|
PR NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY
|
Professional
|
Both
|
$182.14
|
|
|
Service Code
|
HCPCS 51600
|
| Min. Negotiated Rate |
$33.38 |
| Max. Negotiated Rate |
$107.28 |
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.76
|
| Rate for Payer: Healthfirst Commercial |
$47.68
|
| Rate for Payer: Healthfirst Essential Plan |
$107.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.30
|
| Rate for Payer: Healthfirst QHP |
$47.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.76
|
| Rate for Payer: SOMOS Essential |
$35.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.68
|
|
|
PR NJX DRG C-CATHJ NSLCTV P-ART ANGIOGRAPHY
|
Professional
|
Both
|
$206.78
|
|
|
Service Code
|
HCPCS 93568
|
| Min. Negotiated Rate |
$17.31 |
| Max. Negotiated Rate |
$120.31 |
| Rate for Payer: Amida Care Medicaid |
$17.31
|
| Rate for Payer: Cash Price |
$53.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.10
|
| Rate for Payer: Healthfirst Commercial |
$53.47
|
| Rate for Payer: Healthfirst Essential Plan |
$120.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.80
|
| Rate for Payer: Healthfirst QHP |
$53.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.10
|
| Rate for Payer: SOMOS Essential |
$40.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.47
|
|
|
PR NJX DRG C-CATHJ SLCTV P-ART ANGIOGRAPHY BI
|
Professional
|
Both
|
$254.87
|
|
|
Service Code
|
HCPCS 93573
|
| Min. Negotiated Rate |
$33.55 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Amida Care Medicaid |
$33.55
|
| Rate for Payer: Cash Price |
$68.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$67.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$63.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$67.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$63.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.40
|
| Rate for Payer: Healthfirst Commercial |
$67.20
|
| Rate for Payer: Healthfirst Essential Plan |
$151.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$63.84
|
| Rate for Payer: Healthfirst QHP |
$67.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$67.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$57.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$67.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$50.40
|
| Rate for Payer: SOMOS Essential |
$50.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$67.20
|
|
|
PR NJX DRG C-CATHJ SLCTV P-ART ANGIOGRAPHY UNI
|
Professional
|
Both
|
$152.92
|
|
|
Service Code
|
HCPCS 93569
|
| Min. Negotiated Rate |
$20.13 |
| Max. Negotiated Rate |
$90.99 |
| Rate for Payer: Amida Care Medicaid |
$20.13
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.33
|
| Rate for Payer: Healthfirst Commercial |
$40.44
|
| Rate for Payer: Healthfirst Essential Plan |
$90.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.42
|
| Rate for Payer: Healthfirst QHP |
$40.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.33
|
| Rate for Payer: SOMOS Essential |
$30.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.44
|
|
|
PR NJX DRG C-CATHJ SLCTV PULM ANGRPH MAPCA CHD EA
|
Professional
|
Both
|
$375.10
|
|
|
Service Code
|
HCPCS 93575
|
| Min. Negotiated Rate |
$49.46 |
| Max. Negotiated Rate |
$224.55 |
| Rate for Payer: Amida Care Medicaid |
$49.46
|
| Rate for Payer: Cash Price |
$101.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$99.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$89.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$89.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$94.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$99.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$94.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.85
|
| Rate for Payer: Healthfirst Commercial |
$99.80
|
| Rate for Payer: Healthfirst Essential Plan |
$224.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$94.81
|
| Rate for Payer: Healthfirst QHP |
$99.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$69.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$99.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$84.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$69.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$99.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$74.85
|
| Rate for Payer: SOMOS Essential |
$74.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$99.80
|
|
|
PR NJX DRG C-CATHJ SLCTV PULM VEN ANGIOGRAPHY
|
Professional
|
Both
|
$279.58
|
|
|
Service Code
|
HCPCS 93574
|
| Min. Negotiated Rate |
$36.93 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Amida Care Medicaid |
$36.93
|
| Rate for Payer: Cash Price |
$76.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$75.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$75.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$71.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.40
|
| Rate for Payer: Healthfirst Commercial |
$75.20
|
| Rate for Payer: Healthfirst Essential Plan |
$169.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$71.44
|
| Rate for Payer: Healthfirst QHP |
$75.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$75.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$75.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56.40
|
| Rate for Payer: SOMOS Essential |
$56.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.20
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL
|
Professional
|
Both
|
$245.70
|
|
|
Service Code
|
HCPCS 64491
|
| Min. Negotiated Rate |
$46.91 |
| Max. Negotiated Rate |
$150.79 |
| Rate for Payer: Cash Price |
$66.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$67.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$63.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$67.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$63.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.27
|
| Rate for Payer: Healthfirst Commercial |
$67.02
|
| Rate for Payer: Healthfirst Essential Plan |
$150.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$63.67
|
| Rate for Payer: Healthfirst QHP |
$67.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$67.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$56.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$67.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$50.27
|
| Rate for Payer: SOMOS Essential |
$50.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$67.02
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL
|
Professional
|
Both
|
$250.01
|
|
|
Service Code
|
HCPCS 64492
|
| Min. Negotiated Rate |
$47.02 |
| Max. Negotiated Rate |
$151.13 |
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$67.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$63.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$67.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$63.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.38
|
| Rate for Payer: Healthfirst Commercial |
$67.17
|
| Rate for Payer: Healthfirst Essential Plan |
$151.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$63.81
|
| Rate for Payer: Healthfirst QHP |
$67.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$67.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$57.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$67.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$50.38
|
| Rate for Payer: SOMOS Essential |
$50.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$67.17
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL
|
Professional
|
Both
|
$377.76
|
|
|
Service Code
|
HCPCS 64493
|
| Min. Negotiated Rate |
$72.11 |
| Max. Negotiated Rate |
$231.77 |
| Rate for Payer: Cash Price |
$102.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$103.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$92.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$97.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$97.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.26
|
| Rate for Payer: Healthfirst Commercial |
$103.01
|
| Rate for Payer: Healthfirst Essential Plan |
$231.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$97.86
|
| Rate for Payer: Healthfirst QHP |
$103.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$103.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$87.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.26
|
| Rate for Payer: SOMOS Essential |
$77.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.01
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL
|
Professional
|
Both
|
$211.54
|
|
|
Service Code
|
HCPCS 64494
|
| Min. Negotiated Rate |
$39.85 |
| Max. Negotiated Rate |
$128.09 |
| Rate for Payer: Cash Price |
$57.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$51.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$54.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$54.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.70
|
| Rate for Payer: Healthfirst Commercial |
$56.93
|
| Rate for Payer: Healthfirst Essential Plan |
$128.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$54.08
|
| Rate for Payer: Healthfirst QHP |
$56.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$56.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.70
|
| Rate for Payer: SOMOS Essential |
$42.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.93
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL
|
Professional
|
Both
|
$214.41
|
|
|
Service Code
|
HCPCS 64495
|
| Min. Negotiated Rate |
$39.80 |
| Max. Negotiated Rate |
$127.94 |
| Rate for Payer: Cash Price |
$58.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$51.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$54.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$54.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.65
|
| Rate for Payer: Healthfirst Commercial |
$56.86
|
| Rate for Payer: Healthfirst Essential Plan |
$127.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$54.02
|
| Rate for Payer: Healthfirst QHP |
$56.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$56.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.65
|
| Rate for Payer: SOMOS Essential |
$42.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.86
|
|
|
PR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN
|
Professional
|
Both
|
$456.79
|
|
|
Service Code
|
HCPCS 62325
|
| Min. Negotiated Rate |
$84.48 |
| Max. Negotiated Rate |
$271.53 |
| Rate for Payer: Cash Price |
$123.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$120.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$114.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$120.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$114.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$90.51
|
| Rate for Payer: Healthfirst Commercial |
$120.68
|
| Rate for Payer: Healthfirst Essential Plan |
$271.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$114.65
|
| Rate for Payer: Healthfirst QHP |
$120.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$84.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$120.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$102.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$84.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$120.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$90.51
|
| Rate for Payer: SOMOS Essential |
$90.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$120.68
|
|
|
PR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN
|
Professional
|
Both
|
$441.42
|
|
|
Service Code
|
HCPCS 62321
|
| Min. Negotiated Rate |
$84.15 |
| Max. Negotiated Rate |
$270.50 |
| Rate for Payer: Cash Price |
$121.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$120.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$114.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$120.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$114.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$90.17
|
| Rate for Payer: Healthfirst Commercial |
$120.22
|
| Rate for Payer: Healthfirst Essential Plan |
$270.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$114.21
|
| Rate for Payer: Healthfirst QHP |
$120.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$84.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$120.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$102.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$84.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$120.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$90.17
|
| Rate for Payer: SOMOS Essential |
$90.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$120.22
|
|
|
PR NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN
|
Professional
|
Both
|
$428.82
|
|
|
Service Code
|
HCPCS 62320
|
| Min. Negotiated Rate |
$78.95 |
| Max. Negotiated Rate |
$253.75 |
| Rate for Payer: Cash Price |
$114.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$112.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$101.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$101.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$107.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$112.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$107.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$84.58
|
| Rate for Payer: Healthfirst Commercial |
$112.78
|
| Rate for Payer: Healthfirst Essential Plan |
$253.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$107.14
|
| Rate for Payer: Healthfirst QHP |
$112.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$112.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$95.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$112.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$84.58
|
| Rate for Payer: SOMOS Essential |
$84.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$112.78
|
|
|
PR NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN
|
Professional
|
Both
|
$366.59
|
|
|
Service Code
|
HCPCS 62324
|
| Min. Negotiated Rate |
$69.34 |
| Max. Negotiated Rate |
$222.88 |
| Rate for Payer: Cash Price |
$99.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$99.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$89.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$89.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$94.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$99.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$94.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.30
|
| Rate for Payer: Healthfirst Commercial |
$99.06
|
| Rate for Payer: Healthfirst Essential Plan |
$222.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$94.11
|
| Rate for Payer: Healthfirst QHP |
$99.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$69.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$99.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$84.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$69.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$99.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$74.30
|
| Rate for Payer: SOMOS Essential |
$74.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$99.06
|
|
|
PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Professional
|
Both
|
$409.82
|
|
|
Service Code
|
HCPCS 62323
|
| Min. Negotiated Rate |
$77.93 |
| Max. Negotiated Rate |
$250.49 |
| Rate for Payer: Cash Price |
$112.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$111.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$100.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$100.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$105.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$111.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$105.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.50
|
| Rate for Payer: Healthfirst Commercial |
$111.33
|
| Rate for Payer: Healthfirst Essential Plan |
$250.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$105.76
|
| Rate for Payer: Healthfirst QHP |
$111.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$77.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$111.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$94.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$77.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$111.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.50
|
| Rate for Payer: SOMOS Essential |
$83.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.33
|
|
|
PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Professional
|
Both
|
$438.03
|
|
|
Service Code
|
HCPCS 62327
|
| Min. Negotiated Rate |
$84.09 |
| Max. Negotiated Rate |
$270.29 |
| Rate for Payer: Cash Price |
$122.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$120.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$114.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$120.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$114.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$90.10
|
| Rate for Payer: Healthfirst Commercial |
$120.13
|
| Rate for Payer: Healthfirst Essential Plan |
$270.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$114.12
|
| Rate for Payer: Healthfirst QHP |
$120.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$84.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$120.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$102.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$84.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$120.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$90.10
|
| Rate for Payer: SOMOS Essential |
$90.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$120.13
|
|
|
PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN
|
Professional
|
Both
|
$336.81
|
|
|
Service Code
|
HCPCS 62322
|
| Min. Negotiated Rate |
$61.42 |
| Max. Negotiated Rate |
$197.41 |
| Rate for Payer: Cash Price |
$89.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$87.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$78.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$78.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$83.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$87.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$83.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.81
|
| Rate for Payer: Healthfirst Commercial |
$87.74
|
| Rate for Payer: Healthfirst Essential Plan |
$197.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$83.35
|
| Rate for Payer: Healthfirst QHP |
$87.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$61.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$87.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$74.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$61.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$87.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$65.81
|
| Rate for Payer: SOMOS Essential |
$65.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.74
|
|
|
PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN
|
Professional
|
Both
|
$354.27
|
|
|
Service Code
|
HCPCS 62326
|
| Min. Negotiated Rate |
$66.42 |
| Max. Negotiated Rate |
$213.50 |
| Rate for Payer: Cash Price |
$95.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$94.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$85.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$85.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$90.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$94.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$90.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$94.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$94.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$71.17
|
| Rate for Payer: Healthfirst Commercial |
$94.89
|
| Rate for Payer: Healthfirst Essential Plan |
$213.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$90.15
|
| Rate for Payer: Healthfirst QHP |
$94.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$66.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$94.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$80.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$66.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$94.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$71.17
|
| Rate for Payer: SOMOS Essential |
$71.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$94.89
|
|
|
PR NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Professional
|
Both
|
$665.25
|
|
|
Service Code
|
HCPCS 36466
|
| Min. Negotiated Rate |
$121.95 |
| Max. Negotiated Rate |
$391.97 |
| Rate for Payer: Cash Price |
$175.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$174.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$156.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$156.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$165.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$174.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$165.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$130.66
|
| Rate for Payer: Healthfirst Commercial |
$174.21
|
| Rate for Payer: Healthfirst Essential Plan |
$391.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$165.50
|
| Rate for Payer: Healthfirst QHP |
$174.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$121.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$174.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$148.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$121.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$174.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$130.66
|
| Rate for Payer: SOMOS Essential |
$130.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$174.21
|
|
|
PR NJX NONCMPND SCLEROSANT SINGLE INCMPTNT VEIN
|
Professional
|
Both
|
$513.91
|
|
|
Service Code
|
HCPCS 36465
|
| Min. Negotiated Rate |
$96.89 |
| Max. Negotiated Rate |
$311.44 |
| Rate for Payer: Cash Price |
$137.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$138.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$124.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$124.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$138.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$138.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$138.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.81
|
| Rate for Payer: Healthfirst Commercial |
$138.42
|
| Rate for Payer: Healthfirst Essential Plan |
$311.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$131.50
|
| Rate for Payer: Healthfirst QHP |
$138.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$96.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$138.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$117.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$96.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$138.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$103.81
|
| Rate for Payer: SOMOS Essential |
$103.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$138.42
|
|
|
PR NJX PEYRONIE W/SURG EXPOS PLAQUE
|
Professional
|
Both
|
$2,234.33
|
|
|
Service Code
|
HCPCS 54205
|
| Min. Negotiated Rate |
$426.88 |
| Max. Negotiated Rate |
$1,372.12 |
| Rate for Payer: Cash Price |
$614.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$609.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$548.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$548.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$579.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$609.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$579.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$609.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$609.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$457.37
|
| Rate for Payer: Healthfirst Commercial |
$609.83
|
| Rate for Payer: Healthfirst Essential Plan |
$1,372.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$579.34
|
| Rate for Payer: Healthfirst QHP |
$609.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$426.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$609.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$518.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$426.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$609.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$457.37
|
| Rate for Payer: SOMOS Essential |
$457.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$609.83
|
|
|
PR NJX & PLACEMENT CHAIN CONTRAST&/URETHROCSTOGRAPY
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
HCPCS 51605
|
| Min. Negotiated Rate |
$30.41 |
| Max. Negotiated Rate |
$97.76 |
| Rate for Payer: Cash Price |
$44.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.59
|
| Rate for Payer: Healthfirst Commercial |
$43.45
|
| Rate for Payer: Healthfirst Essential Plan |
$97.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.28
|
| Rate for Payer: Healthfirst QHP |
$43.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.59
|
| Rate for Payer: SOMOS Essential |
$32.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.45
|
|
|
PR NJX PX ANTEGRDE NFROSGRM &/URTRGRM EXSTNG ACESS
|
Professional
|
Both
|
$271.36
|
|
|
Service Code
|
HCPCS 50431
|
| Min. Negotiated Rate |
$52.53 |
| Max. Negotiated Rate |
$168.84 |
| Rate for Payer: Cash Price |
$74.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$75.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$75.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$71.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.28
|
| Rate for Payer: Healthfirst Commercial |
$75.04
|
| Rate for Payer: Healthfirst Essential Plan |
$168.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$71.29
|
| Rate for Payer: Healthfirst QHP |
$75.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$75.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$75.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56.28
|
| Rate for Payer: SOMOS Essential |
$56.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.04
|
|
|
PR NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS
|
Professional
|
Both
|
$630.74
|
|
|
Service Code
|
HCPCS 50430
|
| Min. Negotiated Rate |
$119.32 |
| Max. Negotiated Rate |
$383.54 |
| Rate for Payer: Cash Price |
$171.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$170.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$153.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$161.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$170.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$161.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$170.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$127.84
|
| Rate for Payer: Healthfirst Commercial |
$170.46
|
| Rate for Payer: Healthfirst Essential Plan |
$383.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$161.94
|
| Rate for Payer: Healthfirst QHP |
$170.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$119.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$170.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$144.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$119.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$170.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$127.84
|
| Rate for Payer: SOMOS Essential |
$127.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$170.46
|
|
