|
PR INTERTHORACOSCAPULAR AMPUTATION
|
Professional
|
Both
|
$6,115.03
|
|
|
Service Code
|
HCPCS 23900
|
| Min. Negotiated Rate |
$1,146.81 |
| Max. Negotiated Rate |
$3,686.18 |
| Rate for Payer: Cash Price |
$1,646.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,638.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,474.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,474.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,556.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,638.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,556.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,638.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,638.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,228.72
|
| Rate for Payer: Healthfirst Commercial |
$1,638.30
|
| Rate for Payer: Healthfirst Essential Plan |
$3,686.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,556.38
|
| Rate for Payer: Healthfirst QHP |
$1,638.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,146.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,638.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,392.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,146.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,638.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,228.72
|
| Rate for Payer: SOMOS Essential |
$1,228.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,638.30
|
|
|
PR INTESTINAL PLICATION SEPARATE PROCEDURE
|
Professional
|
Both
|
$4,879.28
|
|
|
Service Code
|
HCPCS 44680
|
| Min. Negotiated Rate |
$902.17 |
| Max. Negotiated Rate |
$2,899.82 |
| Rate for Payer: Cash Price |
$1,297.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,288.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,159.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,159.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,224.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,288.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,224.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,288.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,288.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$966.61
|
| Rate for Payer: Healthfirst Commercial |
$1,288.81
|
| Rate for Payer: Healthfirst Essential Plan |
$2,899.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,224.37
|
| Rate for Payer: Healthfirst QHP |
$1,288.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$902.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,288.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,095.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$902.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,288.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$966.61
|
| Rate for Payer: SOMOS Essential |
$966.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,288.81
|
|
|
PR INT HRHC BY LIGATION 2+ HROID W/O IMG GDN
|
Professional
|
Both
|
$1,653.30
|
|
|
Service Code
|
HCPCS 46946
|
| Min. Negotiated Rate |
$312.05 |
| Max. Negotiated Rate |
$1,003.00 |
| Rate for Payer: Cash Price |
$447.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$445.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$401.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$401.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$423.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$445.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$423.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$445.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$445.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$334.33
|
| Rate for Payer: Healthfirst Commercial |
$445.78
|
| Rate for Payer: Healthfirst Essential Plan |
$1,003.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$423.49
|
| Rate for Payer: Healthfirst QHP |
$445.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$312.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$445.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$378.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$312.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$445.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$334.33
|
| Rate for Payer: SOMOS Essential |
$334.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$445.78
|
|
|
PR INT HRHC BY LIGATION SINGLE HROID W/O IMG GDN
|
Professional
|
Both
|
$1,473.15
|
|
|
Service Code
|
HCPCS 46945
|
| Min. Negotiated Rate |
$281.44 |
| Max. Negotiated Rate |
$904.63 |
| Rate for Payer: Cash Price |
$402.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$402.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$361.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$361.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$381.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$402.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$381.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$402.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$402.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$301.55
|
| Rate for Payer: Healthfirst Commercial |
$402.06
|
| Rate for Payer: Healthfirst Essential Plan |
$904.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$381.96
|
| Rate for Payer: Healthfirst QHP |
$402.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$281.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$402.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$341.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$281.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$402.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$301.55
|
| Rate for Payer: SOMOS Essential |
$301.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$402.06
|
|
|
PR INT HRHC TRANSANAL HROID DARTLZJ 2+ W/US GDN
|
Professional
|
Both
|
$1,957.69
|
|
|
Service Code
|
HCPCS 46948
|
| Min. Negotiated Rate |
$365.44 |
| Max. Negotiated Rate |
$1,174.63 |
| Rate for Payer: Cash Price |
$527.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$522.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$469.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$469.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$495.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$522.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$495.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$522.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$522.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$391.55
|
| Rate for Payer: Healthfirst Commercial |
$522.06
|
| Rate for Payer: Healthfirst Essential Plan |
$1,174.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$495.96
|
| Rate for Payer: Healthfirst QHP |
$522.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$365.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$522.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$443.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$365.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$522.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$391.55
|
| Rate for Payer: SOMOS Essential |
$391.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$522.06
|
|
|
PR INTRA-ATRIAL PACING
|
Professional
|
Both
|
$279.76
|
|
|
Service Code
|
HCPCS 93610 TC
|
| Min. Negotiated Rate |
$171.53 |
| Max. Negotiated Rate |
$171.53 |
| Rate for Payer: Amida Care Medicaid |
$171.53
|
|
|
PR INTRA-ATRIAL PACING
|
Professional
|
Both
|
$975.38
|
|
|
Service Code
|
HCPCS 93610
|
| Min. Negotiated Rate |
$171.53 |
| Max. Negotiated Rate |
$171.53 |
| Rate for Payer: Amida Care Medicaid |
$171.53
|
|
|
PR INTRA-ATRIAL PACING
|
Professional
|
Both
|
$695.63
|
|
|
Service Code
|
HCPCS 93610 26
|
| Min. Negotiated Rate |
$127.33 |
| Max. Negotiated Rate |
$409.27 |
| Rate for Payer: Amida Care Medicaid |
$171.53
|
| Rate for Payer: Cash Price |
$183.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$181.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$163.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$163.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$172.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$181.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$172.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$181.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$181.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$136.43
|
| Rate for Payer: Healthfirst Commercial |
$181.90
|
| Rate for Payer: Healthfirst Essential Plan |
$409.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$172.81
|
| Rate for Payer: Healthfirst QHP |
$181.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$127.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$181.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$154.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$127.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$181.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$136.43
|
| Rate for Payer: SOMOS Essential |
$136.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$181.90
|
|
|
PR INTRA-ATRIAL RECORDING
|
Professional
|
Both
|
$717.22
|
|
|
Service Code
|
HCPCS 93602
|
| Min. Negotiated Rate |
$125.89 |
| Max. Negotiated Rate |
$125.89 |
| Rate for Payer: Amida Care Medicaid |
$125.89
|
|
|
PR INTRA-ATRIAL RECORDING
|
Professional
|
Both
|
$226.84
|
|
|
Service Code
|
HCPCS 93602 TC
|
| Min. Negotiated Rate |
$125.89 |
| Max. Negotiated Rate |
$125.89 |
| Rate for Payer: Amida Care Medicaid |
$125.89
|
|
|
PR INTRA-ATRIAL RECORDING
|
Professional
|
Both
|
$490.39
|
|
|
Service Code
|
HCPCS 93602 26
|
| Min. Negotiated Rate |
$90.55 |
| Max. Negotiated Rate |
$291.06 |
| Rate for Payer: Amida Care Medicaid |
$125.89
|
| Rate for Payer: Cash Price |
$129.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$129.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$116.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$116.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$122.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$129.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$122.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.02
|
| Rate for Payer: Healthfirst Commercial |
$129.36
|
| Rate for Payer: Healthfirst Essential Plan |
$291.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$122.89
|
| Rate for Payer: Healthfirst QHP |
$129.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$90.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$129.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$109.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$90.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$129.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$97.02
|
| Rate for Payer: SOMOS Essential |
$97.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.36
|
|
|
PR INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I
|
Professional
|
Both
|
$289.07
|
|
|
Service Code
|
HCPCS 93662 26
|
| Min. Negotiated Rate |
$52.21 |
| Max. Negotiated Rate |
$244.12 |
| Rate for Payer: Amida Care Medicaid |
$244.12
|
| Rate for Payer: Cash Price |
$75.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$74.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$74.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.94
|
| Rate for Payer: Healthfirst Commercial |
$74.59
|
| Rate for Payer: Healthfirst Essential Plan |
$167.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.86
|
| Rate for Payer: Healthfirst QHP |
$74.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$74.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$55.94
|
| Rate for Payer: SOMOS Essential |
$55.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.59
|
|
|
PR INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I
|
Professional
|
Both
|
$922.39
|
|
|
Service Code
|
HCPCS 93662
|
| Min. Negotiated Rate |
$244.12 |
| Max. Negotiated Rate |
$244.12 |
| Rate for Payer: Amida Care Medicaid |
$244.12
|
|
|
PR INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I
|
Professional
|
Both
|
$633.33
|
|
|
Service Code
|
HCPCS 93662 TC
|
| Min. Negotiated Rate |
$244.12 |
| Max. Negotiated Rate |
$244.12 |
| Rate for Payer: Amida Care Medicaid |
$244.12
|
|
|
PR INTRACARDIAC ELECTROPHYSIOLOGIC 3D MAPPING
|
Professional
|
Both
|
$1,288.84
|
|
|
Service Code
|
HCPCS 93613
|
| Min. Negotiated Rate |
$204.70 |
| Max. Negotiated Rate |
$752.38 |
| Rate for Payer: Amida Care Medicaid |
$204.70
|
| Rate for Payer: Cash Price |
$339.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$334.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$300.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$300.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$317.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$334.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$317.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$334.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$334.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$250.79
|
| Rate for Payer: Healthfirst Commercial |
$334.39
|
| Rate for Payer: Healthfirst Essential Plan |
$752.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$317.67
|
| Rate for Payer: Healthfirst QHP |
$334.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$234.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$334.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$284.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$234.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$334.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$250.79
|
| Rate for Payer: SOMOS Essential |
$250.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$334.39
|
|
|
PR INTRACRANIAL ARVEN MALFRMJ DURAL CMPL
|
Professional
|
Both
|
$17,630.76
|
|
|
Service Code
|
HCPCS 61692
|
| Min. Negotiated Rate |
$3,208.48 |
| Max. Negotiated Rate |
$10,312.97 |
| Rate for Payer: Cash Price |
$4,629.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,583.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,125.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,125.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,354.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,583.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,354.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,583.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,583.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,437.66
|
| Rate for Payer: Healthfirst Commercial |
$4,583.54
|
| Rate for Payer: Healthfirst Essential Plan |
$10,312.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,354.36
|
| Rate for Payer: Healthfirst QHP |
$4,583.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,208.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,583.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,896.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3,208.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,583.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,437.66
|
| Rate for Payer: SOMOS Essential |
$3,437.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,583.54
|
|
|
PR INTRACRANIAL ARVEN MALFRMJ DURAL SMPL
|
Professional
|
Both
|
$10,522.89
|
|
|
Service Code
|
HCPCS 61690
|
| Min. Negotiated Rate |
$1,925.43 |
| Max. Negotiated Rate |
$6,188.90 |
| Rate for Payer: Cash Price |
$2,775.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,750.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,475.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,475.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,613.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,750.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,613.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,750.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,750.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,062.97
|
| Rate for Payer: Healthfirst Commercial |
$2,750.62
|
| Rate for Payer: Healthfirst Essential Plan |
$6,188.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,613.09
|
| Rate for Payer: Healthfirst QHP |
$2,750.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,925.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,750.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,338.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,925.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,750.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,062.97
|
| Rate for Payer: SOMOS Essential |
$2,062.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,750.62
|
|
|
PR INTRACRANIAL ARVEN MALFRMJ INFRATENTRL CMPL
|
Professional
|
Both
|
$21,696.50
|
|
|
Service Code
|
HCPCS 61686
|
| Min. Negotiated Rate |
$3,946.87 |
| Max. Negotiated Rate |
$12,686.35 |
| Rate for Payer: Cash Price |
$5,695.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,638.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5,074.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,074.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,356.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,638.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,356.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,638.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,638.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4,228.78
|
| Rate for Payer: Healthfirst Commercial |
$5,638.38
|
| Rate for Payer: Healthfirst Essential Plan |
$12,686.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,356.46
|
| Rate for Payer: Healthfirst QHP |
$5,638.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,946.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5,638.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4,792.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3,946.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,638.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,228.78
|
| Rate for Payer: SOMOS Essential |
$4,228.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,638.38
|
|
|
PR INTRACRANIAL ARVEN MALFRMJ INFRATENTRL SMPL
|
Professional
|
Both
|
$13,728.47
|
|
|
Service Code
|
HCPCS 61684
|
| Min. Negotiated Rate |
$2,503.40 |
| Max. Negotiated Rate |
$8,046.65 |
| Rate for Payer: Cash Price |
$3,611.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,576.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,218.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,218.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,397.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,576.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,397.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,576.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,576.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,682.22
|
| Rate for Payer: Healthfirst Commercial |
$3,576.29
|
| Rate for Payer: Healthfirst Essential Plan |
$8,046.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,397.48
|
| Rate for Payer: Healthfirst QHP |
$3,576.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,503.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,576.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,039.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,503.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,576.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,682.22
|
| Rate for Payer: SOMOS Essential |
$2,682.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,576.29
|
|
|
PR INTRACRANIAL ARVEN MALFRMJ SUPRATENTRL CMPL
|
Professional
|
Both
|
$20,052.34
|
|
|
Service Code
|
HCPCS 61682
|
| Min. Negotiated Rate |
$3,633.92 |
| Max. Negotiated Rate |
$11,680.47 |
| Rate for Payer: Cash Price |
$5,292.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,191.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,672.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,672.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,931.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,191.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,931.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,191.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,191.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,893.49
|
| Rate for Payer: Healthfirst Commercial |
$5,191.32
|
| Rate for Payer: Healthfirst Essential Plan |
$11,680.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,931.75
|
| Rate for Payer: Healthfirst QHP |
$5,191.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,633.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5,191.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4,412.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3,633.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,191.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,893.49
|
| Rate for Payer: SOMOS Essential |
$3,893.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,191.32
|
|
|
PR INTRACRANIAL ARVEN MALFRMJ SUPRATENTRL SMPL
|
Professional
|
Both
|
$10,722.71
|
|
|
Service Code
|
HCPCS 61680
|
| Min. Negotiated Rate |
$1,984.46 |
| Max. Negotiated Rate |
$6,378.61 |
| Rate for Payer: Cash Price |
$2,886.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,834.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,551.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,551.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,693.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,834.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,693.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,834.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,834.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,126.20
|
| Rate for Payer: Healthfirst Commercial |
$2,834.94
|
| Rate for Payer: Healthfirst Essential Plan |
$6,378.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,693.19
|
| Rate for Payer: Healthfirst QHP |
$2,834.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,984.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,834.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,409.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,984.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,834.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,126.20
|
| Rate for Payer: SOMOS Essential |
$2,126.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,834.94
|
|
|
PR INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS
|
Professional
|
Both
|
$5.43
|
|
|
Service Code
|
HCPCS 95024
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Amida Care Medicaid |
$3.70
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.01
|
| Rate for Payer: Healthfirst Commercial |
$1.35
|
| Rate for Payer: Healthfirst Essential Plan |
$3.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1.28
|
| Rate for Payer: Healthfirst QHP |
$1.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.01
|
| Rate for Payer: SOMOS Essential |
$1.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.35
|
|
|
PR INTRACUTANEOUS TESTS W/ALLERGENIC XTRCS AIRBORNE
|
Professional
|
Both
|
$22.68
|
|
|
Service Code
|
HCPCS 95027
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$12.64 |
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.21
|
| Rate for Payer: Healthfirst Commercial |
$5.62
|
| Rate for Payer: Healthfirst Essential Plan |
$12.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.34
|
| Rate for Payer: Healthfirst QHP |
$5.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.21
|
| Rate for Payer: SOMOS Essential |
$4.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.62
|
|
|
PR INTRAOP EPICAR& ENDOCAR PACG& MAPG
|
Professional
|
Both
|
$1,713.53
|
|
|
Service Code
|
HCPCS 93631 26
|
| Min. Negotiated Rate |
$312.81 |
| Max. Negotiated Rate |
$1,005.46 |
| Rate for Payer: Amida Care Medicaid |
$517.37
|
| Rate for Payer: Cash Price |
$453.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$446.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$402.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$402.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$424.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$446.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$424.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$446.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$446.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$335.15
|
| Rate for Payer: Healthfirst Commercial |
$446.87
|
| Rate for Payer: Healthfirst Essential Plan |
$1,005.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$424.53
|
| Rate for Payer: Healthfirst QHP |
$446.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$312.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$446.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$379.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$312.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$446.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$335.15
|
| Rate for Payer: SOMOS Essential |
$335.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$446.87
|
|
|
PR INTRAOP EPICAR& ENDOCAR PACG& MAPG
|
Professional
|
Both
|
$1,156.58
|
|
|
Service Code
|
HCPCS 93631 TC
|
| Min. Negotiated Rate |
$517.37 |
| Max. Negotiated Rate |
$517.37 |
| Rate for Payer: Amida Care Medicaid |
$517.37
|
|
