|
PR TRPOS&/RIMPLTJ CAROTID SUBCLAVIAN ART
|
Professional
|
Both
|
$4,566.63
|
|
|
Service Code
|
HCPCS 35695
|
| Min. Negotiated Rate |
$837.96 |
| Max. Negotiated Rate |
$2,693.45 |
| Rate for Payer: Cash Price |
$1,209.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,197.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,077.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,077.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,137.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,197.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,137.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,197.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,197.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$897.82
|
| Rate for Payer: Healthfirst Commercial |
$1,197.09
|
| Rate for Payer: Healthfirst Essential Plan |
$2,693.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,137.24
|
| Rate for Payer: Healthfirst QHP |
$1,197.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$837.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,197.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,017.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$837.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,197.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$897.82
|
| Rate for Payer: SOMOS Essential |
$897.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,197.09
|
|
|
PR TRPOS&/RIMPLTJ SUBCLAVIAN CAROTID ART
|
Professional
|
Both
|
$4,396.95
|
|
|
Service Code
|
HCPCS 35694
|
| Min. Negotiated Rate |
$807.67 |
| Max. Negotiated Rate |
$2,596.07 |
| Rate for Payer: Cash Price |
$1,165.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,153.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,038.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,038.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,096.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,153.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,096.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,153.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,153.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$865.36
|
| Rate for Payer: Healthfirst Commercial |
$1,153.81
|
| Rate for Payer: Healthfirst Essential Plan |
$2,596.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,096.12
|
| Rate for Payer: Healthfirst QHP |
$1,153.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$807.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,153.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$980.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$807.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,153.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$865.36
|
| Rate for Payer: SOMOS Essential |
$865.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,153.81
|
|
|
PR TRPOS&/RIMPLTJ VERTEBRAL CAROTID ART
|
Professional
|
Both
|
$4,213.13
|
|
|
Service Code
|
HCPCS 35691
|
| Min. Negotiated Rate |
$772.66 |
| Max. Negotiated Rate |
$2,483.55 |
| Rate for Payer: Cash Price |
$1,115.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,103.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$993.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$993.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,048.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,103.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,048.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,103.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,103.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$827.85
|
| Rate for Payer: Healthfirst Commercial |
$1,103.80
|
| Rate for Payer: Healthfirst Essential Plan |
$2,483.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,048.61
|
| Rate for Payer: Healthfirst QHP |
$1,103.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$772.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,103.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$938.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$772.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,103.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$827.85
|
| Rate for Payer: SOMOS Essential |
$827.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,103.80
|
|
|
PR TRPOS&/RIMPLTJ VERTEBRAL SUBCLAVIAN ART
|
Professional
|
Both
|
$3,712.98
|
|
|
Service Code
|
HCPCS 35693
|
| Min. Negotiated Rate |
$685.18 |
| Max. Negotiated Rate |
$2,202.37 |
| Rate for Payer: Cash Price |
$988.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$978.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$880.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$880.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$929.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$978.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$929.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$978.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$978.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$734.12
|
| Rate for Payer: Healthfirst Commercial |
$978.83
|
| Rate for Payer: Healthfirst Essential Plan |
$2,202.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$929.89
|
| Rate for Payer: Healthfirst QHP |
$978.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$685.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$978.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$832.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$685.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$978.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$734.12
|
| Rate for Payer: SOMOS Essential |
$734.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$978.83
|
|
|
PR TR TDN RESTORE INTRNSC FUNCJ ALL 4 FNGRS
|
Professional
|
Both
|
$5,238.94
|
|
|
Service Code
|
HCPCS 26498
|
| Min. Negotiated Rate |
$972.99 |
| Max. Negotiated Rate |
$3,127.45 |
| Rate for Payer: Cash Price |
$1,407.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,389.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,250.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,250.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,320.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,389.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,320.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,389.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,389.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,042.48
|
| Rate for Payer: Healthfirst Commercial |
$1,389.98
|
| Rate for Payer: Healthfirst Essential Plan |
$3,127.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,320.48
|
| Rate for Payer: Healthfirst QHP |
$1,389.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$972.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,389.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,181.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$972.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,389.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,042.48
|
| Rate for Payer: SOMOS Essential |
$1,042.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,389.98
|
|
|
PR TR TDN RESTORE INTRNSC FUNCJ RING&SM FNGR
|
Professional
|
Both
|
$4,031.27
|
|
|
Service Code
|
HCPCS 26497
|
| Min. Negotiated Rate |
$747.50 |
| Max. Negotiated Rate |
$2,402.68 |
| Rate for Payer: Cash Price |
$1,084.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,067.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$961.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$961.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,014.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,067.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,014.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,067.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,067.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$800.89
|
| Rate for Payer: Healthfirst Commercial |
$1,067.86
|
| Rate for Payer: Healthfirst Essential Plan |
$2,402.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,014.47
|
| Rate for Payer: Healthfirst QHP |
$1,067.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$747.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,067.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$907.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$747.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,067.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$800.89
|
| Rate for Payer: SOMOS Essential |
$800.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,067.86
|
|
|
PR TR TOE-TO-HAND W/MVASC ANAST GRT TOE WRP/ARND
|
Professional
|
Both
|
$14,544.39
|
|
|
Service Code
|
HCPCS 26551
|
| Min. Negotiated Rate |
$2,705.25 |
| Max. Negotiated Rate |
$8,695.44 |
| Rate for Payer: Cash Price |
$3,903.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,864.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,478.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,478.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,671.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,864.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,671.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,864.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,864.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,898.48
|
| Rate for Payer: Healthfirst Commercial |
$3,864.64
|
| Rate for Payer: Healthfirst Essential Plan |
$8,695.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,671.41
|
| Rate for Payer: Healthfirst QHP |
$3,864.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,705.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,864.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,284.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,705.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,864.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,898.48
|
| Rate for Payer: SOMOS Essential |
$2,898.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,864.64
|
|
|
PR TR TOE-TO-HAND W/MVASC ANAST OTH/THN GRT TOE 1
|
Professional
|
Both
|
$14,448.91
|
|
|
Service Code
|
HCPCS 26553
|
| Min. Negotiated Rate |
$2,687.46 |
| Max. Negotiated Rate |
$8,638.27 |
| Rate for Payer: Cash Price |
$3,877.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,839.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,455.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,455.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,647.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,839.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,647.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,839.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,839.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,879.42
|
| Rate for Payer: Healthfirst Commercial |
$3,839.23
|
| Rate for Payer: Healthfirst Essential Plan |
$8,638.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,647.27
|
| Rate for Payer: Healthfirst QHP |
$3,839.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,687.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,839.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,263.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,687.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,839.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,879.42
|
| Rate for Payer: SOMOS Essential |
$2,879.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,839.23
|
|
|
PR TR TOE-TO-HAND W/MVASC ANAST OTH/THN GRT TOE 2
|
Professional
|
Both
|
$16,817.96
|
|
|
Service Code
|
HCPCS 26554
|
| Min. Negotiated Rate |
$3,127.91 |
| Max. Negotiated Rate |
$10,053.99 |
| Rate for Payer: Cash Price |
$4,511.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,468.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,021.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,021.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,245.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,468.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,245.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,468.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,468.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,351.33
|
| Rate for Payer: Healthfirst Commercial |
$4,468.44
|
| Rate for Payer: Healthfirst Essential Plan |
$10,053.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,245.02
|
| Rate for Payer: Healthfirst QHP |
$4,468.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,127.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,468.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,798.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3,127.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,468.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,351.33
|
| Rate for Payer: SOMOS Essential |
$3,351.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,468.44
|
|
|
PR TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING DP
|
Professional
|
Both
|
$3,237.78
|
|
|
Service Code
|
HCPCS 27691
|
| Min. Negotiated Rate |
$613.38 |
| Max. Negotiated Rate |
$1,971.59 |
| Rate for Payer: Cash Price |
$879.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$876.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$788.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$788.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$832.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$876.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$832.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$876.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$876.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$657.20
|
| Rate for Payer: Healthfirst Commercial |
$876.26
|
| Rate for Payer: Healthfirst Essential Plan |
$1,971.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$832.45
|
| Rate for Payer: Healthfirst QHP |
$876.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$613.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$876.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$744.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$613.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$876.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$657.20
|
| Rate for Payer: SOMOS Essential |
$657.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$876.26
|
|
|
PR TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING EA TDN
|
Professional
|
Both
|
$431.31
|
|
|
Service Code
|
HCPCS 27692
|
| Min. Negotiated Rate |
$83.01 |
| Max. Negotiated Rate |
$266.83 |
| Rate for Payer: Cash Price |
$118.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$118.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$112.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$118.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$112.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$118.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.94
|
| Rate for Payer: Healthfirst Commercial |
$118.59
|
| Rate for Payer: Healthfirst Essential Plan |
$266.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$112.66
|
| Rate for Payer: Healthfirst QHP |
$118.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$83.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$118.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$100.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$83.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$118.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.94
|
| Rate for Payer: SOMOS Essential |
$88.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$118.59
|
|
|
PR TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING SUPFC
|
Professional
|
Both
|
$2,754.57
|
|
|
Service Code
|
HCPCS 27690
|
| Min. Negotiated Rate |
$524.52 |
| Max. Negotiated Rate |
$1,685.97 |
| Rate for Payer: Cash Price |
$750.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$749.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$674.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$674.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$711.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$749.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$711.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$749.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$749.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$561.99
|
| Rate for Payer: Healthfirst Commercial |
$749.32
|
| Rate for Payer: Healthfirst Essential Plan |
$1,685.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$711.85
|
| Rate for Payer: Healthfirst QHP |
$749.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$524.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$749.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$636.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$524.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$749.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$561.99
|
| Rate for Payer: SOMOS Essential |
$561.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$749.32
|
|
|
PR TR/TRNSPL TDN CARP/MTCRPL HAND W/O FR GRF EA TDN
|
Professional
|
Both
|
$3,474.45
|
|
|
Service Code
|
HCPCS 26480
|
| Min. Negotiated Rate |
$596.64 |
| Max. Negotiated Rate |
$1,917.79 |
| Rate for Payer: Cash Price |
$937.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$852.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$767.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$767.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$809.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$852.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$809.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$852.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$852.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$639.26
|
| Rate for Payer: Healthfirst Commercial |
$852.35
|
| Rate for Payer: Healthfirst Essential Plan |
$1,917.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$809.73
|
| Rate for Payer: Healthfirst QHP |
$852.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$596.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$852.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$724.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$596.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$852.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$639.26
|
| Rate for Payer: SOMOS Essential |
$639.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$852.35
|
|
|
PR TRURL DRAINAGE PROSTATIC ABSCESS
|
Professional
|
Both
|
$1,861.41
|
|
|
Service Code
|
HCPCS 52700
|
| Min. Negotiated Rate |
$354.98 |
| Max. Negotiated Rate |
$1,141.02 |
| Rate for Payer: Cash Price |
$510.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$507.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$456.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$456.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$481.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$507.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$481.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$507.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$507.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$380.34
|
| Rate for Payer: Healthfirst Commercial |
$507.12
|
| Rate for Payer: Healthfirst Essential Plan |
$1,141.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$481.76
|
| Rate for Payer: Healthfirst QHP |
$507.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$354.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$507.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$431.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$354.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$507.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$380.34
|
| Rate for Payer: SOMOS Essential |
$380.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$507.12
|
|
|
PR TRURL DSTRJ PRST8 TISS RF WV THERMOTHERAPY
|
Professional
|
Both
|
$1,603.98
|
|
|
Service Code
|
HCPCS 53854
|
| Min. Negotiated Rate |
$307.40 |
| Max. Negotiated Rate |
$988.07 |
| Rate for Payer: Cash Price |
$441.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$439.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$395.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$395.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$417.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$439.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$417.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$439.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$439.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$329.36
|
| Rate for Payer: Healthfirst Commercial |
$439.14
|
| Rate for Payer: Healthfirst Essential Plan |
$988.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$417.18
|
| Rate for Payer: Healthfirst QHP |
$439.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$307.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$439.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$373.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$307.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$439.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$329.36
|
| Rate for Payer: SOMOS Essential |
$329.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$439.14
|
|
|
PR TRURL DSTRJ PRSTATE TISS MICROWAVE THERMOTH
|
Professional
|
Both
|
$1,497.83
|
|
|
Service Code
|
HCPCS 53850
|
| Min. Negotiated Rate |
$287.62 |
| Max. Negotiated Rate |
$924.48 |
| Rate for Payer: Cash Price |
$412.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$410.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$369.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$369.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$390.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$410.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$390.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$410.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$410.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$308.16
|
| Rate for Payer: Healthfirst Commercial |
$410.88
|
| Rate for Payer: Healthfirst Essential Plan |
$924.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$390.34
|
| Rate for Payer: Healthfirst QHP |
$410.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$287.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$410.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$349.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$287.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$410.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$308.16
|
| Rate for Payer: SOMOS Essential |
$308.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$410.88
|
|
|
PR TRURL DSTRJ PRSTATE TISS RF THERMOTH
|
Professional
|
Both
|
$1,606.71
|
|
|
Service Code
|
HCPCS 53852
|
| Min. Negotiated Rate |
$307.40 |
| Max. Negotiated Rate |
$988.07 |
| Rate for Payer: Cash Price |
$441.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$439.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$395.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$395.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$417.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$439.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$417.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$439.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$439.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$329.36
|
| Rate for Payer: Healthfirst Commercial |
$439.14
|
| Rate for Payer: Healthfirst Essential Plan |
$988.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$417.18
|
| Rate for Payer: Healthfirst QHP |
$439.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$307.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$439.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$373.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$307.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$439.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$329.36
|
| Rate for Payer: SOMOS Essential |
$329.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$439.14
|
|
|
PR TRURL ELECTROSURG RESCJ PROSTATE BLEED COMPLETE
|
Professional
|
Both
|
$3,043.99
|
|
|
Service Code
|
HCPCS 52601
|
| Min. Negotiated Rate |
$579.33 |
| Max. Negotiated Rate |
$1,862.12 |
| Rate for Payer: Cash Price |
$833.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$827.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$744.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$744.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$786.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$827.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$786.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$827.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$827.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$620.71
|
| Rate for Payer: Healthfirst Commercial |
$827.61
|
| Rate for Payer: Healthfirst Essential Plan |
$1,862.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$786.23
|
| Rate for Payer: Healthfirst QHP |
$827.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$579.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$827.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$703.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$579.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$827.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$620.71
|
| Rate for Payer: SOMOS Essential |
$620.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$827.61
|
|
|
PR TRURL RESCJ POSTOP BLADDER NECK CONTRACTURE
|
Professional
|
Both
|
$1,360.94
|
|
|
Service Code
|
HCPCS 52640
|
| Min. Negotiated Rate |
$262.22 |
| Max. Negotiated Rate |
$842.85 |
| Rate for Payer: Cash Price |
$375.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$374.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$337.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$337.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$355.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$374.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$355.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$374.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$374.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$280.95
|
| Rate for Payer: Healthfirst Commercial |
$374.60
|
| Rate for Payer: Healthfirst Essential Plan |
$842.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$355.87
|
| Rate for Payer: Healthfirst QHP |
$374.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$262.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$374.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$318.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$262.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$374.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$280.95
|
| Rate for Payer: SOMOS Essential |
$280.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$374.60
|
|
|
PR TRURL RESCJ RESIDUAL/REGROWTH OBSTR PRSTATE TISS
|
Professional
|
Both
|
$1,706.53
|
|
|
Service Code
|
HCPCS 52630
|
| Min. Negotiated Rate |
$327.33 |
| Max. Negotiated Rate |
$1,052.14 |
| Rate for Payer: Cash Price |
$468.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$467.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$420.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$420.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$444.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$467.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$444.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$467.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$467.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$350.71
|
| Rate for Payer: Healthfirst Commercial |
$467.62
|
| Rate for Payer: Healthfirst Essential Plan |
$1,052.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$444.24
|
| Rate for Payer: Healthfirst QHP |
$467.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$327.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$467.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$397.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$327.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$467.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$350.71
|
| Rate for Payer: SOMOS Essential |
$350.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$467.62
|
|
|
PR TRURL RF FEMALE BLADDER NECK STRS URIN INCONT
|
Professional
|
Both
|
$930.58
|
|
|
Service Code
|
HCPCS 53860
|
| Min. Negotiated Rate |
$179.05 |
| Max. Negotiated Rate |
$575.50 |
| Rate for Payer: Cash Price |
$255.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$255.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$230.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$230.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$242.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$255.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$242.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$255.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$255.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.84
|
| Rate for Payer: Healthfirst Commercial |
$255.78
|
| Rate for Payer: Healthfirst Essential Plan |
$575.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$242.99
|
| Rate for Payer: Healthfirst QHP |
$255.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$179.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$255.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$217.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$179.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$255.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$191.84
|
| Rate for Payer: SOMOS Essential |
$191.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$255.78
|
|
|
PR TR XTRNL OBLQ MUSC TRCHNTR W/FSCAL/TDN XTN GRF
|
Professional
|
Both
|
$3,684.03
|
|
|
Service Code
|
HCPCS 27100
|
| Min. Negotiated Rate |
$693.73 |
| Max. Negotiated Rate |
$2,229.84 |
| Rate for Payer: Cash Price |
$995.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$991.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$891.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$941.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$991.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$941.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$991.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$991.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$743.28
|
| Rate for Payer: Healthfirst Commercial |
$991.04
|
| Rate for Payer: Healthfirst Essential Plan |
$2,229.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$941.49
|
| Rate for Payer: Healthfirst QHP |
$991.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$693.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$991.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$842.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$693.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$991.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$743.28
|
| Rate for Payer: SOMOS Essential |
$743.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$991.04
|
|
|
PR TSTG ANS FUNCJ CARDIOVAGAL INNERVAJ PARASYMP
|
Professional
|
Both
|
$176.86
|
|
|
Service Code
|
HCPCS 95921 26
|
| Min. Negotiated Rate |
$33.05 |
| Max. Negotiated Rate |
$106.25 |
| Rate for Payer: Amida Care Medicaid |
$54.01
|
| Rate for Payer: Cash Price |
$47.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.41
|
| Rate for Payer: Healthfirst Commercial |
$47.22
|
| Rate for Payer: Healthfirst Essential Plan |
$106.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.86
|
| Rate for Payer: Healthfirst QHP |
$47.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.41
|
| Rate for Payer: SOMOS Essential |
$35.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.22
|
|
|
PR TSTG ANS FUNCJ CARDIOVAGAL INNERVAJ PARASYMP
|
Professional
|
Both
|
$365.02
|
|
|
Service Code
|
HCPCS 95921
|
| Min. Negotiated Rate |
$54.01 |
| Max. Negotiated Rate |
$219.42 |
| Rate for Payer: Amida Care Medicaid |
$54.01
|
| Rate for Payer: Cash Price |
$100.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$97.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$87.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$92.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$97.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$92.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.14
|
| Rate for Payer: Healthfirst Commercial |
$97.52
|
| Rate for Payer: Healthfirst Essential Plan |
$219.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$92.64
|
| Rate for Payer: Healthfirst QHP |
$97.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$97.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$82.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$97.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$73.14
|
| Rate for Payer: SOMOS Essential |
$73.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$97.52
|
|
|
PR TSTG ANS FUNCJ CARDIOVAGAL INNERVAJ PARASYMP
|
Professional
|
Both
|
$188.16
|
|
|
Service Code
|
HCPCS 95921 TC
|
| Min. Negotiated Rate |
$35.21 |
| Max. Negotiated Rate |
$113.17 |
| Rate for Payer: Amida Care Medicaid |
$54.01
|
| Rate for Payer: Cash Price |
$52.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$50.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$45.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$50.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$47.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.73
|
| Rate for Payer: Healthfirst Commercial |
$50.30
|
| Rate for Payer: Healthfirst Essential Plan |
$113.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.78
|
| Rate for Payer: Healthfirst QHP |
$50.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$50.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$42.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$37.73
|
| Rate for Payer: SOMOS Essential |
$37.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.30
|
|
