|
PR CRTJ SHUNT LMBR SARACH-PRTL-PLEURAL PRQ X LAM
|
Professional
|
Both
|
$3,250.24
|
|
|
Service Code
|
HCPCS 63741
|
| Min. Negotiated Rate |
$583.49 |
| Max. Negotiated Rate |
$1,875.51 |
| Rate for Payer: Cash Price |
$857.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$833.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$750.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$750.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$791.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$833.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$791.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$833.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$833.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$625.17
|
| Rate for Payer: Healthfirst Commercial |
$833.56
|
| Rate for Payer: Healthfirst Essential Plan |
$1,875.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$791.88
|
| Rate for Payer: Healthfirst QHP |
$833.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$583.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$833.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$708.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$583.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$833.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$625.17
|
| Rate for Payer: SOMOS Essential |
$625.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$833.56
|
|
|
PR CRTJ SHUNT SARACH/SDRL-ATR-JUG-AUR
|
Professional
|
Both
|
$4,470.41
|
|
|
Service Code
|
HCPCS 62190
|
| Min. Negotiated Rate |
$823.81 |
| Max. Negotiated Rate |
$2,647.96 |
| Rate for Payer: Cash Price |
$1,185.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,176.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,059.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,059.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,118.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,176.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,118.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,176.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,176.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$882.65
|
| Rate for Payer: Healthfirst Commercial |
$1,176.87
|
| Rate for Payer: Healthfirst Essential Plan |
$2,647.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,118.03
|
| Rate for Payer: Healthfirst QHP |
$1,176.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$823.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,176.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,000.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$823.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,176.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$882.65
|
| Rate for Payer: SOMOS Essential |
$882.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,176.87
|
|
|
PR CRTJ SHUNT SARACH/SDRL-PRTL-PLEURAL OTH
|
Professional
|
Both
|
$4,657.80
|
|
|
Service Code
|
HCPCS 62192
|
| Min. Negotiated Rate |
$874.37 |
| Max. Negotiated Rate |
$2,810.47 |
| Rate for Payer: Cash Price |
$1,263.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,249.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,124.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,124.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,186.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,249.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,186.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,249.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,249.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$936.83
|
| Rate for Payer: Healthfirst Commercial |
$1,249.10
|
| Rate for Payer: Healthfirst Essential Plan |
$2,810.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,186.64
|
| Rate for Payer: Healthfirst QHP |
$1,249.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$874.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,249.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,061.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$874.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,249.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$936.83
|
| Rate for Payer: SOMOS Essential |
$936.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,249.10
|
|
|
PR CRTJ SHUNT VENTRICULO-ATR-JUG-AUR
|
Professional
|
Both
|
$4,611.60
|
|
|
Service Code
|
HCPCS 62220
|
| Min. Negotiated Rate |
$851.93 |
| Max. Negotiated Rate |
$2,738.36 |
| Rate for Payer: Cash Price |
$1,229.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,217.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,095.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,095.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,156.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,217.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,156.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,217.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,217.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$912.79
|
| Rate for Payer: Healthfirst Commercial |
$1,217.05
|
| Rate for Payer: Healthfirst Essential Plan |
$2,738.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,156.20
|
| Rate for Payer: Healthfirst QHP |
$1,217.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$851.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,217.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,034.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$851.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,217.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$912.79
|
| Rate for Payer: SOMOS Essential |
$912.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,217.05
|
|
|
PR CRTJ SHUNT VENTRICULO-PERITNEAL-PLEURAL TERMINUS
|
Professional
|
Both
|
$4,912.99
|
|
|
Service Code
|
HCPCS 62223
|
| Min. Negotiated Rate |
$897.65 |
| Max. Negotiated Rate |
$2,885.31 |
| Rate for Payer: Cash Price |
$1,299.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,282.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,154.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,154.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,218.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,282.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,218.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,282.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,282.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$961.77
|
| Rate for Payer: Healthfirst Commercial |
$1,282.36
|
| Rate for Payer: Healthfirst Essential Plan |
$2,885.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,218.24
|
| Rate for Payer: Healthfirst QHP |
$1,282.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$897.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,282.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,090.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$897.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,282.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$961.77
|
| Rate for Payer: SOMOS Essential |
$961.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,282.36
|
|
|
PR CRTJ SUBQ INSJ IMPLTBL GLUCOSE SENSOR SYS TRAIN
|
Professional
|
Both
|
$226.63
|
|
|
Service Code
|
HCPCS 0446T
|
| Min. Negotiated Rate |
$43.72 |
| Max. Negotiated Rate |
$140.53 |
| Rate for Payer: Cash Price |
$62.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.84
|
| Rate for Payer: Healthfirst Commercial |
$62.46
|
| Rate for Payer: Healthfirst Essential Plan |
$140.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.34
|
| Rate for Payer: Healthfirst QHP |
$62.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$46.84
|
| Rate for Payer: SOMOS Essential |
$46.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.46
|
|
|
PR CRX RPR DURAL/CSF LEAK RHINORRHEA/OTORRHEA
|
Professional
|
Both
|
$7,360.82
|
|
|
Service Code
|
HCPCS 62100
|
| Min. Negotiated Rate |
$1,354.12 |
| Max. Negotiated Rate |
$4,352.51 |
| Rate for Payer: Cash Price |
$1,959.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,934.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,741.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,741.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,837.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,934.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,837.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,934.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,934.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,450.84
|
| Rate for Payer: Healthfirst Commercial |
$1,934.45
|
| Rate for Payer: Healthfirst Essential Plan |
$4,352.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,837.73
|
| Rate for Payer: Healthfirst QHP |
$1,934.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,354.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,934.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,644.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,354.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,934.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,450.84
|
| Rate for Payer: SOMOS Essential |
$1,450.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,934.45
|
|
|
PR CRYOSURGICAL ABLATION PROSTATE W/US & MONITORI
|
Professional
|
Both
|
$3,200.44
|
|
|
Service Code
|
HCPCS 55873
|
| Min. Negotiated Rate |
$610.04 |
| Max. Negotiated Rate |
$1,960.83 |
| Rate for Payer: Cash Price |
$875.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$871.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$784.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$784.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$827.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$871.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$827.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$871.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$871.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$653.61
|
| Rate for Payer: Healthfirst Commercial |
$871.48
|
| Rate for Payer: Healthfirst Essential Plan |
$1,960.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$827.91
|
| Rate for Payer: Healthfirst QHP |
$871.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$610.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$871.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$740.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$610.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$871.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$653.61
|
| Rate for Payer: SOMOS Essential |
$653.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$871.48
|
|
|
PR CRYOTHERAPY CO2 SLUSH LIQUID N2 ACNE
|
Professional
|
Both
|
$210.04
|
|
|
Service Code
|
HCPCS 17340
|
| Min. Negotiated Rate |
$39.14 |
| Max. Negotiated Rate |
$125.82 |
| Rate for Payer: Cash Price |
$56.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$55.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$53.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.94
|
| Rate for Payer: Healthfirst Commercial |
$55.92
|
| Rate for Payer: Healthfirst Essential Plan |
$125.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$53.12
|
| Rate for Payer: Healthfirst QHP |
$55.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$55.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.94
|
| Rate for Payer: SOMOS Essential |
$41.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.92
|
|
|
PR CSTC COMPL W/CONDUIT/SIGMOID BLDR PEL LMPHADEC
|
Professional
|
Both
|
$9,095.03
|
|
|
Service Code
|
HCPCS 51595
|
| Min. Negotiated Rate |
$1,725.34 |
| Max. Negotiated Rate |
$5,545.73 |
| Rate for Payer: Cash Price |
$2,480.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,464.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,218.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,218.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,341.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,464.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,341.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,464.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,464.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,848.58
|
| Rate for Payer: Healthfirst Commercial |
$2,464.77
|
| Rate for Payer: Healthfirst Essential Plan |
$5,545.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,341.53
|
| Rate for Payer: Healthfirst QHP |
$2,464.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,725.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,464.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,095.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,725.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,464.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,848.58
|
| Rate for Payer: SOMOS Essential |
$1,848.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,464.77
|
|
|
PR CSTC COMPL W/CONTINENT DVRJ OPN NEOBLDR
|
Professional
|
Both
|
$9,834.79
|
|
|
Service Code
|
HCPCS 51596
|
| Min. Negotiated Rate |
$1,866.83 |
| Max. Negotiated Rate |
$6,000.52 |
| Rate for Payer: Cash Price |
$2,674.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,666.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,400.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,400.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,533.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,666.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,533.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,666.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,666.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,000.17
|
| Rate for Payer: Healthfirst Commercial |
$2,666.90
|
| Rate for Payer: Healthfirst Essential Plan |
$6,000.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,533.55
|
| Rate for Payer: Healthfirst QHP |
$2,666.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,866.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,666.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,266.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,866.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,666.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,000.17
|
| Rate for Payer: SOMOS Essential |
$2,000.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,666.90
|
|
|
PR CSTC COMPL W/URTROILEAL CONDUIT/BLDR W/INT ANAST
|
Professional
|
Both
|
$8,043.67
|
|
|
Service Code
|
HCPCS 51590
|
| Min. Negotiated Rate |
$1,526.11 |
| Max. Negotiated Rate |
$4,905.36 |
| Rate for Payer: Cash Price |
$2,192.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,180.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,962.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,962.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,071.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,180.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,071.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,180.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,180.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,635.12
|
| Rate for Payer: Healthfirst Commercial |
$2,180.16
|
| Rate for Payer: Healthfirst Essential Plan |
$4,905.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,071.15
|
| Rate for Payer: Healthfirst QHP |
$2,180.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,526.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,180.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,853.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,526.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,180.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,635.12
|
| Rate for Payer: SOMOS Essential |
$1,635.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,180.16
|
|
|
PR CSTC PRTL W/RIMPLTJ URTR IN BLDR URTRONEOCSTOST
|
Professional
|
Both
|
$5,374.78
|
|
|
Service Code
|
HCPCS 51565
|
| Min. Negotiated Rate |
$1,020.83 |
| Max. Negotiated Rate |
$3,281.24 |
| Rate for Payer: Cash Price |
$1,466.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,458.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,312.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,312.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,385.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,458.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,385.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,458.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,458.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,093.75
|
| Rate for Payer: Healthfirst Commercial |
$1,458.33
|
| Rate for Payer: Healthfirst Essential Plan |
$3,281.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,385.41
|
| Rate for Payer: Healthfirst QHP |
$1,458.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,020.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,458.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,239.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,020.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,458.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,093.75
|
| Rate for Payer: SOMOS Essential |
$1,093.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,458.33
|
|
|
PR CSTOPLASTY/CSTOURTP PLSTC ANY
|
Professional
|
Both
|
$4,336.99
|
|
|
Service Code
|
HCPCS 51800
|
| Min. Negotiated Rate |
$823.98 |
| Max. Negotiated Rate |
$2,648.52 |
| Rate for Payer: Cash Price |
$1,184.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,177.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,059.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,059.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,118.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,177.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,118.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,177.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,177.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$882.84
|
| Rate for Payer: Healthfirst Commercial |
$1,177.12
|
| Rate for Payer: Healthfirst Essential Plan |
$2,648.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,118.26
|
| Rate for Payer: Healthfirst QHP |
$1,177.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$823.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,177.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,000.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$823.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,177.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$882.84
|
| Rate for Payer: SOMOS Essential |
$882.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,177.12
|
|
|
PR CSTOTOMY/CSTOST CRYOSURG DSTRJ INTRAVESICAL LES
|
Professional
|
Both
|
$1,987.62
|
|
|
Service Code
|
HCPCS 51030
|
| Rate for Payer: Cash Price |
$548.14
|
|
|
PR CSTOURTP W/UNI/BI URTRONEOCSTOST
|
Professional
|
Both
|
$4,532.96
|
|
|
Service Code
|
HCPCS 51820
|
| Min. Negotiated Rate |
$862.15 |
| Max. Negotiated Rate |
$2,771.19 |
| Rate for Payer: Cash Price |
$1,238.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,231.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,108.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,108.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,170.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,231.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,170.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,231.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,231.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$923.73
|
| Rate for Payer: Healthfirst Commercial |
$1,231.64
|
| Rate for Payer: Healthfirst Essential Plan |
$2,771.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,170.06
|
| Rate for Payer: Healthfirst QHP |
$1,231.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$862.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,231.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,046.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$862.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,231.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$923.73
|
| Rate for Payer: SOMOS Essential |
$923.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,231.64
|
|
|
PR CSTO W/TRURL RESCJ/INC EJACULATORY DUXS
|
Professional
|
Both
|
$1,102.54
|
|
|
Service Code
|
HCPCS 52402
|
| Min. Negotiated Rate |
$207.33 |
| Max. Negotiated Rate |
$666.40 |
| Rate for Payer: Cash Price |
$298.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$296.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$266.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$266.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$281.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$296.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$281.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$296.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$296.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$222.13
|
| Rate for Payer: Healthfirst Commercial |
$296.18
|
| Rate for Payer: Healthfirst Essential Plan |
$666.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$281.37
|
| Rate for Payer: Healthfirst QHP |
$296.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$207.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$296.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$251.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$207.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$296.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$222.13
|
| Rate for Payer: SOMOS Essential |
$222.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$296.18
|
|
|
PR CTRL NASOPHARYNGEAL HEMORRHAGE W/SEC SURG IVNTJ
|
Professional
|
Both
|
$2,192.02
|
|
|
Service Code
|
HCPCS 42972
|
| Min. Negotiated Rate |
$412.02 |
| Max. Negotiated Rate |
$1,324.35 |
| Rate for Payer: Cash Price |
$595.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$588.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$529.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$529.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$559.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$588.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$559.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$588.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$588.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$441.45
|
| Rate for Payer: Healthfirst Commercial |
$588.60
|
| Rate for Payer: Healthfirst Essential Plan |
$1,324.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$559.17
|
| Rate for Payer: Healthfirst QHP |
$588.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$412.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$588.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$500.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$412.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$588.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$441.45
|
| Rate for Payer: SOMOS Essential |
$441.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$588.60
|
|
|
PR CTRL NASOPHARYNGEAL HEMRRG COMP REQ HOSPIZATION
|
Professional
|
Both
|
$1,956.68
|
|
|
Service Code
|
HCPCS 42971
|
| Min. Negotiated Rate |
$368.45 |
| Max. Negotiated Rate |
$1,184.31 |
| Rate for Payer: Cash Price |
$532.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$526.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$473.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$473.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$500.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$526.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$500.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$526.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$526.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$394.77
|
| Rate for Payer: Healthfirst Commercial |
$526.36
|
| Rate for Payer: Healthfirst Essential Plan |
$1,184.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$500.04
|
| Rate for Payer: Healthfirst QHP |
$526.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$368.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$526.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$447.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$368.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$526.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$394.77
|
| Rate for Payer: SOMOS Essential |
$394.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$526.36
|
|
|
PR CTRL NASOPHARYNGEAL HEMRRG SMPL W/PST NSL PACKS
|
Professional
|
Both
|
$1,778.42
|
|
|
Service Code
|
HCPCS 42970
|
| Min. Negotiated Rate |
$334.83 |
| Max. Negotiated Rate |
$1,076.24 |
| Rate for Payer: Cash Price |
$484.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$478.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$430.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$430.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$454.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$478.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$454.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$478.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$478.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$358.75
|
| Rate for Payer: Healthfirst Commercial |
$478.33
|
| Rate for Payer: Healthfirst Essential Plan |
$1,076.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$454.41
|
| Rate for Payer: Healthfirst QHP |
$478.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$334.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$478.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$406.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$334.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$478.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$358.75
|
| Rate for Payer: SOMOS Essential |
$358.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$478.33
|
|
|
PR CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST
|
Professional
|
Both
|
$463.26
|
|
|
Service Code
|
HCPCS 30905
|
| Min. Negotiated Rate |
$86.45 |
| Max. Negotiated Rate |
$277.88 |
| Rate for Payer: Cash Price |
$123.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$123.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$111.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$111.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$117.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$123.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$117.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$123.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.62
|
| Rate for Payer: Healthfirst Commercial |
$123.50
|
| Rate for Payer: Healthfirst Essential Plan |
$277.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$117.33
|
| Rate for Payer: Healthfirst QHP |
$123.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$86.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$123.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$104.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$86.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$123.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$92.62
|
| Rate for Payer: SOMOS Essential |
$92.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$123.50
|
|
|
PR CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ
|
Professional
|
Both
|
$574.70
|
|
|
Service Code
|
HCPCS 30906
|
| Min. Negotiated Rate |
$107.03 |
| Max. Negotiated Rate |
$344.02 |
| Rate for Payer: Cash Price |
$154.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$152.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$137.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$137.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$145.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$152.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$145.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$152.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$152.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.67
|
| Rate for Payer: Healthfirst Commercial |
$152.90
|
| Rate for Payer: Healthfirst Essential Plan |
$344.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$145.25
|
| Rate for Payer: Healthfirst QHP |
$152.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$107.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$152.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$129.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$107.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$152.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$114.67
|
| Rate for Payer: SOMOS Essential |
$114.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$152.90
|
|
|
PR CTRL OROPHARYNGEAL HEMORRHAGE COMP REQ HOSPITJ
|
Professional
|
Both
|
$1,815.31
|
|
|
Service Code
|
HCPCS 42961
|
| Min. Negotiated Rate |
$341.61 |
| Max. Negotiated Rate |
$1,098.05 |
| Rate for Payer: Cash Price |
$494.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$488.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$439.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$439.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$463.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$488.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$463.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$488.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$488.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$366.01
|
| Rate for Payer: Healthfirst Commercial |
$488.02
|
| Rate for Payer: Healthfirst Essential Plan |
$1,098.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$463.62
|
| Rate for Payer: Healthfirst QHP |
$488.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$341.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$488.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$414.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$341.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$488.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$366.01
|
| Rate for Payer: SOMOS Essential |
$366.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$488.02
|
|
|
PR CTRL OROPHARYNGEAL HEMORRHAGE W/SEC SURG IVNTJ
|
Professional
|
Both
|
$2,246.13
|
|
|
Service Code
|
HCPCS 42962
|
| Min. Negotiated Rate |
$420.43 |
| Max. Negotiated Rate |
$1,351.39 |
| Rate for Payer: Cash Price |
$607.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$600.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$540.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$540.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$570.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$600.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$570.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$600.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$600.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$450.46
|
| Rate for Payer: Healthfirst Commercial |
$600.62
|
| Rate for Payer: Healthfirst Essential Plan |
$1,351.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$570.59
|
| Rate for Payer: Healthfirst QHP |
$600.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$420.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$600.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$510.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$420.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$600.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$450.46
|
| Rate for Payer: SOMOS Essential |
$450.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$600.62
|
|
|
PR CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ LWR LIMBS
|
Professional
|
Both
|
$699.79
|
|
|
Service Code
|
HCPCS 95929 TC
|
| Min. Negotiated Rate |
$130.75 |
| Max. Negotiated Rate |
$420.25 |
| Rate for Payer: Amida Care Medicaid |
$157.38
|
| Rate for Payer: Cash Price |
$196.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$186.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$168.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$168.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$177.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$186.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$177.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$186.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$186.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$140.09
|
| Rate for Payer: Healthfirst Commercial |
$186.78
|
| Rate for Payer: Healthfirst Essential Plan |
$420.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$177.44
|
| Rate for Payer: Healthfirst QHP |
$186.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$130.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$186.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$158.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$130.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$186.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$140.09
|
| Rate for Payer: SOMOS Essential |
$140.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$186.78
|
|
