|
PR PRQ SKEL FIXJ TALOTARSAL JT DISLC W/MANJ
|
Professional
|
Both
|
$1,717.80
|
|
|
Service Code
|
HCPCS 28576
|
| Min. Negotiated Rate |
$331.20 |
| Max. Negotiated Rate |
$1,064.57 |
| Rate for Payer: Cash Price |
$471.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$473.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$425.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$425.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$449.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$473.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$449.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$473.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$473.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$354.86
|
| Rate for Payer: Healthfirst Commercial |
$473.14
|
| Rate for Payer: Healthfirst Essential Plan |
$1,064.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$449.48
|
| Rate for Payer: Healthfirst QHP |
$473.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$331.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$473.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$402.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$331.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$473.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$354.86
|
| Rate for Payer: SOMOS Essential |
$354.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$473.14
|
|
|
PR PRQ SKEL FIXJ TARS JT DISLC W/MANJ
|
Professional
|
Both
|
$1,683.99
|
|
|
Service Code
|
HCPCS 28606
|
| Min. Negotiated Rate |
$332.81 |
| Max. Negotiated Rate |
$1,069.76 |
| Rate for Payer: Cash Price |
$469.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$475.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$427.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$427.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$451.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$475.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$451.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$475.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$475.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$356.59
|
| Rate for Payer: Healthfirst Commercial |
$475.45
|
| Rate for Payer: Healthfirst Essential Plan |
$1,069.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$451.68
|
| Rate for Payer: Healthfirst QHP |
$475.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$332.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$475.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$404.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$332.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$475.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$356.59
|
| Rate for Payer: SOMOS Essential |
$356.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$475.45
|
|
|
PR PRQ SKEL FIXJ TARSL DISLC XCP TALOTARSAL W/MANJ
|
Professional
|
Both
|
$1,557.92
|
|
|
Service Code
|
HCPCS 28546
|
| Min. Negotiated Rate |
$299.92 |
| Max. Negotiated Rate |
$964.03 |
| Rate for Payer: Cash Price |
$429.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$428.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$385.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$385.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$407.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$428.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$407.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$428.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$428.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$321.35
|
| Rate for Payer: Healthfirst Commercial |
$428.46
|
| Rate for Payer: Healthfirst Essential Plan |
$964.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$407.04
|
| Rate for Payer: Healthfirst QHP |
$428.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$299.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$428.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$364.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$299.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$428.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$321.35
|
| Rate for Payer: SOMOS Essential |
$321.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$428.46
|
|
|
PR PRQ SKEL FIXJ TARSL FX XCP TALUS&CALCNS W/MANJ
|
Professional
|
Both
|
$1,646.79
|
|
|
Service Code
|
HCPCS 28456
|
| Min. Negotiated Rate |
$311.86 |
| Max. Negotiated Rate |
$1,002.42 |
| Rate for Payer: Cash Price |
$448.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$445.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$400.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$400.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$423.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$445.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$423.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$445.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$445.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$334.14
|
| Rate for Payer: Healthfirst Commercial |
$445.52
|
| Rate for Payer: Healthfirst Essential Plan |
$1,002.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$423.24
|
| Rate for Payer: Healthfirst QHP |
$445.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$311.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$445.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$378.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$311.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$445.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$334.14
|
| Rate for Payer: SOMOS Essential |
$334.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$445.52
|
|
|
PR PRQ TCAT CLSR CGEN INTRATRL COMUNICAJ W/IMPLT
|
Professional
|
Both
|
$4,256.49
|
|
|
Service Code
|
HCPCS 93580
|
| Min. Negotiated Rate |
$506.18 |
| Max. Negotiated Rate |
$2,523.33 |
| Rate for Payer: Amida Care Medicaid |
$506.18
|
| Rate for Payer: Cash Price |
$1,135.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,121.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,009.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,009.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,065.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,121.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,065.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,121.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,121.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$841.11
|
| Rate for Payer: Healthfirst Commercial |
$1,121.48
|
| Rate for Payer: Healthfirst Essential Plan |
$2,523.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,065.41
|
| Rate for Payer: Healthfirst QHP |
$1,121.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$785.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,121.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$953.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$785.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,121.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$841.11
|
| Rate for Payer: SOMOS Essential |
$841.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,121.48
|
|
|
PR PRQ TCAT CLSR CGEN VENTR SEPTAL DFCT W/IMPLT
|
Professional
|
Both
|
$5,806.01
|
|
|
Service Code
|
HCPCS 93581
|
| Min. Negotiated Rate |
$668.54 |
| Max. Negotiated Rate |
$3,438.41 |
| Rate for Payer: Amida Care Medicaid |
$668.54
|
| Rate for Payer: Cash Price |
$1,544.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,528.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,375.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,375.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,451.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,528.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,451.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,528.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,528.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,146.13
|
| Rate for Payer: Healthfirst Commercial |
$1,528.18
|
| Rate for Payer: Healthfirst Essential Plan |
$3,438.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,451.77
|
| Rate for Payer: Healthfirst QHP |
$1,528.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,069.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,528.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,298.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,069.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,528.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,146.13
|
| Rate for Payer: SOMOS Essential |
$1,146.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,528.18
|
|
|
PR PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING
|
Professional
|
Both
|
$1,270.61
|
|
|
Service Code
|
HCPCS 37197
|
| Min. Negotiated Rate |
$236.58 |
| Max. Negotiated Rate |
$760.43 |
| Rate for Payer: Cash Price |
$341.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$337.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$304.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$304.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$321.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$337.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$321.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$337.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$337.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$253.48
|
| Rate for Payer: Healthfirst Commercial |
$337.97
|
| Rate for Payer: Healthfirst Essential Plan |
$760.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$321.07
|
| Rate for Payer: Healthfirst QHP |
$337.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$236.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$337.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$287.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$236.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$337.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$253.48
|
| Rate for Payer: SOMOS Essential |
$253.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$337.97
|
|
|
PR PRQ TRANSLUMINAL CORONARY MECHANICL THROMBECTOMY
|
Professional
|
Both
|
$768.81
|
|
|
Service Code
|
HCPCS 92973
|
| Min. Negotiated Rate |
$92.20 |
| Max. Negotiated Rate |
$455.33 |
| Rate for Payer: Amida Care Medicaid |
$92.20
|
| Rate for Payer: Cash Price |
$205.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$202.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$182.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$182.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$192.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$202.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$192.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$202.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$151.78
|
| Rate for Payer: Healthfirst Commercial |
$202.37
|
| Rate for Payer: Healthfirst Essential Plan |
$455.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$192.25
|
| Rate for Payer: Healthfirst QHP |
$202.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$141.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$202.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$172.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$141.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$202.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$151.78
|
| Rate for Payer: SOMOS Essential |
$151.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$202.37
|
|
|
PR PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN
|
Professional
|
Both
|
$1,656.27
|
|
|
Service Code
|
HCPCS 37187
|
| Min. Negotiated Rate |
$309.95 |
| Max. Negotiated Rate |
$996.25 |
| Rate for Payer: Cash Price |
$445.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$442.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$398.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$398.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$420.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$442.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$420.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$442.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$442.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$332.08
|
| Rate for Payer: Healthfirst Commercial |
$442.78
|
| Rate for Payer: Healthfirst Essential Plan |
$996.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$420.64
|
| Rate for Payer: Healthfirst QHP |
$442.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$309.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$442.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$376.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$309.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$442.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$332.08
|
| Rate for Payer: SOMOS Essential |
$332.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$442.78
|
|
|
PR PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH
|
Professional
|
Both
|
$2,766.61
|
|
|
Service Code
|
HCPCS 92924
|
| Min. Negotiated Rate |
$337.45 |
| Max. Negotiated Rate |
$1,632.60 |
| Rate for Payer: Amida Care Medicaid |
$337.45
|
| Rate for Payer: Cash Price |
$734.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$725.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$653.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$653.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$689.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$725.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$689.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$725.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$725.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$544.20
|
| Rate for Payer: Healthfirst Commercial |
$725.60
|
| Rate for Payer: Healthfirst Essential Plan |
$1,632.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$689.32
|
| Rate for Payer: Healthfirst QHP |
$725.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$507.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$725.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$616.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$507.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$725.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$544.20
|
| Rate for Payer: SOMOS Essential |
$544.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$725.60
|
|
|
PR PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH
|
Professional
|
Both
|
$211.00
|
|
|
Service Code
|
HCPCS 92921
|
| Min. Negotiated Rate |
$70.96 |
| Max. Negotiated Rate |
$70.96 |
| Rate for Payer: Amida Care Medicaid |
$70.96
|
|
|
PR PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH
|
Professional
|
Both
|
$2,310.60
|
|
|
Service Code
|
HCPCS 92920
|
| Min. Negotiated Rate |
$283.83 |
| Max. Negotiated Rate |
$1,370.92 |
| Rate for Payer: Amida Care Medicaid |
$283.83
|
| Rate for Payer: Cash Price |
$615.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$609.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$548.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$548.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$578.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$609.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$578.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$609.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$609.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$456.98
|
| Rate for Payer: Healthfirst Commercial |
$609.30
|
| Rate for Payer: Healthfirst Essential Plan |
$1,370.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$578.84
|
| Rate for Payer: Healthfirst QHP |
$609.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$426.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$609.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$517.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$426.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$609.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$456.98
|
| Rate for Payer: SOMOS Essential |
$456.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$609.30
|
|
|
PR PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL
|
Professional
|
Both
|
$2,578.17
|
|
|
Service Code
|
HCPCS 92937
|
| Min. Negotiated Rate |
$314.90 |
| Max. Negotiated Rate |
$1,521.36 |
| Rate for Payer: Amida Care Medicaid |
$314.90
|
| Rate for Payer: Cash Price |
$685.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$676.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$608.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$608.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$642.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$676.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$642.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$676.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$676.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$507.12
|
| Rate for Payer: Healthfirst Commercial |
$676.16
|
| Rate for Payer: Healthfirst Essential Plan |
$1,521.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$642.35
|
| Rate for Payer: Healthfirst QHP |
$676.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$473.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$676.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$574.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$473.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$676.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$507.12
|
| Rate for Payer: SOMOS Essential |
$507.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$676.16
|
|
|
PR PRQ TRLUML CORONARY STENT/ATH/ANGIO ADDL BRANCH
|
Professional
|
Both
|
$722.86
|
|
|
Service Code
|
HCPCS 92934
|
| Min. Negotiated Rate |
$88.13 |
| Max. Negotiated Rate |
$88.13 |
| Rate for Payer: Amida Care Medicaid |
$88.13
|
|
|
PR PRQ TRLUML CORONARY STENT W/ANGIO ADDL ART/BRNCH
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS 92929
|
| Min. Negotiated Rate |
$78.81 |
| Max. Negotiated Rate |
$78.81 |
| Rate for Payer: Amida Care Medicaid |
$78.81
|
|
|
PR PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH
|
Professional
|
Both
|
$2,580.83
|
|
|
Service Code
|
HCPCS 92928
|
| Min. Negotiated Rate |
$315.25 |
| Max. Negotiated Rate |
$1,522.15 |
| Rate for Payer: Amida Care Medicaid |
$315.25
|
| Rate for Payer: Cash Price |
$684.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$676.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$608.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$608.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$642.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$676.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$642.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$676.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$676.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$507.38
|
| Rate for Payer: Healthfirst Commercial |
$676.51
|
| Rate for Payer: Healthfirst Essential Plan |
$1,522.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$642.68
|
| Rate for Payer: Healthfirst QHP |
$676.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$473.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$676.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$575.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$473.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$676.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$507.38
|
| Rate for Payer: SOMOS Essential |
$507.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$676.51
|
|
|
PR PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL
|
Professional
|
Both
|
$2,898.14
|
|
|
Service Code
|
HCPCS 92943
|
| Min. Negotiated Rate |
$354.49 |
| Max. Negotiated Rate |
$1,711.46 |
| Rate for Payer: Amida Care Medicaid |
$354.49
|
| Rate for Payer: Cash Price |
$768.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$760.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$684.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$684.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$722.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$760.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$722.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$760.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$760.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$570.49
|
| Rate for Payer: Healthfirst Commercial |
$760.65
|
| Rate for Payer: Healthfirst Essential Plan |
$1,711.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$722.62
|
| Rate for Payer: Healthfirst QHP |
$760.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$532.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$760.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$646.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$532.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$760.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$570.49
|
| Rate for Payer: SOMOS Essential |
$570.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$760.65
|
|
|
PR PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE ART/BRNCH
|
Professional
|
Both
|
$2,891.46
|
|
|
Service Code
|
HCPCS 92933
|
| Min. Negotiated Rate |
$352.53 |
| Max. Negotiated Rate |
$1,709.91 |
| Rate for Payer: Amida Care Medicaid |
$352.53
|
| Rate for Payer: Cash Price |
$768.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$759.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$683.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$683.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$721.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$759.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$721.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$759.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$759.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$569.97
|
| Rate for Payer: Healthfirst Commercial |
$759.96
|
| Rate for Payer: Healthfirst Essential Plan |
$1,709.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$721.96
|
| Rate for Payer: Healthfirst QHP |
$759.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$531.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$759.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$645.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$531.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$759.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$569.97
|
| Rate for Payer: SOMOS Essential |
$569.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$759.96
|
|
|
PR PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL
|
Professional
|
Both
|
$2,891.39
|
|
|
Service Code
|
HCPCS 92941
|
| Min. Negotiated Rate |
$354.49 |
| Max. Negotiated Rate |
$1,710.94 |
| Rate for Payer: Amida Care Medicaid |
$354.49
|
| Rate for Payer: Cash Price |
$768.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$760.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$684.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$684.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$722.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$760.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$722.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$760.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$760.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$570.32
|
| Rate for Payer: Healthfirst Commercial |
$760.42
|
| Rate for Payer: Healthfirst Essential Plan |
$1,710.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$722.40
|
| Rate for Payer: Healthfirst QHP |
$760.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$532.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$760.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$646.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$532.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$760.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$570.32
|
| Rate for Payer: SOMOS Essential |
$570.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$760.42
|
|
|
PR PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX
|
Professional
|
Both
|
$1,193.05
|
|
|
Service Code
|
HCPCS 37188
|
| Min. Negotiated Rate |
$224.06 |
| Max. Negotiated Rate |
$720.20 |
| Rate for Payer: Cash Price |
$320.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$320.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$288.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$288.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$320.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$320.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$320.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$240.07
|
| Rate for Payer: Healthfirst Commercial |
$320.09
|
| Rate for Payer: Healthfirst Essential Plan |
$720.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$304.09
|
| Rate for Payer: Healthfirst QHP |
$320.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$224.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$320.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$272.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$224.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$320.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$240.07
|
| Rate for Payer: SOMOS Essential |
$240.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$320.09
|
|
|
PR PRQ TRLUML PULMONARY ART BALLOON ANGIOP 1 VSL
|
Professional
|
Both
|
$2,757.16
|
|
|
Service Code
|
HCPCS 92997
|
| Min. Negotiated Rate |
$321.45 |
| Max. Negotiated Rate |
$1,620.36 |
| Rate for Payer: Amida Care Medicaid |
$321.45
|
| Rate for Payer: Cash Price |
$729.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$720.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$648.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$648.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$684.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$720.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$684.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$720.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$720.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$540.12
|
| Rate for Payer: Healthfirst Commercial |
$720.16
|
| Rate for Payer: Healthfirst Essential Plan |
$1,620.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$684.15
|
| Rate for Payer: Healthfirst QHP |
$720.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$504.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$720.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$612.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$504.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$720.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$540.12
|
| Rate for Payer: SOMOS Essential |
$540.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$720.16
|
|
|
PR PRQ TRLUML PULMONARY ART BALLOON ANGIOP EA VSL
|
Professional
|
Both
|
$1,385.37
|
|
|
Service Code
|
HCPCS 92998
|
| Min. Negotiated Rate |
$161.93 |
| Max. Negotiated Rate |
$822.74 |
| Rate for Payer: Amida Care Medicaid |
$161.93
|
| Rate for Payer: Cash Price |
$369.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$365.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$329.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$329.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$347.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$365.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$347.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$365.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$365.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$274.25
|
| Rate for Payer: Healthfirst Commercial |
$365.66
|
| Rate for Payer: Healthfirst Essential Plan |
$822.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$347.38
|
| Rate for Payer: Healthfirst QHP |
$365.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$255.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$365.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$310.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$255.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$365.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$274.25
|
| Rate for Payer: SOMOS Essential |
$274.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$365.66
|
|
|
PR PRTL ESOPHAGECTOMY CERVICAL W/FREE INTSTINAL GRF
|
Professional
|
Both
|
$22,143.38
|
|
|
Service Code
|
HCPCS 43116
|
| Min. Negotiated Rate |
$4,059.52 |
| Max. Negotiated Rate |
$13,048.47 |
| Rate for Payer: Cash Price |
$5,867.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,799.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5,219.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,219.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,509.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,799.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,509.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,799.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,799.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4,349.49
|
| Rate for Payer: Healthfirst Commercial |
$5,799.32
|
| Rate for Payer: Healthfirst Essential Plan |
$13,048.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,509.35
|
| Rate for Payer: Healthfirst QHP |
$5,799.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$4,059.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5,799.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4,929.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$4,059.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,799.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,349.49
|
| Rate for Payer: SOMOS Essential |
$4,349.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,799.32
|
|
|
PR PRTL ESOPHAGEC W/WO PROX GASTREC/PYLOROPLASTY
|
Professional
|
Both
|
$12,732.65
|
|
|
Service Code
|
HCPCS 43121
|
| Min. Negotiated Rate |
$2,343.82 |
| Max. Negotiated Rate |
$7,533.72 |
| Rate for Payer: Cash Price |
$3,385.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,348.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,013.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,013.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,180.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,348.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,180.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,348.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,348.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,511.24
|
| Rate for Payer: Healthfirst Commercial |
$3,348.32
|
| Rate for Payer: Healthfirst Essential Plan |
$7,533.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,180.90
|
| Rate for Payer: Healthfirst QHP |
$3,348.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,343.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,348.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,846.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,343.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,348.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,511.24
|
| Rate for Payer: SOMOS Essential |
$2,511.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,348.32
|
|
|
PR PRTL ESOPH DSTL W/WO PROX GASTRC W/COLON NTRPSTJ
|
Professional
|
Both
|
$16,151.59
|
|
|
Service Code
|
HCPCS 43118
|
| Min. Negotiated Rate |
$2,964.30 |
| Max. Negotiated Rate |
$9,528.10 |
| Rate for Payer: Cash Price |
$4,283.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,234.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,811.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,811.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,022.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,234.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,022.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,234.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,234.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,176.03
|
| Rate for Payer: Healthfirst Commercial |
$4,234.71
|
| Rate for Payer: Healthfirst Essential Plan |
$9,528.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,022.97
|
| Rate for Payer: Healthfirst QHP |
$4,234.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,964.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,234.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,599.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,964.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,234.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,176.03
|
| Rate for Payer: SOMOS Essential |
$3,176.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,234.71
|
|
