
$34.18 |
| Max. Negotiated Rate |
$109.87 |
| Rate for Payer: Cash Price |
$48.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$48.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.62
|
| Rate for Payer: Healthfirst Commercial |
$48.83
|
| Rate for Payer: Healthfirst Essential Plan |
$109.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.39
|
| Rate for Payer: Healthfirst QHP |
$48.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.62
|
| Rate for Payer: SOMOS Essential |
$36.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.83
|
|
|
PR CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL
|
Professional
|
Both
|
$321.13
|
|
|
Service Code
|
HCPCS 50688
|
| Min. Negotiated Rate |
$62.28 |
| Max. Negotiated Rate |
$200.18 |
| Rate for Payer: Cash Price |
$88.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$88.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$88.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.73
|
| Rate for Payer: Healthfirst Commercial |
$88.97
|
| Rate for Payer: Healthfirst Essential Plan |
$200.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$84.52
|
| Rate for Payer: Healthfirst QHP |
$88.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$88.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$88.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$66.73
|
| Rate for Payer: SOMOS Essential |
$66.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$88.97
|
|
|
PR CHOLECSTC EXPL DUX SPHNCTROTOMY/SPHNCTROP
|
Professional
|
Both
|
$6,227.62
|
|
|
Service Code
|
HCPCS 47620
|
| Min. Negotiated Rate |
$1,149.30 |
| Max. Negotiated Rate |
$3,694.16 |
| Rate for Payer: Cash Price |
$1,656.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,641.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,477.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,477.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,559.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,641.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,559.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,641.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,641.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,231.39
|
| Rate for Payer: Healthfirst Commercial |
$1,641.85
|
| Rate for Payer: Healthfirst Essential Plan |
$3,694.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,559.76
|
| Rate for Payer: Healthfirst QHP |
$1,641.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,149.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,641.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,395.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,149.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,641.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,231.39
|
| Rate for Payer: SOMOS Essential |
$1,231.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,641.85
|
|
|
PR CHOLECSTONTRSTM ROUX-EN-Y W/GASTRONTRSTM
|
Professional
|
Both
|
$6,678.46
|
|
|
Service Code
|
HCPCS 47741
|
| Min. Negotiated Rate |
$1,233.90 |
| Max. Negotiated Rate |
$3,966.10 |
| Rate for Payer: Cash Price |
$1,777.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,762.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,586.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,586.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,674.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,762.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,674.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,762.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,762.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,322.03
|
| Rate for Payer: Healthfirst Commercial |
$1,762.71
|
| Rate for Payer: Healthfirst Essential Plan |
$3,966.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,674.57
|
| Rate for Payer: Healthfirst QHP |
$1,762.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,233.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,762.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,498.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,233.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,762.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,322.03
|
| Rate for Payer: SOMOS Essential |
$1,322.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,762.71
|
|
|
PR CHOLECSTOT/CHOLECSTOST W/EXPL DRG/RMVL ST1 SPX
|
Professional
|
Both
|
$3,940.23
|
|
|
Service Code
|
HCPCS 47480
|
| Min. Negotiated Rate |
$734.20 |
| Max. Negotiated Rate |
$2,359.91 |
| Rate for Payer: Cash Price |
$1,050.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$943.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$943.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$996.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$996.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,048.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$786.64
|
| Rate for Payer: Healthfirst Commercial |
$1,048.85
|
| Rate for Payer: Healthfirst Essential Plan |
$2,359.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$996.41
|
| Rate for Payer: Healthfirst QHP |
$1,048.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$734.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,048.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$891.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$734.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$786.64
|
| Rate for Payer: SOMOS Essential |
$786.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.85
|
|
|
PR CHOLECYSTECTOMY
|
Professional
|
Both
|
$4,821.74
|
|
|
Service Code
|
HCPCS 47600
|
| Min. Negotiated Rate |
$896.29 |
| Max. Negotiated Rate |
$2,880.95 |
| Rate for Payer: Cash Price |
$1,287.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,280.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,152.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,152.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,216.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,280.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,216.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,280.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,280.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$960.32
|
| Rate for Payer: Healthfirst Commercial |
$1,280.42
|
| Rate for Payer: Healthfirst Essential Plan |
$2,880.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,216.40
|
| Rate for Payer: Healthfirst QHP |
$1,280.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$896.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,280.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,088.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$896.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,280.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$960.32
|
| Rate for Payer: SOMOS Essential |
$960.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,280.42
|
|
|
PR CHOLECYSTECTOMY EXPL DUCT CHOLEDOCHOENTEROSTOMY
|
Professional
|
Both
|
$5,765.41
|
|
|
Service Code
|
HCPCS 47612
|
| Min. Negotiated Rate |
$1,064.65 |
| Max. Negotiated Rate |
$3,422.09 |
| Rate for Payer: Cash Price |
$1,534.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,520.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,368.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,368.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,444.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,520.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,444.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,520.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,520.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,140.70
|
| Rate for Payer: Healthfirst Commercial |
$1,520.93
|
| Rate for Payer: Healthfirst Essential Plan |
$3,422.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,444.88
|
| Rate for Payer: Healthfirst QHP |
$1,520.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,064.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,520.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,292.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,064.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,520.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,140.70
|
| Rate for Payer: SOMOS Essential |
$1,140.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,520.93
|
|
|
PR CHOLECYSTECTOMY W/CHOLANGIOGRAPHY
|
Professional
|
Both
|
$5,096.39
|
|
|
Service Code
|
HCPCS 47605
|
| Min. Negotiated Rate |
$943.28 |
| Max. Negotiated Rate |
$3,031.99 |
| Rate for Payer: Cash Price |
$1,357.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,347.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,212.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,212.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,280.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,347.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,280.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,347.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,347.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,010.66
|
| Rate for Payer: Healthfirst Commercial |
$1,347.55
|
| Rate for Payer: Healthfirst Essential Plan |
$3,031.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,280.17
|
| Rate for Payer: Healthfirst QHP |
$1,347.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$943.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,347.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,145.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$943.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,347.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,010.66
|
| Rate for Payer: SOMOS Essential |
$1,010.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,347.55
|
|
|
PR CHOLECYSTECTOMY W/EXPLORATION COMMON DUCT
|
Professional
|
Both
|
$5,661.01
|
|
|
Service Code
|
HCPCS 47610
|
| Min. Negotiated Rate |
$1,048.78 |
| Max. Negotiated Rate |
$3,371.09 |
| Rate for Payer: Cash Price |
$1,502.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,498.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,348.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,348.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,423.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,498.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,423.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,498.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,498.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,123.69
|
| Rate for Payer: Healthfirst Commercial |
$1,498.26
|
| Rate for Payer: Healthfirst Essential Plan |
$3,371.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,423.35
|
| Rate for Payer: Healthfirst QHP |
$1,498.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,048.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,498.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,273.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,048.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,498.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,123.69
|
| Rate for Payer: SOMOS Essential |
$1,123.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,498.26
|
|
|
PR CHOLECYSTOENTEROSTOMY DIRECT
|
Professional
|
Both
|
$5,231.80
|
|
|
Service Code
|
HCPCS 47720
|
| Min. Negotiated Rate |
$967.23 |
| Max. Negotiated Rate |
$3,108.96 |
| Rate for Payer: Cash Price |
$1,393.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,381.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,243.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,243.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,312.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,381.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,312.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,381.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,381.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,036.32
|
| Rate for Payer: Healthfirst Commercial |
$1,381.76
|
| Rate for Payer: Healthfirst Essential Plan |
$3,108.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,312.67
|
| Rate for Payer: Healthfirst QHP |
$1,381.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$967.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,381.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,174.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$967.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,381.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,036.32
|
| Rate for Payer: SOMOS Essential |
$1,036.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,381.76
|
|
|
PR CHOLECYSTOENTEROSTOMY ROUX-EN-Y
|
Professional
|
Both
|
$5,941.85
|
|
|
Service Code
|
HCPCS 47740
|
| Min. Negotiated Rate |
$1,098.29 |
| Max. Negotiated Rate |
$3,530.20 |
| Rate for Payer: Cash Price |
$1,583.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,568.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,412.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,412.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,490.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,568.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,490.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,568.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,568.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,176.73
|
| Rate for Payer: Healthfirst Commercial |
$1,568.98
|
| Rate for Payer: Healthfirst Essential Plan |
$3,530.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,490.53
|
| Rate for Payer: Healthfirst QHP |
$1,568.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,098.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,568.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,333.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,098.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,568.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,176.73
|
| Rate for Payer: SOMOS Essential |
$1,176.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,568.98
|
|
|
PR CHOLECYSTOENTEROSTOMY W/GASTROENTEROSTOMY
|
Professional
|
Both
|
$6,134.77
|
|
|
Service Code
|
HCPCS 47721
|
| Min. Negotiated Rate |
$1,133.74 |
| Max. Negotiated Rate |
$3,644.17 |
| Rate for Payer: Cash Price |
$1,633.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,619.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,457.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,457.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,538.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,619.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,538.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,619.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,619.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,214.72
|
| Rate for Payer: Healthfirst Commercial |
$1,619.63
|
| Rate for Payer: Healthfirst Essential Plan |
$3,644.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,538.65
|
| Rate for Payer: Healthfirst QHP |
$1,619.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,133.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,619.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,376.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,133.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,619.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,214.72
|
| Rate for Payer: SOMOS Essential |
$1,214.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,619.63
|
|
|
PR CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT
|
Professional
|
Both
|
$1,384.74
|
|
|
Service Code
|
HCPCS 47490
|
| Min. Negotiated Rate |
$261.52 |
| Max. Negotiated Rate |
$840.60 |
| Rate for Payer: Cash Price |
$374.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$373.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$336.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$336.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$354.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$373.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$354.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$373.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$373.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$280.20
|
| Rate for Payer: Healthfirst Commercial |
$373.60
|
| Rate for Payer: Healthfirst Essential Plan |
$840.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$354.92
|
| Rate for Payer: Healthfirst QHP |
$373.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$261.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$373.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$317.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$261.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$373.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$280.20
|
| Rate for Payer: SOMOS Essential |
$280.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$373.60
|
|
|
PR CHOLEDOCHOT/OST W/O SPHNCTROTOMY/SPHNCTROP
|
Professional
|
Both
|
$5,999.07
|
|
|
Service Code
|
HCPCS 47420
|
| Min. Negotiated Rate |
$1,112.57 |
| Max. Negotiated Rate |
$3,576.13 |
| Rate for Payer: Cash Price |
$1,608.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,589.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,430.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,430.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,509.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,589.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,509.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,589.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,589.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,192.04
|
| Rate for Payer: Healthfirst Commercial |
$1,589.39
|
| Rate for Payer: Healthfirst Essential Plan |
$3,576.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,509.92
|
| Rate for Payer: Healthfirst QHP |
$1,589.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,112.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,589.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,350.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,112.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,589.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,192.04
|
| Rate for Payer: SOMOS Essential |
$1,192.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,589.39
|
|
|
PR CHOLEDOCHOT/OST W/SPHNCTROTOMY/SPHNCTROP
|
Professional
|
Both
|
$6,189.54
|
|
|
Service Code
|
HCPCS 47425
|
| Min. Negotiated Rate |
$1,141.99 |
| Max. Negotiated Rate |
$3,670.67 |
| Rate for Payer: Cash Price |
$1,646.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,631.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,468.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,468.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,549.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,631.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,549.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,631.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,631.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,223.56
|
| Rate for Payer: Healthfirst Commercial |
$1,631.41
|
| Rate for Payer: Healthfirst Essential Plan |
$3,670.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,549.84
|
| Rate for Payer: Healthfirst QHP |
$1,631.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,141.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,631.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,386.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,141.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,631.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,223.56
|
| Rate for Payer: SOMOS Essential |
$1,223.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,631.41
|
|
