|
PR PERQ P-ART REVSC ST 1ST NML NATIVE CONNJ BI
|
Professional
|
Both
|
$3,338.83
|
|
|
Service Code
|
HCPCS 33901
|
| Min. Negotiated Rate |
$628.73 |
| Max. Negotiated Rate |
$2,020.93 |
| Rate for Payer: Cash Price |
$874.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$898.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$808.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$808.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$853.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$898.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$853.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$898.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$898.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$673.64
|
| Rate for Payer: Healthfirst Commercial |
$898.19
|
| Rate for Payer: Healthfirst Essential Plan |
$2,020.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$853.28
|
| Rate for Payer: Healthfirst QHP |
$898.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$628.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$898.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$763.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$628.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$898.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$673.64
|
| Rate for Payer: SOMOS Essential |
$673.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$898.19
|
|
|
PR PERQ P-ART REVSC ST 1ST NML NATIVE CONNJ UNI
|
Professional
|
Both
|
$2,541.32
|
|
|
Service Code
|
HCPCS 33900
|
| Min. Negotiated Rate |
$478.11 |
| Max. Negotiated Rate |
$1,536.77 |
| Rate for Payer: Cash Price |
$665.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$683.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$614.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$614.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$648.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$683.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$648.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$683.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$683.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$512.26
|
| Rate for Payer: Healthfirst Commercial |
$683.01
|
| Rate for Payer: Healthfirst Essential Plan |
$1,536.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$648.86
|
| Rate for Payer: Healthfirst QHP |
$683.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$478.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$683.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$580.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$478.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$683.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$512.26
|
| Rate for Payer: SOMOS Essential |
$512.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$683.01
|
|
|
PR PERQ P-ART REVSC ST EA ADDL VSL/SEP LES NM/ABNL
|
Professional
|
Both
|
$1,278.10
|
|
|
Service Code
|
HCPCS 33904
|
| Min. Negotiated Rate |
$239.93 |
| Max. Negotiated Rate |
$771.21 |
| Rate for Payer: Cash Price |
$334.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$342.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$308.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$308.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$325.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$342.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$325.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$342.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$342.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$257.07
|
| Rate for Payer: Healthfirst Commercial |
$342.76
|
| Rate for Payer: Healthfirst Essential Plan |
$771.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$325.62
|
| Rate for Payer: Healthfirst QHP |
$342.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$239.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$342.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$291.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$239.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$342.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$257.07
|
| Rate for Payer: SOMOS Essential |
$257.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$342.76
|
|
|
PR PERQ PERICARDIAL DRG W/INSJ NDWELLG CATH W/CT
|
Professional
|
Both
|
$882.14
|
|
|
Service Code
|
HCPCS 33019
|
| Min. Negotiated Rate |
$162.04 |
| Max. Negotiated Rate |
$520.83 |
| Rate for Payer: Cash Price |
$234.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$208.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$208.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$231.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$173.61
|
| Rate for Payer: Healthfirst Commercial |
$231.48
|
| Rate for Payer: Healthfirst Essential Plan |
$520.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$219.91
|
| Rate for Payer: Healthfirst QHP |
$231.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$162.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$196.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$162.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$173.61
|
| Rate for Payer: SOMOS Essential |
$173.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.48
|
|
|
PR PERQ PRCRD DRG 0-5YR/ANY AGE W/CGEN CAR ANOMALY
|
Professional
|
Both
|
$1,271.90
|
|
|
Service Code
|
HCPCS 33018
|
| Min. Negotiated Rate |
$234.84 |
| Max. Negotiated Rate |
$754.85 |
| Rate for Payer: Cash Price |
$337.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$335.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$301.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$301.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$318.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$335.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$318.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$335.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$335.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$251.62
|
| Rate for Payer: Healthfirst Commercial |
$335.49
|
| Rate for Payer: Healthfirst Essential Plan |
$754.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$318.72
|
| Rate for Payer: Healthfirst QHP |
$335.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$234.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$335.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$285.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$234.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$335.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$251.62
|
| Rate for Payer: SOMOS Essential |
$251.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$335.49
|
|
|
PR PERQ PRCRD DRG 6YR+ W/O CONGENITAL CAR ANOMALY
|
Professional
|
Both
|
$1,076.78
|
|
|
Service Code
|
HCPCS 33017
|
| Min. Negotiated Rate |
$199.29 |
| Max. Negotiated Rate |
$640.58 |
| Rate for Payer: Cash Price |
$288.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$284.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$256.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$256.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$270.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$284.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$270.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$284.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$284.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$213.53
|
| Rate for Payer: Healthfirst Commercial |
$284.70
|
| Rate for Payer: Healthfirst Essential Plan |
$640.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$270.46
|
| Rate for Payer: Healthfirst QHP |
$284.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$199.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$284.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$242.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$199.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$284.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$213.53
|
| Rate for Payer: SOMOS Essential |
$213.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$284.70
|
|
|
PR PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC
|
Professional
|
Both
|
$158.41
|
|
|
Service Code
|
HCPCS 43762
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$98.21 |
| Rate for Payer: Cash Price |
$43.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.74
|
| Rate for Payer: Healthfirst Commercial |
$43.65
|
| Rate for Payer: Healthfirst Essential Plan |
$98.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.47
|
| Rate for Payer: Healthfirst QHP |
$43.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.74
|
| Rate for Payer: SOMOS Essential |
$32.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.65
|
|
|
PR PERQ REPLACEMENT GTUBE REQ REVJ GSTRST TRC
|
Professional
|
Both
|
$381.29
|
|
|
Service Code
|
HCPCS 43763
|
| Min. Negotiated Rate |
$71.66 |
| Max. Negotiated Rate |
$230.33 |
| Rate for Payer: Cash Price |
$102.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$102.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$92.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$97.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$102.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$97.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$76.78
|
| Rate for Payer: Healthfirst Commercial |
$102.37
|
| Rate for Payer: Healthfirst Essential Plan |
$230.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$97.25
|
| Rate for Payer: Healthfirst QHP |
$102.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$71.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$102.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$87.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$71.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$76.78
|
| Rate for Payer: SOMOS Essential |
$76.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.37
|
|
|
PR PERQ SKEL FIXJ DISTAL RADIAL FX/EPIPHYSL SEP
|
Professional
|
Both
|
$2,966.01
|
|
|
Service Code
|
HCPCS 25606
|
| Min. Negotiated Rate |
$563.33 |
| Max. Negotiated Rate |
$1,810.71 |
| Rate for Payer: Cash Price |
$807.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$804.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$724.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$724.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$764.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$804.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$764.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$804.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$804.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$603.57
|
| Rate for Payer: Healthfirst Commercial |
$804.76
|
| Rate for Payer: Healthfirst Essential Plan |
$1,810.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$764.52
|
| Rate for Payer: Healthfirst QHP |
$804.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$563.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$804.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$684.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$563.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$804.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$603.57
|
| Rate for Payer: SOMOS Essential |
$603.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$804.76
|
|
|
PR PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT
|
Professional
|
Both
|
$2,136.96
|
|
|
Service Code
|
HCPCS 36906
|
| Min. Negotiated Rate |
$397.42 |
| Max. Negotiated Rate |
$1,277.41 |
| Rate for Payer: Cash Price |
$572.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$567.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$510.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$510.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$539.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$567.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$539.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$567.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$567.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$425.81
|
| Rate for Payer: Healthfirst Commercial |
$567.74
|
| Rate for Payer: Healthfirst Essential Plan |
$1,277.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$539.35
|
| Rate for Payer: Healthfirst QHP |
$567.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$397.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$567.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$482.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$397.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$567.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$425.81
|
| Rate for Payer: SOMOS Essential |
$425.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$567.74
|
|
|
PR PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP
|
Professional
|
Both
|
$1,844.99
|
|
|
Service Code
|
HCPCS 36905
|
| Min. Negotiated Rate |
$344.64 |
| Max. Negotiated Rate |
$1,107.77 |
| Rate for Payer: Cash Price |
$494.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$492.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$443.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$443.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$467.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$492.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$467.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$492.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$492.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$369.25
|
| Rate for Payer: Healthfirst Commercial |
$492.34
|
| Rate for Payer: Healthfirst Essential Plan |
$1,107.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$467.72
|
| Rate for Payer: Healthfirst QHP |
$492.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$344.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$492.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$418.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$344.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$492.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$369.25
|
| Rate for Payer: SOMOS Essential |
$369.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$492.34
|
|
|
PR PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH
|
Professional
|
Both
|
$1,543.92
|
|
|
Service Code
|
HCPCS 36904
|
| Min. Negotiated Rate |
$287.15 |
| Max. Negotiated Rate |
$922.97 |
| Rate for Payer: Cash Price |
$414.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$410.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$369.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$369.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$389.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$410.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$389.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$410.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$410.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$307.66
|
| Rate for Payer: Healthfirst Commercial |
$410.21
|
| Rate for Payer: Healthfirst Essential Plan |
$922.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$389.70
|
| Rate for Payer: Healthfirst QHP |
$410.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$287.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$410.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$348.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$287.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$410.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$307.66
|
| Rate for Payer: SOMOS Essential |
$307.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$410.21
|
|
|
PR PERQ TRANSCATH CLS PARAVALVR LEAK 1 AORTIC VALVE
|
Professional
|
Both
|
$3,545.96
|
|
|
Service Code
|
HCPCS 93591
|
| Min. Negotiated Rate |
$565.17 |
| Max. Negotiated Rate |
$2,170.03 |
| Rate for Payer: Amida Care Medicaid |
$565.17
|
| Rate for Payer: Cash Price |
$961.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$964.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$868.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$868.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$916.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$964.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$916.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$964.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$964.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$723.35
|
| Rate for Payer: Healthfirst Commercial |
$964.46
|
| Rate for Payer: Healthfirst Essential Plan |
$2,170.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$916.24
|
| Rate for Payer: Healthfirst QHP |
$964.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$675.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$964.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$819.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$675.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$964.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$723.35
|
| Rate for Payer: SOMOS Essential |
$723.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$964.46
|
|
|
PR PERQ TRANSCATH CLS PARAVALVR LEAK 1 MITRAL VALVE
|
Professional
|
Both
|
$4,320.82
|
|
|
Service Code
|
HCPCS 93590
|
| Min. Negotiated Rate |
$680.90 |
| Max. Negotiated Rate |
$2,613.42 |
| Rate for Payer: Amida Care Medicaid |
$680.90
|
| Rate for Payer: Cash Price |
$1,173.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,161.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,045.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,045.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,103.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,161.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,103.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,161.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,161.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$871.14
|
| Rate for Payer: Healthfirst Commercial |
$1,161.52
|
| Rate for Payer: Healthfirst Essential Plan |
$2,613.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,103.44
|
| Rate for Payer: Healthfirst QHP |
$1,161.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$813.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,161.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$987.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$813.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,161.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$871.14
|
| Rate for Payer: SOMOS Essential |
$871.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,161.52
|
|
|
PR PERQ TRANSCATH CLS PARAVALVR LEAK EACH OCCLS DEV
|
Professional
|
Both
|
$1,572.27
|
|
|
Service Code
|
HCPCS 93592
|
| Min. Negotiated Rate |
$244.03 |
| Max. Negotiated Rate |
$936.23 |
| Rate for Payer: Amida Care Medicaid |
$244.03
|
| Rate for Payer: Cash Price |
$419.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$416.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$374.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$374.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$395.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$416.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$395.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$416.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$416.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$312.07
|
| Rate for Payer: Healthfirst Commercial |
$416.10
|
| Rate for Payer: Healthfirst Essential Plan |
$936.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$395.30
|
| Rate for Payer: Healthfirst QHP |
$416.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$291.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$416.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$353.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$291.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$416.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$312.07
|
| Rate for Payer: SOMOS Essential |
$312.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$416.10
|
|
|
PR PERQ TRANSLUMINAL ANGIOPLASTY NATIVE/RECR COA
|
Professional
|
Both
|
$2,551.99
|
|
|
Service Code
|
HCPCS 33897
|
| Min. Negotiated Rate |
$468.47 |
| Max. Negotiated Rate |
$1,505.79 |
| Rate for Payer: Cash Price |
$677.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$669.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$602.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$602.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$635.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$669.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$635.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$669.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$669.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$501.93
|
| Rate for Payer: Healthfirst Commercial |
$669.24
|
| Rate for Payer: Healthfirst Essential Plan |
$1,505.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$635.78
|
| Rate for Payer: Healthfirst QHP |
$669.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$468.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$669.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$568.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$468.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$669.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$501.93
|
| Rate for Payer: SOMOS Essential |
$501.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$669.24
|
|
|
PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION
|
Professional
|
Both
|
$2,225.55
|
|
|
Service Code
|
HCPCS 22513
|
| Min. Negotiated Rate |
$413.36 |
| Max. Negotiated Rate |
$1,328.65 |
| Rate for Payer: Cash Price |
$597.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$590.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$531.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$531.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$560.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$590.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$560.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$590.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$590.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$442.88
|
| Rate for Payer: Healthfirst Commercial |
$590.51
|
| Rate for Payer: Healthfirst Essential Plan |
$1,328.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$560.98
|
| Rate for Payer: Healthfirst QHP |
$590.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$413.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$590.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$501.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$413.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$590.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$442.88
|
| Rate for Payer: SOMOS Essential |
$442.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$590.51
|
|
|
PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH
|
Professional
|
Both
|
$957.22
|
|
|
Service Code
|
HCPCS 22515
|
| Min. Negotiated Rate |
$176.72 |
| Max. Negotiated Rate |
$568.03 |
| Rate for Payer: Cash Price |
$254.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$252.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$227.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$227.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$239.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$252.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$239.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$252.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$252.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$189.34
|
| Rate for Payer: Healthfirst Commercial |
$252.46
|
| Rate for Payer: Healthfirst Essential Plan |
$568.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$239.84
|
| Rate for Payer: Healthfirst QHP |
$252.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$176.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$252.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$214.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$176.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$252.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$189.34
|
| Rate for Payer: SOMOS Essential |
$189.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$252.46
|
|
|
PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR
|
Professional
|
Both
|
$2,075.57
|
|
|
Service Code
|
HCPCS 22514
|
| Min. Negotiated Rate |
$386.43 |
| Max. Negotiated Rate |
$1,242.09 |
| Rate for Payer: Cash Price |
$556.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$552.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$496.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$496.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$524.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$552.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$524.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$552.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$552.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$414.03
|
| Rate for Payer: Healthfirst Commercial |
$552.04
|
| Rate for Payer: Healthfirst Essential Plan |
$1,242.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$524.44
|
| Rate for Payer: Healthfirst QHP |
$552.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$386.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$552.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$469.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$386.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$552.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$414.03
|
| Rate for Payer: SOMOS Essential |
$414.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$552.04
|
|
|
PR PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL
|
Professional
|
Both
|
$1,726.17
|
|
|
Service Code
|
HCPCS 22511
|
| Min. Negotiated Rate |
$325.01 |
| Max. Negotiated Rate |
$1,044.67 |
| Rate for Payer: Cash Price |
$467.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$464.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$417.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$417.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$441.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$464.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$441.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$464.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$464.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$348.23
|
| Rate for Payer: Healthfirst Commercial |
$464.30
|
| Rate for Payer: Healthfirst Essential Plan |
$1,044.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$441.08
|
| Rate for Payer: Healthfirst QHP |
$464.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$325.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$464.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$394.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$325.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$464.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$348.23
|
| Rate for Payer: SOMOS Essential |
$348.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$464.30
|
|
|
PR PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC
|
Professional
|
Both
|
$1,840.86
|
|
|
Service Code
|
HCPCS 22510
|
| Min. Negotiated Rate |
$345.09 |
| Max. Negotiated Rate |
$1,109.23 |
| Rate for Payer: Cash Price |
$495.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$492.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$443.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$443.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$468.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$492.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$468.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$492.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$492.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$369.74
|
| Rate for Payer: Healthfirst Commercial |
$492.99
|
| Rate for Payer: Healthfirst Essential Plan |
$1,109.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$468.34
|
| Rate for Payer: Healthfirst QHP |
$492.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$345.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$492.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$419.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$345.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$492.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$369.74
|
| Rate for Payer: SOMOS Essential |
$369.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$492.99
|
|
|
PR PETROUS APICECTOMY RADICAL MASTOIDECTOMY
|
Professional
|
Both
|
$7,270.55
|
|
|
Service Code
|
HCPCS 69530
|
| Min. Negotiated Rate |
$1,359.97 |
| Max. Negotiated Rate |
$4,371.32 |
| Rate for Payer: Cash Price |
$1,958.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,942.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,748.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,748.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,845.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,942.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,845.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,942.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,942.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,457.11
|
| Rate for Payer: Healthfirst Commercial |
$1,942.81
|
| Rate for Payer: Healthfirst Essential Plan |
$4,371.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,845.67
|
| Rate for Payer: Healthfirst QHP |
$1,942.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,359.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,942.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,651.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,359.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,942.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,457.11
|
| Rate for Payer: SOMOS Essential |
$1,457.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,942.81
|
|
|
PR PHALANGECTOMY TOE EACH TOE
|
Professional
|
Both
|
$1,166.80
|
|
|
Service Code
|
HCPCS 28150
|
| Min. Negotiated Rate |
$226.30 |
| Max. Negotiated Rate |
$727.40 |
| Rate for Payer: Cash Price |
$323.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$323.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$290.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$290.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$307.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$323.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$307.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$323.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$323.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$242.47
|
| Rate for Payer: Healthfirst Commercial |
$323.29
|
| Rate for Payer: Healthfirst Essential Plan |
$727.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$307.13
|
| Rate for Payer: Healthfirst QHP |
$323.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$226.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$323.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$274.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$226.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$323.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$242.47
|
| Rate for Payer: SOMOS Essential |
$242.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$323.29
|
|
|
PR PHARYNGOESOPHAGEAL REPAIR
|
Professional
|
Both
|
$4,144.07
|
|
|
Service Code
|
HCPCS 42953
|
| Min. Negotiated Rate |
$777.03 |
| Max. Negotiated Rate |
$2,497.61 |
| Rate for Payer: Cash Price |
$1,120.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,110.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$999.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$999.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,054.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,110.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,054.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,110.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,110.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$832.54
|
| Rate for Payer: Healthfirst Commercial |
$1,110.05
|
| Rate for Payer: Healthfirst Essential Plan |
$2,497.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,054.55
|
| Rate for Payer: Healthfirst QHP |
$1,110.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$777.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,110.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$943.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$777.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,110.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$832.54
|
| Rate for Payer: SOMOS Essential |
$832.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,110.05
|
|
|
PR PHARYNGOLARYNGECTOMY W/RAD NECK DSJ W/O RCNSTJ
|
Professional
|
Both
|
$12,059.92
|
|
|
Service Code
|
HCPCS 31390
|
| Min. Negotiated Rate |
$2,244.48 |
| Max. Negotiated Rate |
$7,214.40 |
| Rate for Payer: Cash Price |
$3,250.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,206.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,885.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,885.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,046.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,206.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,046.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,206.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,206.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,404.80
|
| Rate for Payer: Healthfirst Commercial |
$3,206.40
|
| Rate for Payer: Healthfirst Essential Plan |
$7,214.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,046.08
|
| Rate for Payer: Healthfirst QHP |
$3,206.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,244.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,206.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,725.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,244.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,206.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,404.80
|
| Rate for Payer: SOMOS Essential |
$2,404.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,206.40
|
|
