|
PR INTRAOP EPICAR& ENDOCAR PACG& MAPG
|
Professional
|
Both
|
$2,870.11
|
|
|
Service Code
|
HCPCS 93631
|
| Min. Negotiated Rate |
$517.37 |
| Max. Negotiated Rate |
$517.37 |
| Rate for Payer: Amida Care Medicaid |
$517.37
|
|
|
PR INTRAOPERATIVE COLONIC LAVAGE
|
Professional
|
Both
|
$765.56
|
|
|
Service Code
|
HCPCS 44701
|
| Min. Negotiated Rate |
$141.16 |
| Max. Negotiated Rate |
$453.74 |
| Rate for Payer: Cash Price |
$202.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$201.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$181.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$181.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$191.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$201.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$191.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$201.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$201.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$151.25
|
| Rate for Payer: Healthfirst Commercial |
$201.66
|
| Rate for Payer: Healthfirst Essential Plan |
$453.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$191.58
|
| Rate for Payer: Healthfirst QHP |
$201.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$141.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$201.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$171.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$141.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$201.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$151.25
|
| Rate for Payer: SOMOS Essential |
$151.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$201.66
|
|
|
PR INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION
|
Professional
|
Both
|
$612.71
|
|
|
Service Code
|
HCPCS 38900
|
| Min. Negotiated Rate |
$113.53 |
| Max. Negotiated Rate |
$364.93 |
| Rate for Payer: Cash Price |
$163.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$162.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$145.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$145.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$154.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$162.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$154.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$162.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$162.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$121.64
|
| Rate for Payer: Healthfirst Commercial |
$162.19
|
| Rate for Payer: Healthfirst Essential Plan |
$364.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$154.08
|
| Rate for Payer: Healthfirst QHP |
$162.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$113.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$162.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$137.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$113.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$162.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$121.64
|
| Rate for Payer: SOMOS Essential |
$121.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$162.19
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR LINGUAL
|
Professional
|
Both
|
$452.66
|
|
|
Service Code
|
HCPCS 41000
|
| Min. Negotiated Rate |
$86.76 |
| Max. Negotiated Rate |
$278.87 |
| Rate for Payer: Cash Price |
$120.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$123.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$111.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$111.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$117.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$123.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$117.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$123.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.95
|
| Rate for Payer: Healthfirst Commercial |
$123.94
|
| Rate for Payer: Healthfirst Essential Plan |
$278.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$117.74
|
| Rate for Payer: Healthfirst QHP |
$123.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$86.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$123.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$105.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$86.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$123.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$92.95
|
| Rate for Payer: SOMOS Essential |
$92.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$123.94
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR MASTICATOR SPACE
|
Professional
|
Both
|
$1,206.49
|
|
|
Service Code
|
HCPCS 41009
|
| Min. Negotiated Rate |
$232.95 |
| Max. Negotiated Rate |
$748.75 |
| Rate for Payer: Cash Price |
$331.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$332.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$299.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$299.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$316.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$332.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$316.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$332.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$332.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$249.59
|
| Rate for Payer: Healthfirst Commercial |
$332.78
|
| Rate for Payer: Healthfirst Essential Plan |
$748.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$316.14
|
| Rate for Payer: Healthfirst QHP |
$332.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$232.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$332.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$282.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$232.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$332.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$249.59
|
| Rate for Payer: SOMOS Essential |
$249.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$332.78
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD
|
Professional
|
Both
|
$972.79
|
|
|
Service Code
|
HCPCS 41006
|
| Min. Negotiated Rate |
$188.45 |
| Max. Negotiated Rate |
$605.72 |
| Rate for Payer: Cash Price |
$266.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$269.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$242.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$242.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$255.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$269.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$255.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$269.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$269.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$201.91
|
| Rate for Payer: Healthfirst Commercial |
$269.21
|
| Rate for Payer: Healthfirst Essential Plan |
$605.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$255.75
|
| Rate for Payer: Healthfirst QHP |
$269.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$188.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$269.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$228.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$188.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$269.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$201.91
|
| Rate for Payer: SOMOS Essential |
$201.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$269.21
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR SUBLNGL SUPFC
|
Professional
|
Both
|
$513.91
|
|
|
Service Code
|
HCPCS 41005
|
| Min. Negotiated Rate |
$95.68 |
| Max. Negotiated Rate |
$307.55 |
| Rate for Payer: Cash Price |
$134.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$136.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$123.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$129.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$136.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$129.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.52
|
| Rate for Payer: Healthfirst Commercial |
$136.69
|
| Rate for Payer: Healthfirst Essential Plan |
$307.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$129.86
|
| Rate for Payer: Healthfirst QHP |
$136.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$95.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$136.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$116.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$95.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$136.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.52
|
| Rate for Payer: SOMOS Essential |
$102.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$136.69
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR SUBMENTAL SPACE
|
Professional
|
Both
|
$924.18
|
|
|
Service Code
|
HCPCS 41007
|
| Min. Negotiated Rate |
$179.65 |
| Max. Negotiated Rate |
$577.44 |
| Rate for Payer: Cash Price |
$254.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$256.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$230.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$230.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$243.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$256.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$243.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$256.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$256.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$192.48
|
| Rate for Payer: Healthfirst Commercial |
$256.64
|
| Rate for Payer: Healthfirst Essential Plan |
$577.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$243.81
|
| Rate for Payer: Healthfirst QHP |
$256.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$179.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$256.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$218.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$179.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$256.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$192.48
|
| Rate for Payer: SOMOS Essential |
$192.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$256.64
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPACE
|
Professional
|
Both
|
$1,090.50
|
|
|
Service Code
|
HCPCS 41008
|
| Min. Negotiated Rate |
$214.25 |
| Max. Negotiated Rate |
$688.66 |
| Rate for Payer: Cash Price |
$299.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$306.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$275.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$275.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$290.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$306.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$290.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$306.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$306.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$229.55
|
| Rate for Payer: Healthfirst Commercial |
$306.07
|
| Rate for Payer: Healthfirst Essential Plan |
$688.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$290.77
|
| Rate for Payer: Healthfirst QHP |
$306.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$214.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$306.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$260.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$214.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$306.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$229.55
|
| Rate for Payer: SOMOS Essential |
$229.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$306.07
|
|
|
PR INTRAPULMONARY SURFACTANT ADMINISTJ PHYS/QHP
|
Professional
|
Both
|
$227.54
|
|
|
Service Code
|
HCPCS 94610
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$136.33 |
| Rate for Payer: Amida Care Medicaid |
$31.86
|
| Rate for Payer: Cash Price |
$62.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$60.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$54.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$54.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$57.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$60.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$57.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.44
|
| Rate for Payer: Healthfirst Commercial |
$60.59
|
| Rate for Payer: Healthfirst Essential Plan |
$136.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$57.56
|
| Rate for Payer: Healthfirst QHP |
$60.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$42.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$60.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$51.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$42.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$60.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.44
|
| Rate for Payer: SOMOS Essential |
$45.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$60.59
|
|
|
PR INTRAVASCULAR US NONCORONARY RS&I ADDL VESSEL
|
Professional
|
Both
|
$303.24
|
|
|
Service Code
|
HCPCS 37253
|
| Min. Negotiated Rate |
$56.62 |
| Max. Negotiated Rate |
$182.00 |
| Rate for Payer: Cash Price |
$80.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$80.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.67
|
| Rate for Payer: Healthfirst Commercial |
$80.89
|
| Rate for Payer: Healthfirst Essential Plan |
$182.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.85
|
| Rate for Payer: Healthfirst QHP |
$80.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.67
|
| Rate for Payer: SOMOS Essential |
$60.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.89
|
|
|
PR INTRAVASCULAR US NONCORONARY RS&I INTIAL VESSEL
|
Professional
|
Both
|
$385.91
|
|
|
Service Code
|
HCPCS 37252
|
| Min. Negotiated Rate |
$71.21 |
| Max. Negotiated Rate |
$228.89 |
| Rate for Payer: Cash Price |
$101.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$101.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$91.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$91.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$96.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$101.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$96.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$101.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$101.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$76.30
|
| Rate for Payer: Healthfirst Commercial |
$101.73
|
| Rate for Payer: Healthfirst Essential Plan |
$228.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$96.64
|
| Rate for Payer: Healthfirst QHP |
$101.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$71.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$101.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$86.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$71.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$101.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$76.30
|
| Rate for Payer: SOMOS Essential |
$76.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$101.73
|
|
|
PR INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MA
|
Professional
|
Both
|
$557.24
|
|
|
Service Code
|
HCPCS 93609 TC
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Amida Care Medicaid |
$300.00
|
|
|
PR INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MA
|
Professional
|
Both
|
$1,180.17
|
|
|
Service Code
|
HCPCS 93609 26
|
| Min. Negotiated Rate |
$215.30 |
| Max. Negotiated Rate |
$692.03 |
| Rate for Payer: Amida Care Medicaid |
$300.00
|
| Rate for Payer: Cash Price |
$311.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$307.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$276.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$276.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$292.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$307.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$292.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$307.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$230.68
|
| Rate for Payer: Healthfirst Commercial |
$307.57
|
| Rate for Payer: Healthfirst Essential Plan |
$692.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$292.19
|
| Rate for Payer: Healthfirst QHP |
$307.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$215.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$307.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$261.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$215.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$307.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$230.68
|
| Rate for Payer: SOMOS Essential |
$230.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$307.57
|
|
|
PR INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MA
|
Professional
|
Both
|
$1,737.40
|
|
|
Service Code
|
HCPCS 93609
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Amida Care Medicaid |
$300.00
|
|
|
PR INTRAVENTRICULAR PACING
|
Professional
|
Both
|
$1,011.43
|
|
|
Service Code
|
HCPCS 93612
|
| Min. Negotiated Rate |
$179.94 |
| Max. Negotiated Rate |
$179.94 |
| Rate for Payer: Amida Care Medicaid |
$179.94
|
|
|
PR INTRAVENTRICULAR PACING
|
Professional
|
Both
|
$331.21
|
|
|
Service Code
|
HCPCS 93612 TC
|
| Min. Negotiated Rate |
$179.94 |
| Max. Negotiated Rate |
$179.94 |
| Rate for Payer: Amida Care Medicaid |
$179.94
|
|
|
PR INTRAVENTRICULAR PACING
|
Professional
|
Both
|
$680.23
|
|
|
Service Code
|
HCPCS 93612 26
|
| Min. Negotiated Rate |
$125.32 |
| Max. Negotiated Rate |
$402.82 |
| Rate for Payer: Amida Care Medicaid |
$179.94
|
| Rate for Payer: Cash Price |
$180.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$179.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$161.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$161.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$170.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$179.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$170.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$134.27
|
| Rate for Payer: Healthfirst Commercial |
$179.03
|
| Rate for Payer: Healthfirst Essential Plan |
$402.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$170.08
|
| Rate for Payer: Healthfirst QHP |
$179.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$125.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$179.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$152.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$125.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$179.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$134.27
|
| Rate for Payer: SOMOS Essential |
$134.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$179.03
|
|
|
PR INTRAVITREAL NJX PHARMACOLOGIC AGT SPX
|
Professional
|
Both
|
$374.33
|
|
|
Service Code
|
HCPCS 67028
|
| Min. Negotiated Rate |
$71.98 |
| Max. Negotiated Rate |
$231.37 |
| Rate for Payer: Cash Price |
$102.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$102.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$92.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$97.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$102.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$97.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.12
|
| Rate for Payer: Healthfirst Commercial |
$102.83
|
| Rate for Payer: Healthfirst Essential Plan |
$231.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$97.69
|
| Rate for Payer: Healthfirst QHP |
$102.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$71.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$102.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$87.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$71.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.12
|
| Rate for Payer: SOMOS Essential |
$77.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.83
|
|
|
PR INTRO ANY HEMOSTATIC AGENT/PACK VAG HEMRRG SPX
|
Professional
|
Both
|
$529.73
|
|
|
Service Code
|
HCPCS 57180
|
| Min. Negotiated Rate |
$98.70 |
| Max. Negotiated Rate |
$317.25 |
| Rate for Payer: Cash Price |
$142.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$141.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$126.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$133.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$141.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$133.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$141.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$141.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.75
|
| Rate for Payer: Healthfirst Commercial |
$141.00
|
| Rate for Payer: Healthfirst Essential Plan |
$317.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.95
|
| Rate for Payer: Healthfirst QHP |
$141.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$141.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$119.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$141.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.75
|
| Rate for Payer: SOMOS Essential |
$105.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$141.00
|
|
|
PR INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I
|
Professional
|
Both
|
$709.87
|
|
|
Service Code
|
HCPCS 36901
|
| Min. Negotiated Rate |
$132.33 |
| Max. Negotiated Rate |
$425.34 |
| Rate for Payer: Cash Price |
$189.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$189.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$170.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$170.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$179.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$189.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$179.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$189.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$189.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$141.78
|
| Rate for Payer: Healthfirst Commercial |
$189.04
|
| Rate for Payer: Healthfirst Essential Plan |
$425.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$179.59
|
| Rate for Payer: Healthfirst QHP |
$189.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$132.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$189.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$160.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$132.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$189.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$141.78
|
| Rate for Payer: SOMOS Essential |
$141.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$189.04
|
|
|
PR INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT
|
Professional
|
Both
|
$1,327.24
|
|
|
Service Code
|
HCPCS 36903
|
| Min. Negotiated Rate |
$247.41 |
| Max. Negotiated Rate |
$795.24 |
| Rate for Payer: Cash Price |
$356.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$353.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$318.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$318.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$335.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$353.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$335.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$353.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$353.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$265.08
|
| Rate for Payer: Healthfirst Commercial |
$353.44
|
| Rate for Payer: Healthfirst Essential Plan |
$795.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$335.77
|
| Rate for Payer: Healthfirst QHP |
$353.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$247.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$353.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$300.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$247.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$353.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$265.08
|
| Rate for Payer: SOMOS Essential |
$265.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$353.44
|
|
|
PR INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP
|
Professional
|
Both
|
$1,003.63
|
|
|
Service Code
|
HCPCS 36902
|
| Min. Negotiated Rate |
$187.14 |
| Max. Negotiated Rate |
$601.51 |
| Rate for Payer: Cash Price |
$270.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$267.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$240.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$253.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$267.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$253.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$267.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$267.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$200.50
|
| Rate for Payer: Healthfirst Commercial |
$267.34
|
| Rate for Payer: Healthfirst Essential Plan |
$601.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$253.97
|
| Rate for Payer: Healthfirst QHP |
$267.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$187.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$267.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$227.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$187.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$267.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$200.50
|
| Rate for Payer: SOMOS Essential |
$200.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$267.34
|
|
|
PR INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY
|
Professional
|
Both
|
$522.20
|
|
|
Service Code
|
HCPCS 36013
|
| Min. Negotiated Rate |
$98.46 |
| Max. Negotiated Rate |
$316.49 |
| Rate for Payer: Cash Price |
$141.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$140.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$126.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$133.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$140.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$133.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.50
|
| Rate for Payer: Healthfirst Commercial |
$140.66
|
| Rate for Payer: Healthfirst Essential Plan |
$316.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.63
|
| Rate for Payer: Healthfirst QHP |
$140.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$140.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$119.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$140.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.50
|
| Rate for Payer: SOMOS Essential |
$105.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$140.66
|
|
|
PR INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA
|
Professional
|
Both
|
$463.26
|
|
|
Service Code
|
HCPCS 36010
|
| Min. Negotiated Rate |
$85.48 |
| Max. Negotiated Rate |
$274.75 |
| Rate for Payer: Cash Price |
$124.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$122.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$109.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$109.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$116.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$122.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$116.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.58
|
| Rate for Payer: Healthfirst Commercial |
$122.11
|
| Rate for Payer: Healthfirst Essential Plan |
$274.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$116.00
|
| Rate for Payer: Healthfirst QHP |
$122.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$85.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$122.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$103.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$85.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$122.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$91.58
|
| Rate for Payer: SOMOS Essential |
$91.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.11
|
|
