|
PR TOT ESOPHG W/THORCOM W/COLON NTRPSTJ/INT RCNSTJ
|
Professional
|
Both
|
$19,356.61
|
|
|
Service Code
|
HCPCS 43113
|
| Min. Negotiated Rate |
$3,555.02 |
| Max. Negotiated Rate |
$11,426.85 |
| Rate for Payer: Cash Price |
$5,135.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,078.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,570.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,570.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,824.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,078.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,824.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,078.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,078.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,808.95
|
| Rate for Payer: Healthfirst Commercial |
$5,078.60
|
| Rate for Payer: Healthfirst Essential Plan |
$11,426.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,824.67
|
| Rate for Payer: Healthfirst QHP |
$5,078.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,555.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5,078.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4,316.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3,555.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,078.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,808.95
|
| Rate for Payer: SOMOS Essential |
$3,808.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,078.60
|
|
|
PR TOT/PRTL ESPHG W/O RCNSTJ W/CRV ESOPHAGOSTOMY
|
Professional
|
Both
|
$16,961.28
|
|
|
Service Code
|
HCPCS 43124
|
| Min. Negotiated Rate |
$3,119.37 |
| Max. Negotiated Rate |
$10,026.54 |
| Rate for Payer: Cash Price |
$4,504.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,456.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,010.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,010.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,233.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,456.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,233.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,456.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,456.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,342.18
|
| Rate for Payer: Healthfirst Commercial |
$4,456.24
|
| Rate for Payer: Healthfirst Essential Plan |
$10,026.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,233.43
|
| Rate for Payer: Healthfirst QHP |
$4,456.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,119.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,456.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,787.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3,119.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,456.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,342.18
|
| Rate for Payer: SOMOS Essential |
$3,342.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,456.24
|
|
|
PR TRABECULOPLASTY BY LASER SURGERY
|
Professional
|
Both
|
$842.63
|
|
|
Service Code
|
HCPCS 65855
|
| Min. Negotiated Rate |
$160.01 |
| Max. Negotiated Rate |
$514.30 |
| Rate for Payer: Cash Price |
$231.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$228.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$205.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$205.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$217.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$228.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$217.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$228.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$228.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$171.44
|
| Rate for Payer: Healthfirst Commercial |
$228.58
|
| Rate for Payer: Healthfirst Essential Plan |
$514.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$217.15
|
| Rate for Payer: Healthfirst QHP |
$228.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$160.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$228.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$194.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$160.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$228.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$171.44
|
| Rate for Payer: SOMOS Essential |
$171.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$228.58
|
|
|
PR TRABECULOTOMY AB EXTERNO
|
Professional
|
Both
|
$3,474.28
|
|
|
Service Code
|
HCPCS 65850
|
| Min. Negotiated Rate |
$657.54 |
| Max. Negotiated Rate |
$2,113.51 |
| Rate for Payer: Cash Price |
$954.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$939.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$845.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$845.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$892.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$939.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$892.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$939.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$939.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$704.50
|
| Rate for Payer: Healthfirst Commercial |
$939.34
|
| Rate for Payer: Healthfirst Essential Plan |
$2,113.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$892.37
|
| Rate for Payer: Healthfirst QHP |
$939.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$657.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$939.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$798.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$657.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$939.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$704.50
|
| Rate for Payer: SOMOS Essential |
$704.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$939.34
|
|
|
PR TRACHEAL PNXR PRQ W/TRANSTRACHEAL ASPIR&/NJX
|
Professional
|
Both
|
$213.68
|
|
|
Service Code
|
HCPCS 31612
|
| Min. Negotiated Rate |
$39.03 |
| Max. Negotiated Rate |
$125.46 |
| Rate for Payer: Cash Price |
$55.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$55.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$52.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.82
|
| Rate for Payer: Healthfirst Commercial |
$55.76
|
| Rate for Payer: Healthfirst Essential Plan |
$125.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.97
|
| Rate for Payer: Healthfirst QHP |
$55.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$55.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.82
|
| Rate for Payer: SOMOS Essential |
$41.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.76
|
|
|
PR TRACHELECTOMY CERVICECTOMY AMP CERVIX SPX
|
Professional
|
Both
|
$1,631.49
|
|
|
Service Code
|
HCPCS 57530
|
| Min. Negotiated Rate |
$305.75 |
| Max. Negotiated Rate |
$982.75 |
| Rate for Payer: Cash Price |
$443.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$436.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$393.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$393.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$414.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$436.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$414.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$436.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$436.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$327.58
|
| Rate for Payer: Healthfirst Commercial |
$436.78
|
| Rate for Payer: Healthfirst Essential Plan |
$982.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$414.94
|
| Rate for Payer: Healthfirst QHP |
$436.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$305.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$436.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$371.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$305.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$436.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$327.58
|
| Rate for Payer: SOMOS Essential |
$327.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$436.78
|
|
|
PR TRACHELORRHAPHY PLSTC RPR UTERINE CERVIX VAG
|
Professional
|
Both
|
$1,462.55
|
|
|
Service Code
|
HCPCS 57720
|
| Min. Negotiated Rate |
$273.33 |
| Max. Negotiated Rate |
$878.56 |
| Rate for Payer: Cash Price |
$395.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$390.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$351.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$351.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$370.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$390.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$370.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$390.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$390.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$292.85
|
| Rate for Payer: Healthfirst Commercial |
$390.47
|
| Rate for Payer: Healthfirst Essential Plan |
$878.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$370.95
|
| Rate for Payer: Healthfirst QHP |
$390.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$273.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$390.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$331.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$273.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$390.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$292.85
|
| Rate for Payer: SOMOS Essential |
$292.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$390.47
|
|
|
PR TRACHEOBRNCHSC THRU EST TRACHS INC
|
Professional
|
Both
|
$490.04
|
|
|
Service Code
|
HCPCS 31615
|
| Min. Negotiated Rate |
$92.95 |
| Max. Negotiated Rate |
$298.78 |
| Rate for Payer: Cash Price |
$133.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$132.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$119.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$119.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$126.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$132.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$126.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$132.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$132.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$99.59
|
| Rate for Payer: Healthfirst Commercial |
$132.79
|
| Rate for Payer: Healthfirst Essential Plan |
$298.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$126.15
|
| Rate for Payer: Healthfirst QHP |
$132.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$132.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$112.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$92.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$132.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$99.59
|
| Rate for Payer: SOMOS Essential |
$99.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$132.79
|
|
|
PR TRACHEOPLASTY CERVICAL
|
Professional
|
Both
|
$5,892.46
|
|
|
Service Code
|
HCPCS 31750
|
| Min. Negotiated Rate |
$1,090.91 |
| Max. Negotiated Rate |
$3,506.49 |
| Rate for Payer: Cash Price |
$1,578.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,558.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,402.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,402.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,480.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,558.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,480.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,558.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,558.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,168.83
|
| Rate for Payer: Healthfirst Commercial |
$1,558.44
|
| Rate for Payer: Healthfirst Essential Plan |
$3,506.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,480.52
|
| Rate for Payer: Healthfirst QHP |
$1,558.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,090.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,558.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,324.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,090.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,558.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,168.83
|
| Rate for Payer: SOMOS Essential |
$1,168.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,558.44
|
|
|
PR TRACHEOPLASTY INTRATHORACIC
|
Professional
|
Both
|
$6,129.69
|
|
|
Service Code
|
HCPCS 31760
|
| Min. Negotiated Rate |
$1,132.47 |
| Max. Negotiated Rate |
$3,640.09 |
| Rate for Payer: Cash Price |
$1,633.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,617.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,456.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,456.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,536.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,617.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,536.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,617.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,617.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,213.37
|
| Rate for Payer: Healthfirst Commercial |
$1,617.82
|
| Rate for Payer: Healthfirst Essential Plan |
$3,640.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,536.93
|
| Rate for Payer: Healthfirst QHP |
$1,617.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,132.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,617.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,375.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,132.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,617.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,213.37
|
| Rate for Payer: SOMOS Essential |
$1,213.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,617.82
|
|
|
PR TRACHEOPLASTY TRACHEOPHARYNGEAL FSTLJ EA STG
|
Professional
|
Both
|
$7,504.14
|
|
|
Service Code
|
HCPCS 31755
|
| Min. Negotiated Rate |
$1,395.93 |
| Max. Negotiated Rate |
$4,486.93 |
| Rate for Payer: Cash Price |
$2,026.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,994.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,794.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,794.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,894.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,994.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,894.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,994.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,994.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,495.64
|
| Rate for Payer: Healthfirst Commercial |
$1,994.19
|
| Rate for Payer: Healthfirst Essential Plan |
$4,486.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,894.48
|
| Rate for Payer: Healthfirst QHP |
$1,994.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,395.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,994.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,695.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,395.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,994.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,495.64
|
| Rate for Payer: SOMOS Essential |
$1,495.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,994.19
|
|
|
PR TRACHEOSTOMA REVJ CPLX W/FLAP ROTATION
|
Professional
|
Both
|
$3,102.79
|
|
|
Service Code
|
HCPCS 31614
|
| Min. Negotiated Rate |
$576.17 |
| Max. Negotiated Rate |
$1,851.97 |
| Rate for Payer: Cash Price |
$836.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$823.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$740.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$740.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$781.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$823.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$781.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$823.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$823.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$617.33
|
| Rate for Payer: Healthfirst Commercial |
$823.10
|
| Rate for Payer: Healthfirst Essential Plan |
$1,851.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$781.95
|
| Rate for Payer: Healthfirst QHP |
$823.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$576.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$823.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$699.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$576.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$823.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$617.33
|
| Rate for Payer: SOMOS Essential |
$617.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$823.10
|
|
|
PR TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION
|
Professional
|
Both
|
$1,854.30
|
|
|
Service Code
|
HCPCS 31613
|
| Min. Negotiated Rate |
$343.07 |
| Max. Negotiated Rate |
$1,102.72 |
| Rate for Payer: Cash Price |
$500.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$490.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$441.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$441.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$465.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$490.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$465.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$490.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$490.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$367.57
|
| Rate for Payer: Healthfirst Commercial |
$490.10
|
| Rate for Payer: Healthfirst Essential Plan |
$1,102.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$465.60
|
| Rate for Payer: Healthfirst QHP |
$490.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$343.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$490.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$416.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$343.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$490.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$367.57
|
| Rate for Payer: SOMOS Essential |
$367.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$490.10
|
|
|
PR TRACHEOSTOMY EMERGENCY CRICOTHYROID MEMBRANE
|
Professional
|
Both
|
$1,462.83
|
|
|
Service Code
|
HCPCS 31605
|
| Min. Negotiated Rate |
$268.90 |
| Max. Negotiated Rate |
$864.34 |
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$384.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$345.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$345.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$364.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$384.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$364.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$384.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$384.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$288.11
|
| Rate for Payer: Healthfirst Commercial |
$384.15
|
| Rate for Payer: Healthfirst Essential Plan |
$864.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$364.94
|
| Rate for Payer: Healthfirst QHP |
$384.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$268.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$384.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$326.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$268.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$384.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$288.11
|
| Rate for Payer: SOMOS Essential |
$288.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$384.15
|
|
|
PR TRACHEOSTOMY EMERGENCY PROCEDURE TRANSTRACHEAL
|
Professional
|
Both
|
$1,398.92
|
|
|
Service Code
|
HCPCS 31603
|
| Min. Negotiated Rate |
$256.96 |
| Max. Negotiated Rate |
$825.95 |
| Rate for Payer: Cash Price |
$373.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$367.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$330.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$330.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$348.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$367.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$348.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$367.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$367.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$275.32
|
| Rate for Payer: Healthfirst Commercial |
$367.09
|
| Rate for Payer: Healthfirst Essential Plan |
$825.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$348.74
|
| Rate for Payer: Healthfirst QHP |
$367.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$256.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$367.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$312.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$256.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$367.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$275.32
|
| Rate for Payer: SOMOS Essential |
$275.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$367.09
|
|
|
PR TRACHEOSTOMY FENESTRATION W/SKIN FLAPS
|
Professional
|
Both
|
$4,163.08
|
|
|
Service Code
|
HCPCS 31610
|
| Min. Negotiated Rate |
$772.85 |
| Max. Negotiated Rate |
$2,484.16 |
| Rate for Payer: Cash Price |
$1,121.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,104.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$993.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$993.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,048.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,104.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,048.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,104.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,104.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$828.05
|
| Rate for Payer: Healthfirst Commercial |
$1,104.07
|
| Rate for Payer: Healthfirst Essential Plan |
$2,484.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,048.87
|
| Rate for Payer: Healthfirst QHP |
$1,104.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$772.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,104.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$938.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$772.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,104.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$828.05
|
| Rate for Payer: SOMOS Essential |
$828.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,104.07
|
|
|
PR TRACHEOSTOMY PLANNED SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,337.18
|
|
|
Service Code
|
HCPCS 31600
|
| Min. Negotiated Rate |
$246.46 |
| Max. Negotiated Rate |
$792.20 |
| Rate for Payer: Cash Price |
$356.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$352.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$316.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$316.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$334.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$352.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$334.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$352.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$264.07
|
| Rate for Payer: Healthfirst Commercial |
$352.09
|
| Rate for Payer: Healthfirst Essential Plan |
$792.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$334.49
|
| Rate for Payer: Healthfirst QHP |
$352.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$246.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$352.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$299.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$246.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$352.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$264.07
|
| Rate for Payer: SOMOS Essential |
$264.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$352.09
|
|
|
PR TRACHEOSTOMY PLANNED UNDER 2 YEARS SPX
|
Professional
|
Both
|
$1,920.66
|
|
|
Service Code
|
HCPCS 31601
|
| Min. Negotiated Rate |
$359.40 |
| Max. Negotiated Rate |
$1,155.22 |
| Rate for Payer: Cash Price |
$519.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$513.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$462.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$462.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$487.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$513.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$487.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$513.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$513.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$385.07
|
| Rate for Payer: Healthfirst Commercial |
$513.43
|
| Rate for Payer: Healthfirst Essential Plan |
$1,155.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$487.76
|
| Rate for Payer: Healthfirst QHP |
$513.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$359.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$513.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$436.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$359.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$513.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$385.07
|
| Rate for Payer: SOMOS Essential |
$385.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$513.43
|
|
|
PR TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT
|
Professional
|
Both
|
$150.47
|
|
|
Service Code
|
HCPCS 31502
|
| Min. Negotiated Rate |
$27.29 |
| Max. Negotiated Rate |
$87.70 |
| Rate for Payer: Cash Price |
$40.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.23
|
| Rate for Payer: Healthfirst Commercial |
$38.98
|
| Rate for Payer: Healthfirst Essential Plan |
$87.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.03
|
| Rate for Payer: Healthfirst QHP |
$38.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.23
|
| Rate for Payer: SOMOS Essential |
$29.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.98
|
|
|
PR TRANSABDOMINAL AMNIOINFUSION W/ULTRSND GUIDANCE
|
Professional
|
Both
|
$1,429.58
|
|
|
Service Code
|
HCPCS 59070
|
| Min. Negotiated Rate |
$261.46 |
| Max. Negotiated Rate |
$840.40 |
| Rate for Payer: Cash Price |
$377.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$373.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$336.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$336.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$354.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$373.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$354.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$373.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$373.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$280.13
|
| Rate for Payer: Healthfirst Commercial |
$373.51
|
| Rate for Payer: Healthfirst Essential Plan |
$840.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$354.83
|
| Rate for Payer: Healthfirst QHP |
$373.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$261.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$373.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$317.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$261.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$373.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$280.13
|
| Rate for Payer: SOMOS Essential |
$280.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$373.51
|
|
|
PR TRANSCATHETER BIOPSY
|
Professional
|
Both
|
$873.99
|
|
|
Service Code
|
HCPCS 37200
|
| Min. Negotiated Rate |
$165.87 |
| Max. Negotiated Rate |
$533.14 |
| Rate for Payer: Cash Price |
$235.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$236.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$213.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$213.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$225.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$236.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$225.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$236.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$236.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$177.71
|
| Rate for Payer: Healthfirst Commercial |
$236.95
|
| Rate for Payer: Healthfirst Essential Plan |
$533.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.10
|
| Rate for Payer: Healthfirst QHP |
$236.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$165.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$236.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$201.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$165.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$236.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$177.71
|
| Rate for Payer: SOMOS Essential |
$177.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$236.95
|
|
|
PR TRANSCATHETER DLVR ENHNCD FIXATION DEVICES RS&I
|
Professional
|
Both
|
$2,897.30
|
|
|
Service Code
|
HCPCS 34712
|
| Min. Negotiated Rate |
$532.02 |
| Max. Negotiated Rate |
$1,710.07 |
| Rate for Payer: Cash Price |
$767.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$760.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$684.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$684.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$722.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$760.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$722.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$760.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$760.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$570.02
|
| Rate for Payer: Healthfirst Commercial |
$760.03
|
| Rate for Payer: Healthfirst Essential Plan |
$1,710.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$722.03
|
| Rate for Payer: Healthfirst QHP |
$760.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$532.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$760.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$646.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$532.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$760.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$570.02
|
| Rate for Payer: SOMOS Essential |
$570.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$760.03
|
|
|
PR TRANSCATHETER PLACEMENT&SBSQ REMOVAL CEPD PERQ
|
Professional
|
Both
|
$589.96
|
|
|
Service Code
|
HCPCS 33370
|
| Min. Negotiated Rate |
$108.48 |
| Max. Negotiated Rate |
$348.68 |
| Rate for Payer: Cash Price |
$155.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$154.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$139.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$139.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$147.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$154.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$147.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$116.23
|
| Rate for Payer: Healthfirst Commercial |
$154.97
|
| Rate for Payer: Healthfirst Essential Plan |
$348.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$147.22
|
| Rate for Payer: Healthfirst QHP |
$154.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$108.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$154.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$131.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$108.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$154.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$116.23
|
| Rate for Payer: SOMOS Essential |
$116.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$154.97
|
|
|
PR TRANSCATHETER TRANSAPICAL REPLACEMT AORTIC VALVE
|
Professional
|
Both
|
$6,928.08
|
|
|
Service Code
|
HCPCS 33366
|
| Min. Negotiated Rate |
$1,272.13 |
| Max. Negotiated Rate |
$4,088.99 |
| Rate for Payer: Cash Price |
$1,832.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,817.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,635.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,635.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,726.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,817.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,726.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,817.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,817.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,363.00
|
| Rate for Payer: Healthfirst Commercial |
$1,817.33
|
| Rate for Payer: Healthfirst Essential Plan |
$4,088.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,726.46
|
| Rate for Payer: Healthfirst QHP |
$1,817.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,272.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,817.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,544.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,272.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,817.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,363.00
|
| Rate for Payer: SOMOS Essential |
$1,363.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,817.33
|
|
|
PR TRANSCERV FALLOPIAN TUBE CATH W/WO HYSTOSALPING
|
Professional
|
Both
|
$1,263.54
|
|
|
Service Code
|
HCPCS 58345
|
| Min. Negotiated Rate |
$235.44 |
| Max. Negotiated Rate |
$756.79 |
| Rate for Payer: Cash Price |
$340.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$336.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$302.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$302.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$319.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$336.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$319.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$336.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$336.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$252.26
|
| Rate for Payer: Healthfirst Commercial |
$336.35
|
| Rate for Payer: Healthfirst Essential Plan |
$756.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$319.53
|
| Rate for Payer: Healthfirst QHP |
$336.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$235.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$336.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$285.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$235.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$336.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$252.26
|
| Rate for Payer: SOMOS Essential |
$252.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$336.35
|
|
