|
PR LEFT HEART CATH BY TRANSEPTAL PUNCTURE
|
Professional
|
Both
|
$915.78
|
|
|
Service Code
|
HCPCS 93462
|
| Min. Negotiated Rate |
$78.93 |
| Max. Negotiated Rate |
$535.54 |
| Rate for Payer: Amida Care Medicaid |
$78.93
|
| Rate for Payer: Cash Price |
$241.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$238.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$214.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$214.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$226.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$238.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$226.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$238.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$238.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$178.51
|
| Rate for Payer: Healthfirst Commercial |
$238.02
|
| Rate for Payer: Healthfirst Essential Plan |
$535.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$226.12
|
| Rate for Payer: Healthfirst QHP |
$238.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$166.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$238.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$202.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$166.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$238.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$178.51
|
| Rate for Payer: SOMOS Essential |
$178.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$238.02
|
|
|
PR LENGTHENING HAMSTRING TENDON MULTIPLE 1 LEG
|
Professional
|
Both
|
$2,906.44
|
|
|
Service Code
|
HCPCS 27394
|
| Min. Negotiated Rate |
$550.15 |
| Max. Negotiated Rate |
$1,768.34 |
| Rate for Payer: Cash Price |
$788.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$785.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$707.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$707.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$746.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$785.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$746.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$785.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$785.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$589.45
|
| Rate for Payer: Healthfirst Commercial |
$785.93
|
| Rate for Payer: Healthfirst Essential Plan |
$1,768.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$746.63
|
| Rate for Payer: Healthfirst QHP |
$785.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$550.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$785.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$668.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$550.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$785.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$589.45
|
| Rate for Payer: SOMOS Essential |
$589.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$785.93
|
|
|
PR LENGTHENING HAMSTRING TENDON MULTIPLE BILATERAL
|
Professional
|
Both
|
$3,909.57
|
|
|
Service Code
|
HCPCS 27395
|
| Min. Negotiated Rate |
$735.75 |
| Max. Negotiated Rate |
$2,364.91 |
| Rate for Payer: Cash Price |
$1,057.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,051.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$945.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$945.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$998.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,051.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$998.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,051.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,051.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$788.30
|
| Rate for Payer: Healthfirst Commercial |
$1,051.07
|
| Rate for Payer: Healthfirst Essential Plan |
$2,364.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$998.52
|
| Rate for Payer: Healthfirst QHP |
$1,051.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$735.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,051.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$893.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$735.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,051.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$788.30
|
| Rate for Payer: SOMOS Essential |
$788.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,051.07
|
|
|
PR LENGTHENING HAMSTRING TENDON SINGLE
|
Professional
|
Both
|
$2,226.70
|
|
|
Service Code
|
HCPCS 27393
|
| Min. Negotiated Rate |
$421.62 |
| Max. Negotiated Rate |
$1,355.20 |
| Rate for Payer: Cash Price |
$603.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$602.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$542.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$542.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$572.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$602.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$572.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$602.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$602.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$451.73
|
| Rate for Payer: Healthfirst Commercial |
$602.31
|
| Rate for Payer: Healthfirst Essential Plan |
$1,355.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$572.19
|
| Rate for Payer: Healthfirst QHP |
$602.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$421.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$602.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$511.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$421.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$602.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$451.73
|
| Rate for Payer: SOMOS Essential |
$451.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$602.31
|
|
|
PR LENGTHENING PALATE & PHARYNGEAL FLAP
|
Professional
|
Both
|
$3,923.64
|
|
|
Service Code
|
HCPCS 42226
|
| Min. Negotiated Rate |
$736.46 |
| Max. Negotiated Rate |
$2,367.18 |
| Rate for Payer: Cash Price |
$1,061.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,052.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$946.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$946.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$999.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,052.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$999.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,052.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,052.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$789.06
|
| Rate for Payer: Healthfirst Commercial |
$1,052.08
|
| Rate for Payer: Healthfirst Essential Plan |
$2,367.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$999.48
|
| Rate for Payer: Healthfirst QHP |
$1,052.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$736.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,052.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$894.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$736.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,052.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$789.06
|
| Rate for Payer: SOMOS Essential |
$789.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,052.08
|
|
|
PR LENGTHENING PALATE W/ISLAND FLAP
|
Professional
|
Both
|
$3,650.01
|
|
|
Service Code
|
HCPCS 42227
|
| Min. Negotiated Rate |
$685.62 |
| Max. Negotiated Rate |
$2,203.78 |
| Rate for Payer: Cash Price |
$988.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$979.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$881.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$881.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$930.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$979.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$930.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$979.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$979.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$734.60
|
| Rate for Payer: Healthfirst Commercial |
$979.46
|
| Rate for Payer: Healthfirst Essential Plan |
$2,203.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$930.49
|
| Rate for Payer: Healthfirst QHP |
$979.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$685.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$979.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$832.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$685.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$979.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$734.60
|
| Rate for Payer: SOMOS Essential |
$734.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$979.46
|
|
|
PR LENGTHENING TENDON EXTENSOR HAND/FINGER EACH
|
Professional
|
Both
|
$2,864.51
|
|
|
Service Code
|
HCPCS 26476
|
| Min. Negotiated Rate |
$530.92 |
| Max. Negotiated Rate |
$1,706.54 |
| Rate for Payer: Cash Price |
$773.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$758.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$682.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$682.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$720.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$758.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$720.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$758.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$758.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$568.85
|
| Rate for Payer: Healthfirst Commercial |
$758.46
|
| Rate for Payer: Healthfirst Essential Plan |
$1,706.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$720.54
|
| Rate for Payer: Healthfirst QHP |
$758.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$530.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$758.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$644.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$530.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$758.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$568.85
|
| Rate for Payer: SOMOS Essential |
$568.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$758.46
|
|
|
PR LENGTHENING TENDON FLEXOR HAND/FINGER EACH
|
Professional
|
Both
|
$2,944.48
|
|
|
Service Code
|
HCPCS 26478
|
| Min. Negotiated Rate |
$542.61 |
| Max. Negotiated Rate |
$1,744.11 |
| Rate for Payer: Cash Price |
$786.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$775.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$697.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$697.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$736.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$775.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$736.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$775.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$775.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$581.37
|
| Rate for Payer: Healthfirst Commercial |
$775.16
|
| Rate for Payer: Healthfirst Essential Plan |
$1,744.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$736.40
|
| Rate for Payer: Healthfirst QHP |
$775.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$542.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$775.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$658.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$542.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$775.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$581.37
|
| Rate for Payer: SOMOS Essential |
$581.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$775.16
|
|
|
PR L HRT CATH CHD IMG CATH TRGT ZON NML/ABNL NT CNJ
|
Professional
|
Both
|
$1,026.45
|
|
|
Service Code
|
HCPCS 93595 26
|
| Min. Negotiated Rate |
$191.99 |
| Max. Negotiated Rate |
$617.11 |
| Rate for Payer: Cash Price |
$277.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$274.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$246.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$246.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$260.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$274.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$260.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$274.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$274.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$205.70
|
| Rate for Payer: Healthfirst Commercial |
$274.27
|
| Rate for Payer: Healthfirst Essential Plan |
$617.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$260.56
|
| Rate for Payer: Healthfirst QHP |
$274.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$191.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$274.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$233.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$191.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$274.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$205.70
|
| Rate for Payer: SOMOS Essential |
$205.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$274.27
|
|
|
PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I
|
Professional
|
Both
|
$1,006.78
|
|
|
Service Code
|
HCPCS 93452 26
|
| Min. Negotiated Rate |
$186.82 |
| Max. Negotiated Rate |
$600.48 |
| Rate for Payer: Amida Care Medicaid |
$409.11
|
| Rate for Payer: Cash Price |
$270.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$266.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$240.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$253.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$266.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$253.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$266.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$266.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$200.16
|
| Rate for Payer: Healthfirst Commercial |
$266.88
|
| Rate for Payer: Healthfirst Essential Plan |
$600.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$253.54
|
| Rate for Payer: Healthfirst QHP |
$266.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$186.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$266.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$226.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$186.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$266.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$200.16
|
| Rate for Payer: SOMOS Essential |
$200.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$266.88
|
|
|
PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I
|
Professional
|
Both
|
$2,900.31
|
|
|
Service Code
|
HCPCS 93452 TC
|
| Min. Negotiated Rate |
$409.11 |
| Max. Negotiated Rate |
$1,641.35 |
| Rate for Payer: Amida Care Medicaid |
$409.11
|
| Rate for Payer: Cash Price |
$772.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$729.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$656.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$656.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$693.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$729.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$693.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$729.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$547.12
|
| Rate for Payer: Healthfirst Commercial |
$729.49
|
| Rate for Payer: Healthfirst Essential Plan |
$1,641.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$693.02
|
| Rate for Payer: Healthfirst QHP |
$729.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$510.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$729.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$620.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$510.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$729.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$547.12
|
| Rate for Payer: SOMOS Essential |
$547.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$729.49
|
|
|
PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I
|
Professional
|
Both
|
$3,907.09
|
|
|
Service Code
|
HCPCS 93452
|
| Min. Negotiated Rate |
$409.11 |
| Max. Negotiated Rate |
$2,241.83 |
| Rate for Payer: Amida Care Medicaid |
$409.11
|
| Rate for Payer: Cash Price |
$1,043.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$996.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$896.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$896.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$946.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$996.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$946.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$996.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$996.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$747.28
|
| Rate for Payer: Healthfirst Commercial |
$996.37
|
| Rate for Payer: Healthfirst Essential Plan |
$2,241.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$946.55
|
| Rate for Payer: Healthfirst QHP |
$996.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$697.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$996.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$846.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$697.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$996.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$747.28
|
| Rate for Payer: SOMOS Essential |
$747.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$996.37
|
|
|
PR LIGAMENTOUS RECONSTRUCTION KNEE EXTRA-ARTICULAR
|
Professional
|
Both
|
$3,139.40
|
|
|
Service Code
|
HCPCS 27427
|
| Min. Negotiated Rate |
$590.23 |
| Max. Negotiated Rate |
$1,897.15 |
| Rate for Payer: Cash Price |
$847.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$843.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$758.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$758.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$801.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$843.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$801.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$843.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$843.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$632.38
|
| Rate for Payer: Healthfirst Commercial |
$843.18
|
| Rate for Payer: Healthfirst Essential Plan |
$1,897.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$801.02
|
| Rate for Payer: Healthfirst QHP |
$843.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$590.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$843.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$716.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$590.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$843.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$632.38
|
| Rate for Payer: SOMOS Essential |
$632.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$843.18
|
|
|
PR LIGAMENTOUS RECONSTRUCTION KNEE INTRA-ARTICULAR
|
Professional
|
Both
|
$4,939.59
|
|
|
Service Code
|
HCPCS 27428
|
| Min. Negotiated Rate |
$931.03 |
| Max. Negotiated Rate |
$2,992.59 |
| Rate for Payer: Cash Price |
$1,335.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,330.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,197.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,197.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,263.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,330.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,263.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,330.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,330.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$997.53
|
| Rate for Payer: Healthfirst Commercial |
$1,330.04
|
| Rate for Payer: Healthfirst Essential Plan |
$2,992.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,263.54
|
| Rate for Payer: Healthfirst QHP |
$1,330.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$931.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,330.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,130.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$931.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,330.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$997.53
|
| Rate for Payer: SOMOS Essential |
$997.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,330.04
|
|
|
PR LIGATION ARTERIES ETHMOIDAL
|
Professional
|
Both
|
$2,626.30
|
|
|
Service Code
|
HCPCS 30915
|
| Min. Negotiated Rate |
$486.55 |
| Max. Negotiated Rate |
$1,563.91 |
| Rate for Payer: Cash Price |
$710.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$695.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$625.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$625.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$660.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$695.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$660.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$695.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$695.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$521.30
|
| Rate for Payer: Healthfirst Commercial |
$695.07
|
| Rate for Payer: Healthfirst Essential Plan |
$1,563.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$660.32
|
| Rate for Payer: Healthfirst QHP |
$695.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$486.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$695.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$590.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$486.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$695.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$521.30
|
| Rate for Payer: SOMOS Essential |
$521.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$695.07
|
|
|
PR LIGATION ARTERIES INT MAXILLARY TRANSANTRAL
|
Professional
|
Both
|
$3,798.24
|
|
|
Service Code
|
HCPCS 30920
|
| Min. Negotiated Rate |
$702.12 |
| Max. Negotiated Rate |
$2,256.82 |
| Rate for Payer: Cash Price |
$1,023.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,003.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$902.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$902.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$952.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,003.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$952.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,003.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,003.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$752.27
|
| Rate for Payer: Healthfirst Commercial |
$1,003.03
|
| Rate for Payer: Healthfirst Essential Plan |
$2,256.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$952.88
|
| Rate for Payer: Healthfirst QHP |
$1,003.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$702.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,003.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$852.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$702.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,003.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$752.27
|
| Rate for Payer: SOMOS Essential |
$752.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,003.03
|
|
|
PR LIGATION/BIOPSY TEMPORAL ARTERY
|
Professional
|
Both
|
$904.86
|
|
|
Service Code
|
HCPCS 37609
|
| Min. Negotiated Rate |
$166.73 |
| Max. Negotiated Rate |
$535.90 |
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$238.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$214.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$214.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$226.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$238.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$226.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$238.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$238.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$178.63
|
| Rate for Payer: Healthfirst Commercial |
$238.18
|
| Rate for Payer: Healthfirst Essential Plan |
$535.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$226.27
|
| Rate for Payer: Healthfirst QHP |
$238.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$166.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$238.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$202.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$166.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$238.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$178.63
|
| Rate for Payer: SOMOS Essential |
$178.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$238.18
|
|
|
PR LIGATION DIRECT ESOPHAGEAL VARICES
|
Professional
|
Both
|
$6,897.56
|
|
|
Service Code
|
HCPCS 43400
|
| Min. Negotiated Rate |
$1,273.59 |
| Max. Negotiated Rate |
$4,093.70 |
| Rate for Payer: Cash Price |
$1,834.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,819.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,637.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,637.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,728.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,819.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,728.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,819.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,819.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,364.57
|
| Rate for Payer: Healthfirst Commercial |
$1,819.42
|
| Rate for Payer: Healthfirst Essential Plan |
$4,093.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,728.45
|
| Rate for Payer: Healthfirst QHP |
$1,819.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,273.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,819.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,546.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,273.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,819.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,364.57
|
| Rate for Payer: SOMOS Essential |
$1,364.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,819.42
|
|
|
PR LIGATION EXTERNAL CAROTID ARTERY
|
Professional
|
Both
|
$3,222.94
|
|
|
Service Code
|
HCPCS 37600
|
| Min. Negotiated Rate |
$607.52 |
| Max. Negotiated Rate |
$1,952.75 |
| Rate for Payer: Cash Price |
$872.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$867.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$781.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$781.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$824.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$867.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$824.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$867.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$867.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$650.92
|
| Rate for Payer: Healthfirst Commercial |
$867.89
|
| Rate for Payer: Healthfirst Essential Plan |
$1,952.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$824.50
|
| Rate for Payer: Healthfirst QHP |
$867.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$607.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$867.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$737.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$607.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$867.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$650.92
|
| Rate for Payer: SOMOS Essential |
$650.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$867.89
|
|
|
PR LIGATION INTERNAL/COMMON CAROTID ARTERY
|
Professional
|
Both
|
$3,290.00
|
|
|
Service Code
|
HCPCS 37605
|
| Min. Negotiated Rate |
$604.10 |
| Max. Negotiated Rate |
$1,941.75 |
| Rate for Payer: Cash Price |
$872.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$863.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$776.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$776.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$819.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$863.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$819.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$863.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$863.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$647.25
|
| Rate for Payer: Healthfirst Commercial |
$863.00
|
| Rate for Payer: Healthfirst Essential Plan |
$1,941.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$819.85
|
| Rate for Payer: Healthfirst QHP |
$863.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$604.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$863.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$733.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$604.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$863.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$647.25
|
| Rate for Payer: SOMOS Essential |
$647.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$863.00
|
|
|
PR LIGATION INTERNAL JUGULAR VEIN
|
Professional
|
Both
|
$3,207.12
|
|
|
Service Code
|
HCPCS 37565
|
| Min. Negotiated Rate |
$591.81 |
| Max. Negotiated Rate |
$1,902.24 |
| Rate for Payer: Cash Price |
$857.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$845.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$760.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$760.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$803.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$845.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$803.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$845.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$845.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$634.08
|
| Rate for Payer: Healthfirst Commercial |
$845.44
|
| Rate for Payer: Healthfirst Essential Plan |
$1,902.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$803.17
|
| Rate for Payer: Healthfirst QHP |
$845.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$591.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$845.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$718.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$591.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$845.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$634.08
|
| Rate for Payer: SOMOS Essential |
$634.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$845.44
|
|
|
PR LIGATION MAJOR ARTERY ABDOMEN
|
Professional
|
Both
|
$5,856.17
|
|
|
Service Code
|
HCPCS 37617
|
| Min. Negotiated Rate |
$1,085.61 |
| Max. Negotiated Rate |
$3,489.46 |
| Rate for Payer: Cash Price |
$1,566.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,550.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,395.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,395.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,473.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,550.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,473.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,550.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,550.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,163.15
|
| Rate for Payer: Healthfirst Commercial |
$1,550.87
|
| Rate for Payer: Healthfirst Essential Plan |
$3,489.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,473.33
|
| Rate for Payer: Healthfirst QHP |
$1,550.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,085.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,550.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,318.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,085.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,550.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,163.15
|
| Rate for Payer: SOMOS Essential |
$1,163.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,550.87
|
|
|
PR LIGATION MAJOR ARTERY CHEST
|
Professional
|
Both
|
$4,930.28
|
|
|
Service Code
|
HCPCS 37616
|
| Min. Negotiated Rate |
$944.44 |
| Max. Negotiated Rate |
$3,035.70 |
| Rate for Payer: Cash Price |
$1,340.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,349.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,214.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,214.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,281.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,349.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,281.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,349.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,349.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,011.90
|
| Rate for Payer: Healthfirst Commercial |
$1,349.20
|
| Rate for Payer: Healthfirst Essential Plan |
$3,035.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,281.74
|
| Rate for Payer: Healthfirst QHP |
$1,349.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$944.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,349.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,146.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$944.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,349.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,011.90
|
| Rate for Payer: SOMOS Essential |
$1,011.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,349.20
|
|
|
PR LIGATION MAJOR ARTERY EXTREMITY
|
Professional
|
Both
|
$1,730.82
|
|
|
Service Code
|
HCPCS 37618
|
| Min. Negotiated Rate |
$322.71 |
| Max. Negotiated Rate |
$1,037.30 |
| Rate for Payer: Cash Price |
$467.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$414.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$414.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$437.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$437.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$461.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$345.76
|
| Rate for Payer: Healthfirst Commercial |
$461.02
|
| Rate for Payer: Healthfirst Essential Plan |
$1,037.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$437.97
|
| Rate for Payer: Healthfirst QHP |
$461.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$322.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$391.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$322.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$345.76
|
| Rate for Payer: SOMOS Essential |
$345.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.02
|
|
|
PR LIGATION MAJOR ARTERY NECK
|
Professional
|
Both
|
$2,266.29
|
|
|
Service Code
|
HCPCS 37615
|
| Min. Negotiated Rate |
$422.54 |
| Max. Negotiated Rate |
$1,358.17 |
| Rate for Payer: Cash Price |
$608.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$603.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$543.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$543.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$573.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$603.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$573.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$603.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$603.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$452.72
|
| Rate for Payer: Healthfirst Commercial |
$603.63
|
| Rate for Payer: Healthfirst Essential Plan |
$1,358.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$573.45
|
| Rate for Payer: Healthfirst QHP |
$603.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$422.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$603.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$513.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$422.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$603.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$452.72
|
| Rate for Payer: SOMOS Essential |
$452.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$603.63
|
|
