|
PR DISE DYN EVAL SLEEP DISORDERED BREATHING FLX DX
|
Professional
|
Both
|
$410.45
|
|
|
Service Code
|
HCPCS 42975
|
| Min. Negotiated Rate |
$78.05 |
| Max. Negotiated Rate |
$250.88 |
| Rate for Payer: Cash Price |
$112.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$111.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$100.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$100.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$105.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$111.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$105.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.62
|
| Rate for Payer: Healthfirst Commercial |
$111.50
|
| Rate for Payer: Healthfirst Essential Plan |
$250.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$105.92
|
| Rate for Payer: Healthfirst QHP |
$111.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$111.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$94.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$111.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.62
|
| Rate for Payer: SOMOS Essential |
$83.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.50
|
|
|
PR DISPLACEMENT THERAPY PROETZ TYPE
|
Professional
|
Both
|
$446.81
|
|
|
Service Code
|
HCPCS 30210
|
| Min. Negotiated Rate |
$84.44 |
| Max. Negotiated Rate |
$271.42 |
| Rate for Payer: Cash Price |
$121.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$120.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$114.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$120.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$114.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$90.47
|
| Rate for Payer: Healthfirst Commercial |
$120.63
|
| Rate for Payer: Healthfirst Essential Plan |
$271.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$114.60
|
| Rate for Payer: Healthfirst QHP |
$120.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$84.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$120.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$102.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$84.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$120.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$90.47
|
| Rate for Payer: SOMOS Essential |
$90.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$120.63
|
|
|
PR DISRTCJ SHOULDER SECONDARY CLSR/SCAR REVISION
|
Professional
|
Both
|
$2,093.53
|
|
|
Service Code
|
HCPCS 23921
|
| Min. Negotiated Rate |
$397.34 |
| Max. Negotiated Rate |
$1,277.17 |
| Rate for Payer: Cash Price |
$571.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$567.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$510.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$510.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$539.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$567.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$539.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$567.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$567.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$425.72
|
| Rate for Payer: Healthfirst Commercial |
$567.63
|
| Rate for Payer: Healthfirst Essential Plan |
$1,277.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$539.25
|
| Rate for Payer: Healthfirst QHP |
$567.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$397.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$567.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$482.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$397.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$567.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$425.72
|
| Rate for Payer: SOMOS Essential |
$425.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$567.63
|
|
|
PR DISSECTION DEEP JUGULAR NODE
|
Professional
|
Both
|
$2,281.06
|
|
|
Service Code
|
HCPCS 38542
|
| Min. Negotiated Rate |
$428.69 |
| Max. Negotiated Rate |
$1,377.92 |
| Rate for Payer: Cash Price |
$618.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$612.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$551.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$551.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$581.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$612.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$581.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$612.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$612.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$459.31
|
| Rate for Payer: Healthfirst Commercial |
$612.41
|
| Rate for Payer: Healthfirst Essential Plan |
$1,377.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$581.79
|
| Rate for Payer: Healthfirst QHP |
$612.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$428.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$612.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$520.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$428.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$612.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$459.31
|
| Rate for Payer: SOMOS Essential |
$459.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$612.41
|
|
|
PR DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD
|
Professional
|
Both
|
$71.02
|
|
|
Service Code
|
HCPCS 92587 26
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$44.23 |
| Rate for Payer: Amida Care Medicaid |
$38.01
|
| Rate for Payer: Cash Price |
$19.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.74
|
| Rate for Payer: Healthfirst Commercial |
$19.66
|
| Rate for Payer: Healthfirst Essential Plan |
$44.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.68
|
| Rate for Payer: Healthfirst QHP |
$19.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.74
|
| Rate for Payer: SOMOS Essential |
$14.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.66
|
|
|
PR DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD
|
Professional
|
Both
|
$89.57
|
|
|
Service Code
|
HCPCS 92587
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$54.36 |
| Rate for Payer: Amida Care Medicaid |
$38.01
|
| Rate for Payer: Cash Price |
$24.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.12
|
| Rate for Payer: Healthfirst Commercial |
$24.16
|
| Rate for Payer: Healthfirst Essential Plan |
$54.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.95
|
| Rate for Payer: Healthfirst QHP |
$24.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.12
|
| Rate for Payer: SOMOS Essential |
$18.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.16
|
|
|
PR DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD
|
Professional
|
Both
|
$18.55
|
|
|
Service Code
|
HCPCS 92587 TC
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$38.01 |
| Rate for Payer: Amida Care Medicaid |
$38.01
|
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.38
|
| Rate for Payer: Healthfirst Commercial |
$4.50
|
| Rate for Payer: Healthfirst Essential Plan |
$10.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.28
|
| Rate for Payer: Healthfirst QHP |
$4.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.38
|
| Rate for Payer: SOMOS Essential |
$3.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.50
|
|
|
PR DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL
|
Professional
|
Both
|
$113.30
|
|
|
Service Code
|
HCPCS 92588 26
|
| Min. Negotiated Rate |
$21.57 |
| Max. Negotiated Rate |
$69.34 |
| Rate for Payer: Amida Care Medicaid |
$56.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.11
|
| Rate for Payer: Healthfirst Commercial |
$30.82
|
| Rate for Payer: Healthfirst Essential Plan |
$69.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.28
|
| Rate for Payer: Healthfirst QHP |
$30.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$30.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.11
|
| Rate for Payer: SOMOS Essential |
$23.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.82
|
|
|
PR DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL
|
Professional
|
Both
|
$137.62
|
|
|
Service Code
|
HCPCS 92588
|
| Min. Negotiated Rate |
$25.81 |
| Max. Negotiated Rate |
$82.96 |
| Rate for Payer: Amida Care Medicaid |
$56.22
|
| Rate for Payer: Cash Price |
$36.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.65
|
| Rate for Payer: Healthfirst Commercial |
$36.87
|
| Rate for Payer: Healthfirst Essential Plan |
$82.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.03
|
| Rate for Payer: Healthfirst QHP |
$36.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.65
|
| Rate for Payer: SOMOS Essential |
$27.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.87
|
|
|
PR DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL
|
Professional
|
Both
|
$24.29
|
|
|
Service Code
|
HCPCS 92588 TC
|
| Min. Negotiated Rate |
$4.24 |
| Max. Negotiated Rate |
$56.22 |
| Rate for Payer: Amida Care Medicaid |
$56.22
|
| Rate for Payer: Cash Price |
$6.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.54
|
| Rate for Payer: Healthfirst Commercial |
$6.05
|
| Rate for Payer: Healthfirst Essential Plan |
$13.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.75
|
| Rate for Payer: Healthfirst QHP |
$6.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$4.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$6.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$5.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$4.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.54
|
| Rate for Payer: SOMOS Essential |
$4.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.05
|
|
|
PR DIVERTICULECTOMY HYPOPHARYNX/ESOPH CRV APPR
|
Professional
|
Both
|
$3,462.73
|
|
|
Service Code
|
HCPCS 43130
|
| Min. Negotiated Rate |
$648.67 |
| Max. Negotiated Rate |
$2,085.01 |
| Rate for Payer: Cash Price |
$936.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$926.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$834.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$834.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$880.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$926.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$880.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$926.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$926.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$695.00
|
| Rate for Payer: Healthfirst Commercial |
$926.67
|
| Rate for Payer: Healthfirst Essential Plan |
$2,085.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$880.34
|
| Rate for Payer: Healthfirst QHP |
$926.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$648.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$926.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$787.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$648.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$926.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$695.00
|
| Rate for Payer: SOMOS Essential |
$695.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$926.67
|
|
|
PR DIVERTICULECTOMY HYPOPHARYNX/ESOPH THRC APPR
|
Professional
|
Both
|
$6,561.07
|
|
|
Service Code
|
HCPCS 43135
|
| Min. Negotiated Rate |
$1,208.94 |
| Max. Negotiated Rate |
$3,885.89 |
| Rate for Payer: Cash Price |
$1,744.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,727.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,554.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,554.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,640.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,727.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,640.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,727.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,727.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,295.30
|
| Rate for Payer: Healthfirst Commercial |
$1,727.06
|
| Rate for Payer: Healthfirst Essential Plan |
$3,885.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,640.71
|
| Rate for Payer: Healthfirst QHP |
$1,727.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,208.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,727.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,468.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,208.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,727.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,295.30
|
| Rate for Payer: SOMOS Essential |
$1,295.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,727.06
|
|
|
PR DIVISION ABERRANT VESSEL VASCULAR RING
|
Professional
|
Both
|
$4,834.27
|
|
|
Service Code
|
HCPCS 33802
|
| Min. Negotiated Rate |
$896.09 |
| Max. Negotiated Rate |
$2,880.29 |
| Rate for Payer: Cash Price |
$1,291.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,280.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,152.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,152.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,216.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,280.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,216.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,280.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,280.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$960.10
|
| Rate for Payer: Healthfirst Commercial |
$1,280.13
|
| Rate for Payer: Healthfirst Essential Plan |
$2,880.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,216.12
|
| Rate for Payer: Healthfirst QHP |
$1,280.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$896.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,280.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,088.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$896.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,280.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$960.10
|
| Rate for Payer: SOMOS Essential |
$960.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,280.13
|
|
|
PR DIVISION ABERRANT VESSEL W/REANASTOMOSIS
|
Professional
|
Both
|
$5,128.10
|
|
|
Service Code
|
HCPCS 33803
|
| Min. Negotiated Rate |
$944.57 |
| Max. Negotiated Rate |
$3,036.13 |
| Rate for Payer: Cash Price |
$1,363.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,349.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,214.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,214.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,281.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,349.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,281.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,349.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,349.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,012.04
|
| Rate for Payer: Healthfirst Commercial |
$1,349.39
|
| Rate for Payer: Healthfirst Essential Plan |
$3,036.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,281.92
|
| Rate for Payer: Healthfirst QHP |
$1,349.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$944.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,349.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,146.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$944.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,349.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,012.04
|
| Rate for Payer: SOMOS Essential |
$1,012.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,349.39
|
|
|
PR DIVISION PLANTAR FASCIA & MUSCLE SPX
|
Professional
|
Both
|
$1,761.06
|
|
|
Service Code
|
HCPCS 28250
|
| Min. Negotiated Rate |
$338.72 |
| Max. Negotiated Rate |
$1,088.73 |
| Rate for Payer: Cash Price |
$483.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$483.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$435.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$435.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$459.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$483.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$459.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$483.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$362.91
|
| Rate for Payer: Healthfirst Commercial |
$483.88
|
| Rate for Payer: Healthfirst Essential Plan |
$1,088.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$459.69
|
| Rate for Payer: Healthfirst QHP |
$483.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$338.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$483.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$411.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$338.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$483.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$362.91
|
| Rate for Payer: SOMOS Essential |
$362.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$483.88
|
|
|
PR DIVISION SCALENUS ANTICUS RESECTION CERVICAL RIB
|
Professional
|
Both
|
$2,394.95
|
|
|
Service Code
|
HCPCS 21705
|
| Min. Negotiated Rate |
$441.25 |
| Max. Negotiated Rate |
$1,418.31 |
| Rate for Payer: Cash Price |
$636.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$630.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$567.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$567.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$598.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$630.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$598.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$630.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$630.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$472.77
|
| Rate for Payer: Healthfirst Commercial |
$630.36
|
| Rate for Payer: Healthfirst Essential Plan |
$1,418.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$598.84
|
| Rate for Payer: Healthfirst QHP |
$630.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$441.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$630.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$535.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$441.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$630.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$472.77
|
| Rate for Payer: SOMOS Essential |
$472.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$630.36
|
|
|
PR DIVISION SCALENUS ANTICUS W/O RESCJ CERVICAL RIB
|
Professional
|
Both
|
$1,601.25
|
|
|
Service Code
|
HCPCS 21700
|
| Min. Negotiated Rate |
$295.74 |
| Max. Negotiated Rate |
$950.60 |
| Rate for Payer: Cash Price |
$426.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$422.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$380.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$380.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$401.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$422.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$401.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$422.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$422.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$316.87
|
| Rate for Payer: Healthfirst Commercial |
$422.49
|
| Rate for Payer: Healthfirst Essential Plan |
$950.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$401.37
|
| Rate for Payer: Healthfirst QHP |
$422.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$295.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$422.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$359.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$295.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$422.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$316.87
|
| Rate for Payer: SOMOS Essential |
$316.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$422.49
|
|
|
PR DIVISION STERNOCLEIDOMASTOID OPEN W/CAST
|
Professional
|
Both
|
$2,408.46
|
|
|
Service Code
|
HCPCS 21725
|
| Min. Negotiated Rate |
$455.18 |
| Max. Negotiated Rate |
$1,463.06 |
| Rate for Payer: Cash Price |
$652.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$650.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$585.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$585.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$617.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$650.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$617.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$650.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$650.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$487.69
|
| Rate for Payer: Healthfirst Commercial |
$650.25
|
| Rate for Payer: Healthfirst Essential Plan |
$1,463.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$617.74
|
| Rate for Payer: Healthfirst QHP |
$650.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$455.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$650.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$552.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$455.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$650.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$487.69
|
| Rate for Payer: SOMOS Essential |
$487.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$650.25
|
|
|
PR DIVISION STERNOCLEIDOMASTOID OPEN W/O CAST
|
Professional
|
Both
|
$2,516.57
|
|
|
Service Code
|
HCPCS 21720
|
| Min. Negotiated Rate |
$469.07 |
| Max. Negotiated Rate |
$1,507.72 |
| Rate for Payer: Cash Price |
$672.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$670.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$603.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$603.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$636.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$670.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$636.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$670.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$670.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$502.57
|
| Rate for Payer: Healthfirst Commercial |
$670.10
|
| Rate for Payer: Healthfirst Essential Plan |
$1,507.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$636.60
|
| Rate for Payer: Healthfirst QHP |
$670.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$469.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$670.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$569.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$469.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$670.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$502.57
|
| Rate for Payer: SOMOS Essential |
$502.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$670.10
|
|
|
PR DIVISION STRICTURE RECTUM
|
Professional
|
Both
|
$1,915.34
|
|
|
Service Code
|
HCPCS 45150
|
| Min. Negotiated Rate |
$357.86 |
| Max. Negotiated Rate |
$1,150.27 |
| Rate for Payer: Cash Price |
$514.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$511.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$460.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$460.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$485.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$511.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$485.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$511.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$511.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$383.42
|
| Rate for Payer: Healthfirst Commercial |
$511.23
|
| Rate for Payer: Healthfirst Essential Plan |
$1,150.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$485.67
|
| Rate for Payer: Healthfirst QHP |
$511.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$357.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$511.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$434.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$357.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$511.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$383.42
|
| Rate for Payer: SOMOS Essential |
$383.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$511.23
|
|
|
PR DLYD PLACEMENT XTN PROSTH FOR EVASC RPR 1ST VSL
|
Professional
|
Both
|
$3,511.87
|
|
|
Service Code
|
HCPCS 34710
|
| Min. Negotiated Rate |
$646.27 |
| Max. Negotiated Rate |
$2,077.31 |
| Rate for Payer: Cash Price |
$933.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$923.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$830.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$830.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$877.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$923.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$877.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$923.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$692.44
|
| Rate for Payer: Healthfirst Commercial |
$923.25
|
| Rate for Payer: Healthfirst Essential Plan |
$2,077.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$877.09
|
| Rate for Payer: Healthfirst QHP |
$923.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$646.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$923.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$784.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$646.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$923.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$692.44
|
| Rate for Payer: SOMOS Essential |
$692.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$923.25
|
|
|
PR DLYD PLACEMENT XTN PROSTH FOR EVASC RPR EA ADDL
|
Professional
|
Both
|
$1,301.30
|
|
|
Service Code
|
HCPCS 34711
|
| Min. Negotiated Rate |
$239.11 |
| Max. Negotiated Rate |
$768.55 |
| Rate for Payer: Cash Price |
$344.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$341.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$307.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$307.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$324.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$341.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$324.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$341.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$341.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$256.19
|
| Rate for Payer: Healthfirst Commercial |
$341.58
|
| Rate for Payer: Healthfirst Essential Plan |
$768.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$324.50
|
| Rate for Payer: Healthfirst QHP |
$341.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$239.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$341.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$290.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$239.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$341.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$256.19
|
| Rate for Payer: SOMOS Essential |
$256.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$341.58
|
|
|
PR DNRVTJ HIP JT INTRAPEL/XTRPEL INTRA-ARTCLR BRNCH
|
Professional
|
Both
|
$4,613.84
|
|
|
Service Code
|
HCPCS 27035
|
| Min. Negotiated Rate |
$888.63 |
| Max. Negotiated Rate |
$2,856.31 |
| Rate for Payer: Cash Price |
$1,276.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,269.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,142.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,142.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,206.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,269.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,206.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,269.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,269.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$952.10
|
| Rate for Payer: Healthfirst Commercial |
$1,269.47
|
| Rate for Payer: Healthfirst Essential Plan |
$2,856.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,206.00
|
| Rate for Payer: Healthfirst QHP |
$1,269.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$888.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,269.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,079.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$888.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,269.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$952.10
|
| Rate for Payer: SOMOS Essential |
$952.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,269.47
|
|
|
PR DONOR HEPATECTOMY LIVING DONOR SEG II & III
|
Professional
|
Both
|
$16,119.64
|
|
|
Service Code
|
HCPCS 47140
|
| Min. Negotiated Rate |
$2,989.46 |
| Max. Negotiated Rate |
$9,608.99 |
| Rate for Payer: Cash Price |
$4,299.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,270.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,843.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,843.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,057.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,270.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,057.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,270.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,270.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,202.99
|
| Rate for Payer: Healthfirst Commercial |
$4,270.66
|
| Rate for Payer: Healthfirst Essential Plan |
$9,608.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,057.13
|
| Rate for Payer: Healthfirst QHP |
$4,270.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,989.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,270.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,630.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,989.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,270.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,202.99
|
| Rate for Payer: SOMOS Essential |
$3,202.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,270.66
|
|
|
PR DONOR HEPATECTOMY LIVING DONOR SEG II III & IV
|
Professional
|
Both
|
$19,271.95
|
|
|
Service Code
|
HCPCS 47141
|
| Min. Negotiated Rate |
$3,569.18 |
| Max. Negotiated Rate |
$11,472.37 |
| Rate for Payer: Cash Price |
$5,136.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,098.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,588.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,588.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,843.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,098.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,843.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,098.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,098.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,824.12
|
| Rate for Payer: Healthfirst Commercial |
$5,098.83
|
| Rate for Payer: Healthfirst Essential Plan |
$11,472.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,843.89
|
| Rate for Payer: Healthfirst QHP |
$5,098.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,569.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5,098.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4,334.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3,569.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,098.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,824.12
|
| Rate for Payer: SOMOS Essential |
$3,824.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,098.83
|
|
