|
PR ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL
|
Professional
|
Both
|
$407.61
|
|
|
Service Code
|
HCPCS 92978 26
|
| Min. Negotiated Rate |
$75.24 |
| Max. Negotiated Rate |
$241.83 |
| Rate for Payer: Amida Care Medicaid |
$223.28
|
| Rate for Payer: Cash Price |
$108.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$107.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.61
|
| Rate for Payer: Healthfirst Commercial |
$107.48
|
| Rate for Payer: Healthfirst Essential Plan |
$241.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$102.11
|
| Rate for Payer: Healthfirst QHP |
$107.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$107.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$91.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$80.61
|
| Rate for Payer: SOMOS Essential |
$80.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.48
|
|
|
PR ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL
|
Professional
|
Both
|
$921.17
|
|
|
Service Code
|
HCPCS 92978 TC
|
| Min. Negotiated Rate |
$223.28 |
| Max. Negotiated Rate |
$223.28 |
| Rate for Payer: Amida Care Medicaid |
$223.28
|
|
|
PR ENDOLYMPHATIC SAC SHUNT
|
Professional
|
Both
|
$3,993.57
|
|
|
Service Code
|
HCPCS 69806
|
| Min. Negotiated Rate |
$741.00 |
| Max. Negotiated Rate |
$2,381.78 |
| Rate for Payer: Cash Price |
$1,077.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,058.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$952.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$952.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,005.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,058.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,005.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,058.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,058.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$793.93
|
| Rate for Payer: Healthfirst Commercial |
$1,058.57
|
| Rate for Payer: Healthfirst Essential Plan |
$2,381.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,005.64
|
| Rate for Payer: Healthfirst QHP |
$1,058.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$741.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,058.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$899.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$741.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,058.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$793.93
|
| Rate for Payer: SOMOS Essential |
$793.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,058.57
|
|
|
PR ENDOLYMPHATIC SAC W/O SHUNT
|
Professional
|
Both
|
$4,449.90
|
|
|
Service Code
|
HCPCS 69805
|
| Min. Negotiated Rate |
$828.91 |
| Max. Negotiated Rate |
$2,664.36 |
| Rate for Payer: Cash Price |
$1,203.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,184.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,065.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,065.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,124.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,184.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,124.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,184.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,184.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$888.12
|
| Rate for Payer: Healthfirst Commercial |
$1,184.16
|
| Rate for Payer: Healthfirst Essential Plan |
$2,664.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,124.95
|
| Rate for Payer: Healthfirst QHP |
$1,184.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$828.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,184.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,006.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$828.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,184.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$888.12
|
| Rate for Payer: SOMOS Essential |
$888.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,184.16
|
|
|
PR ENDOMETRIAL ABLTJ THERMAL W/O HYSTEROSCOPIC GUID
|
Professional
|
Both
|
$1,010.52
|
|
|
Service Code
|
HCPCS 58353
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$602.66 |
| Rate for Payer: Cash Price |
$271.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$267.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$241.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$241.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$254.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$267.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$254.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$267.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$267.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$200.89
|
| Rate for Payer: Healthfirst Commercial |
$267.85
|
| Rate for Payer: Healthfirst Essential Plan |
$602.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$254.46
|
| Rate for Payer: Healthfirst QHP |
$267.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$187.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$267.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$227.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$187.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$267.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$200.89
|
| Rate for Payer: SOMOS Essential |
$200.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$267.85
|
|
|
PR ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY
|
Professional
|
Both
|
$172.41
|
|
|
Service Code
|
HCPCS 58110
|
| Min. Negotiated Rate |
$32.61 |
| Max. Negotiated Rate |
$104.83 |
| Rate for Payer: Cash Price |
$46.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.94
|
| Rate for Payer: Healthfirst Commercial |
$46.59
|
| Rate for Payer: Healthfirst Essential Plan |
$104.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.26
|
| Rate for Payer: Healthfirst QHP |
$46.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.94
|
| Rate for Payer: SOMOS Essential |
$34.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.59
|
|
|
PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX
|
Professional
|
Both
|
$272.55
|
|
|
Service Code
|
HCPCS 58100
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$163.53 |
| Rate for Payer: Cash Price |
$73.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$65.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$69.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.51
|
| Rate for Payer: Healthfirst Commercial |
$72.68
|
| Rate for Payer: Healthfirst Essential Plan |
$163.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.05
|
| Rate for Payer: Healthfirst QHP |
$72.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$50.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$72.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$61.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.51
|
| Rate for Payer: SOMOS Essential |
$54.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.68
|
|
|
PR ENDOMETRIAL CRYOABLATION W/US & ENDOMETRIAL CR
|
Professional
|
Both
|
$1,545.67
|
|
|
Service Code
|
HCPCS 58356
|
| Min. Negotiated Rate |
$284.83 |
| Max. Negotiated Rate |
$915.52 |
| Rate for Payer: Cash Price |
$414.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$406.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$366.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$366.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$386.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$406.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$386.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$406.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$406.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$305.18
|
| Rate for Payer: Healthfirst Commercial |
$406.90
|
| Rate for Payer: Healthfirst Essential Plan |
$915.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$386.56
|
| Rate for Payer: Healthfirst QHP |
$406.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$284.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$406.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$345.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$284.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$406.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$305.18
|
| Rate for Payer: SOMOS Essential |
$305.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$406.90
|
|
|
PR ENDOMYOCARDIAL BIOPSY
|
Professional
|
Both
|
$969.92
|
|
|
Service Code
|
HCPCS 93505 26
|
| Min. Negotiated Rate |
$180.49 |
| Max. Negotiated Rate |
$580.14 |
| Rate for Payer: Amida Care Medicaid |
$507.56
|
| Rate for Payer: Cash Price |
$260.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$257.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$232.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$232.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$244.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$257.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$244.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$257.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$257.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$193.38
|
| Rate for Payer: Healthfirst Commercial |
$257.84
|
| Rate for Payer: Healthfirst Essential Plan |
$580.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$244.95
|
| Rate for Payer: Healthfirst QHP |
$257.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$180.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$257.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$219.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$180.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$257.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$193.38
|
| Rate for Payer: SOMOS Essential |
$193.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$257.84
|
|
|
PR ENDOMYOCARDIAL BIOPSY
|
Professional
|
Both
|
$1,832.53
|
|
|
Service Code
|
HCPCS 93505 TC
|
| Min. Negotiated Rate |
$323.66 |
| Max. Negotiated Rate |
$1,040.33 |
| Rate for Payer: Amida Care Medicaid |
$507.56
|
| Rate for Payer: Cash Price |
$491.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$462.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$416.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$416.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$439.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$462.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$439.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$462.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$462.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$346.78
|
| Rate for Payer: Healthfirst Commercial |
$462.37
|
| Rate for Payer: Healthfirst Essential Plan |
$1,040.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$439.25
|
| Rate for Payer: Healthfirst QHP |
$462.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$323.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$462.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$393.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$323.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$462.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$346.78
|
| Rate for Payer: SOMOS Essential |
$346.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$462.37
|
|
|
PR ENDOMYOCARDIAL BIOPSY
|
Professional
|
Both
|
$2,802.45
|
|
|
Service Code
|
HCPCS 93505
|
| Min. Negotiated Rate |
$504.15 |
| Max. Negotiated Rate |
$1,620.47 |
| Rate for Payer: Amida Care Medicaid |
$507.56
|
| Rate for Payer: Cash Price |
$751.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$720.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$648.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$648.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$684.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$720.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$684.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$720.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$720.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$540.16
|
| Rate for Payer: Healthfirst Commercial |
$720.21
|
| Rate for Payer: Healthfirst Essential Plan |
$1,620.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$684.20
|
| Rate for Payer: Healthfirst QHP |
$720.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$504.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$720.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$612.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$504.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$720.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$540.16
|
| Rate for Payer: SOMOS Essential |
$540.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$720.21
|
|
|
PR ENDOSCOPIC HARVEST UXTR ARTERY 1 SEGMENT CAB PX
|
Professional
|
Both
|
$766.89
|
|
|
Service Code
|
HCPCS 33509
|
| Min. Negotiated Rate |
$140.97 |
| Max. Negotiated Rate |
$453.13 |
| Rate for Payer: Cash Price |
$202.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$201.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$181.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$181.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$191.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$201.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$191.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$201.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$201.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$151.04
|
| Rate for Payer: Healthfirst Commercial |
$201.39
|
| Rate for Payer: Healthfirst Essential Plan |
$453.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$191.32
|
| Rate for Payer: Healthfirst QHP |
$201.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$140.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$201.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$171.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$140.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$201.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$151.04
|
| Rate for Payer: SOMOS Essential |
$151.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$201.39
|
|
|
PR ENDOSCOPIC PAPILLA CANNULATION BILE/PANCREATIC
|
Professional
|
Both
|
$489.83
|
|
|
Service Code
|
HCPCS 43273
|
| Min. Negotiated Rate |
$92.87 |
| Max. Negotiated Rate |
$298.51 |
| Rate for Payer: Cash Price |
$133.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$132.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$119.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$119.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$126.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$132.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$126.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$132.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$132.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$99.50
|
| Rate for Payer: Healthfirst Commercial |
$132.67
|
| Rate for Payer: Healthfirst Essential Plan |
$298.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$126.04
|
| Rate for Payer: Healthfirst QHP |
$132.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$132.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$112.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$92.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$132.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$99.50
|
| Rate for Payer: SOMOS Essential |
$99.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$132.67
|
|
|
PR ENDOSCOPIC PLANTAR FASCIOTOMY
|
Professional
|
Both
|
$1,819.20
|
|
|
Service Code
|
HCPCS 29893
|
| Min. Negotiated Rate |
$354.98 |
| Max. Negotiated Rate |
$1,141.02 |
| Rate for Payer: Cash Price |
$506.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$507.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$456.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$456.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$481.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$507.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$481.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$507.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$507.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$380.34
|
| Rate for Payer: Healthfirst Commercial |
$507.12
|
| Rate for Payer: Healthfirst Essential Plan |
$1,141.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$481.76
|
| Rate for Payer: Healthfirst QHP |
$507.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$354.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$507.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$431.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$354.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$507.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$380.34
|
| Rate for Payer: SOMOS Essential |
$380.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$507.12
|
|
|
PR ENDOSCOPY UPPER SMALL INTESTINE
|
Professional
|
Both
|
$596.79
|
|
|
Service Code
|
HCPCS 44360
|
| Min. Negotiated Rate |
$112.53 |
| Max. Negotiated Rate |
$361.71 |
| Rate for Payer: Cash Price |
$162.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$160.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$144.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$144.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$152.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$160.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$152.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$160.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$120.57
|
| Rate for Payer: Healthfirst Commercial |
$160.76
|
| Rate for Payer: Healthfirst Essential Plan |
$361.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$152.72
|
| Rate for Payer: Healthfirst QHP |
$160.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$112.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$160.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$136.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$112.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$160.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$120.57
|
| Rate for Payer: SOMOS Essential |
$120.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$160.76
|
|
|
PR ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY
|
Professional
|
Both
|
$656.01
|
|
|
Service Code
|
HCPCS 44361
|
| Min. Negotiated Rate |
$124.55 |
| Max. Negotiated Rate |
$400.34 |
| Rate for Payer: Cash Price |
$179.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$177.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$160.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$160.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$169.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$177.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$169.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$133.45
|
| Rate for Payer: Healthfirst Commercial |
$177.93
|
| Rate for Payer: Healthfirst Essential Plan |
$400.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$169.03
|
| Rate for Payer: Healthfirst QHP |
$177.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$124.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$177.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$151.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$124.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$177.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$133.45
|
| Rate for Payer: SOMOS Essential |
$133.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$177.93
|
|
|
PR ENDOVEN ABLTI THER CHEM ADHESIVE 1ST VEIN
|
Professional
|
Both
|
$775.22
|
|
|
Service Code
|
HCPCS 36482
|
| Min. Negotiated Rate |
$144.19 |
| Max. Negotiated Rate |
$463.48 |
| Rate for Payer: Cash Price |
$207.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$205.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$185.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$185.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$195.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$205.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$195.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$205.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$205.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$154.49
|
| Rate for Payer: Healthfirst Commercial |
$205.99
|
| Rate for Payer: Healthfirst Essential Plan |
$463.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$195.69
|
| Rate for Payer: Healthfirst QHP |
$205.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$144.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$205.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$175.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$144.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$205.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$154.49
|
| Rate for Payer: SOMOS Essential |
$154.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$205.99
|
|
|
PR ENDOVEN ABLTI THER CHEM ADHESIVE SBSQ VEIN
|
Professional
|
Both
|
$387.98
|
|
|
Service Code
|
HCPCS 36483
|
| Min. Negotiated Rate |
$71.85 |
| Max. Negotiated Rate |
$230.94 |
| Rate for Payer: Cash Price |
$103.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$102.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$92.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$97.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$102.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$97.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$76.98
|
| Rate for Payer: Healthfirst Commercial |
$102.64
|
| Rate for Payer: Healthfirst Essential Plan |
$230.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$97.51
|
| Rate for Payer: Healthfirst QHP |
$102.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$71.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$102.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$87.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$71.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$76.98
|
| Rate for Payer: SOMOS Essential |
$76.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.64
|
|
|
PR ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM 1ST VEIN
|
Professional
|
Both
|
$787.89
|
|
|
Service Code
|
HCPCS 36473
|
| Min. Negotiated Rate |
$145.28 |
| Max. Negotiated Rate |
$466.99 |
| Rate for Payer: Cash Price |
$210.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$207.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$186.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$186.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$197.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$207.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$197.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$207.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$207.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$155.66
|
| Rate for Payer: Healthfirst Commercial |
$207.55
|
| Rate for Payer: Healthfirst Essential Plan |
$466.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$197.17
|
| Rate for Payer: Healthfirst QHP |
$207.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$145.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$207.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$176.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$145.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$207.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$155.66
|
| Rate for Payer: SOMOS Essential |
$155.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$207.55
|
|
|
PR ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM SBSQ VEINS
|
Professional
|
Both
|
$389.83
|
|
|
Service Code
|
HCPCS 36474
|
| Min. Negotiated Rate |
$72.18 |
| Max. Negotiated Rate |
$232.00 |
| Rate for Payer: Cash Price |
$102.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$103.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$92.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$97.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$97.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.33
|
| Rate for Payer: Healthfirst Commercial |
$103.11
|
| Rate for Payer: Healthfirst Essential Plan |
$232.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$97.95
|
| Rate for Payer: Healthfirst QHP |
$103.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$103.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$87.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.33
|
| Rate for Payer: SOMOS Essential |
$77.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.11
|
|
|
PR ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN
|
Professional
|
Both
|
$1,206.84
|
|
|
Service Code
|
HCPCS 36478
|
| Min. Negotiated Rate |
$223.29 |
| Max. Negotiated Rate |
$717.71 |
| Rate for Payer: Cash Price |
$322.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$318.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$287.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$287.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$303.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$318.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$303.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$318.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$318.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$239.24
|
| Rate for Payer: Healthfirst Commercial |
$318.98
|
| Rate for Payer: Healthfirst Essential Plan |
$717.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$303.03
|
| Rate for Payer: Healthfirst QHP |
$318.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$223.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$318.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$271.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$223.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$318.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$239.24
|
| Rate for Payer: SOMOS Essential |
$239.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$318.98
|
|
|
PR ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS
|
Professional
|
Both
|
$590.35
|
|
|
Service Code
|
HCPCS 36479
|
| Min. Negotiated Rate |
$109.00 |
| Max. Negotiated Rate |
$350.37 |
| Rate for Payer: Cash Price |
$157.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$155.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$140.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$140.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$147.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$155.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$147.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$155.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$155.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$116.79
|
| Rate for Payer: Healthfirst Commercial |
$155.72
|
| Rate for Payer: Healthfirst Essential Plan |
$350.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$147.93
|
| Rate for Payer: Healthfirst QHP |
$155.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$109.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$155.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$132.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$109.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$155.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$116.79
|
| Rate for Payer: SOMOS Essential |
$116.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$155.72
|
|
|
PR ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN
|
Professional
|
Both
|
$1,214.78
|
|
|
Service Code
|
HCPCS 36475
|
| Min. Negotiated Rate |
$224.03 |
| Max. Negotiated Rate |
$720.09 |
| Rate for Payer: Cash Price |
$323.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$320.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$288.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$288.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$320.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$320.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$320.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$240.03
|
| Rate for Payer: Healthfirst Commercial |
$320.04
|
| Rate for Payer: Healthfirst Essential Plan |
$720.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$304.04
|
| Rate for Payer: Healthfirst QHP |
$320.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$224.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$320.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$272.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$224.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$320.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$240.03
|
| Rate for Payer: SOMOS Essential |
$240.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$320.04
|
|
|
PR ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS
|
Professional
|
Both
|
$587.20
|
|
|
Service Code
|
HCPCS 36476
|
| Min. Negotiated Rate |
$108.02 |
| Max. Negotiated Rate |
$347.20 |
| Rate for Payer: Cash Price |
$154.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$154.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$138.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$138.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$146.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$154.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$146.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$115.73
|
| Rate for Payer: Healthfirst Commercial |
$154.31
|
| Rate for Payer: Healthfirst Essential Plan |
$347.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$146.59
|
| Rate for Payer: Healthfirst QHP |
$154.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$108.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$154.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$131.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$108.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$154.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$115.73
|
| Rate for Payer: SOMOS Essential |
$115.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$154.31
|
|
|
PR ENTERECTOMY RESCJ SMALL INTESTINE EA RESCJ & ANA
|
Professional
|
Both
|
$1,076.57
|
|
|
Service Code
|
HCPCS 44121
|
| Min. Negotiated Rate |
$197.99 |
| Max. Negotiated Rate |
$636.39 |
| Rate for Payer: Cash Price |
$286.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$282.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$254.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$254.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$268.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$282.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$268.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$282.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$212.13
|
| Rate for Payer: Healthfirst Commercial |
$282.84
|
| Rate for Payer: Healthfirst Essential Plan |
$636.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$268.70
|
| Rate for Payer: Healthfirst QHP |
$282.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$197.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$282.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$240.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$197.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$282.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$212.13
|
| Rate for Payer: SOMOS Essential |
$212.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$282.84
|
|
