|
PR VCRPEC THORACOLMBR DCMPRN LWR THRC/LMBR 1 SEG
|
Professional
|
Both
|
$11,208.23
|
|
|
Service Code
|
HCPCS 63087
|
| Min. Negotiated Rate |
$2,078.31 |
| Max. Negotiated Rate |
$6,680.30 |
| Rate for Payer: Cash Price |
$2,989.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,969.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,672.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,672.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,820.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,969.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,820.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,969.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,969.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,226.76
|
| Rate for Payer: Healthfirst Commercial |
$2,969.02
|
| Rate for Payer: Healthfirst Essential Plan |
$6,680.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,820.57
|
| Rate for Payer: Healthfirst QHP |
$2,969.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,078.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,969.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,523.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,078.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,969.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,226.76
|
| Rate for Payer: SOMOS Essential |
$2,226.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,969.02
|
|
|
PR VCRPEC THORACOLMBR DCMPRN LWR THRC/LMBR EA SEG
|
Professional
|
Both
|
$1,202.15
|
|
|
Service Code
|
HCPCS 63088
|
| Min. Negotiated Rate |
$220.02 |
| Max. Negotiated Rate |
$707.20 |
| Rate for Payer: Cash Price |
$318.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$314.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$282.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$282.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$298.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$314.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$298.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$314.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$314.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$235.73
|
| Rate for Payer: Healthfirst Commercial |
$314.31
|
| Rate for Payer: Healthfirst Essential Plan |
$707.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$298.59
|
| Rate for Payer: Healthfirst QHP |
$314.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$220.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$314.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$267.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$220.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$314.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$235.73
|
| Rate for Payer: SOMOS Essential |
$235.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$314.31
|
|
|
PR VCRPEC TRANSPRTL/RPR DCMPRN THRC LMBR/SAC 1 SEG
|
Professional
|
Both
|
$8,868.41
|
|
|
Service Code
|
HCPCS 63090
|
| Min. Negotiated Rate |
$1,635.40 |
| Max. Negotiated Rate |
$5,256.65 |
| Rate for Payer: Cash Price |
$2,364.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,336.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,102.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,102.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,219.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,336.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,219.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,336.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,336.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,752.22
|
| Rate for Payer: Healthfirst Commercial |
$2,336.29
|
| Rate for Payer: Healthfirst Essential Plan |
$5,256.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,219.48
|
| Rate for Payer: Healthfirst QHP |
$2,336.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,635.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,336.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,985.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,635.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,336.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,752.22
|
| Rate for Payer: SOMOS Essential |
$1,752.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,336.29
|
|
|
PR VCRPEC TRANSPRTL/RPR DCMPRN THRC LMBR/SAC EA SEG
|
Professional
|
Both
|
$799.65
|
|
|
Service Code
|
HCPCS 63091
|
| Min. Negotiated Rate |
$145.83 |
| Max. Negotiated Rate |
$468.74 |
| Rate for Payer: Cash Price |
$210.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$208.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$187.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$187.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$197.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$208.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$197.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$208.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$208.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$156.25
|
| Rate for Payer: Healthfirst Commercial |
$208.33
|
| Rate for Payer: Healthfirst Essential Plan |
$468.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$197.91
|
| Rate for Payer: Healthfirst QHP |
$208.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$145.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$208.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$177.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$145.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$208.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$156.25
|
| Rate for Payer: SOMOS Essential |
$156.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$208.33
|
|
|
PR VEEG BY TECH 2-12 HOURS UNMONITORED
|
Professional
|
Both
|
$600.88
|
|
|
Service Code
|
HCPCS 95711
|
| Min. Negotiated Rate |
$44.29 |
| Max. Negotiated Rate |
$44.29 |
| Rate for Payer: Amida Care Medicaid |
$44.29
|
|
|
PR VEEG BY TECH 2-12 HR CONTINUOUS R-T MONITORING
|
Professional
|
Both
|
$2,603.62
|
|
|
Service Code
|
HCPCS 95713
|
| Min. Negotiated Rate |
$66.43 |
| Max. Negotiated Rate |
$66.43 |
| Rate for Payer: Amida Care Medicaid |
$66.43
|
|
|
PR VEEG BY TECH 2-12 HR INTERMITTENT MONITORING
|
Professional
|
Both
|
$1,747.41
|
|
|
Service Code
|
HCPCS 95712
|
| Min. Negotiated Rate |
$55.36 |
| Max. Negotiated Rate |
$55.36 |
| Rate for Payer: Amida Care Medicaid |
$55.36
|
|
|
PR VEEG BY TECH EA INCR 12-26 HR CONT R-T MNTR
|
Professional
|
Both
|
$3,767.93
|
|
|
Service Code
|
HCPCS 95716
|
| Min. Negotiated Rate |
$102.88 |
| Max. Negotiated Rate |
$102.88 |
| Rate for Payer: Amida Care Medicaid |
$102.88
|
|
|
PR VEEG BY TECH EA INCR 12-26 HR INTERMITTENT MNTR
|
Professional
|
Both
|
$2,867.27
|
|
|
Service Code
|
HCPCS 95715
|
| Min. Negotiated Rate |
$85.74 |
| Max. Negotiated Rate |
$85.74 |
| Rate for Payer: Amida Care Medicaid |
$85.74
|
|
|
PR VEEG BY TECH EA INCR 12-26 HR UNMONITORED
|
Professional
|
Both
|
$913.43
|
|
|
Service Code
|
HCPCS 95714
|
| Min. Negotiated Rate |
$68.59 |
| Max. Negotiated Rate |
$68.59 |
| Rate for Payer: Amida Care Medicaid |
$68.59
|
|
|
PR VEN CATHJ SLCTV ORGAN BLD SAMPLING
|
Professional
|
Both
|
$782.78
|
|
|
Service Code
|
HCPCS 36500
|
| Min. Negotiated Rate |
$146.08 |
| Max. Negotiated Rate |
$469.53 |
| Rate for Payer: Cash Price |
$209.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$208.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$187.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$187.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$198.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$208.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$198.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$208.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$208.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$156.51
|
| Rate for Payer: Healthfirst Commercial |
$208.68
|
| Rate for Payer: Healthfirst Essential Plan |
$469.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$198.25
|
| Rate for Payer: Healthfirst QHP |
$208.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$146.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$208.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$177.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$146.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$208.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$156.51
|
| Rate for Payer: SOMOS Essential |
$156.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$208.68
|
|
|
PR VENIPUNCTURE CUTDOWN AGE 1 YR/>
|
Professional
|
Both
|
$167.13
|
|
|
Service Code
|
HCPCS 36425
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$100.94 |
| Rate for Payer: Cash Price |
$45.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$44.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.65
|
| Rate for Payer: Healthfirst Commercial |
$44.86
|
| Rate for Payer: Healthfirst Essential Plan |
$100.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.62
|
| Rate for Payer: Healthfirst QHP |
$44.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.65
|
| Rate for Payer: SOMOS Essential |
$33.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.86
|
|
|
PR VENIPUNCTURE CUTDOWN YOUNGER THAN AGE 1 YR
|
Professional
|
Both
|
$212.56
|
|
|
Service Code
|
HCPCS 36420
|
| Min. Negotiated Rate |
$38.33 |
| Max. Negotiated Rate |
$123.21 |
| Rate for Payer: Cash Price |
$56.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$52.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.07
|
| Rate for Payer: Healthfirst Commercial |
$54.76
|
| Rate for Payer: Healthfirst Essential Plan |
$123.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.02
|
| Rate for Payer: Healthfirst QHP |
$54.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$54.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$46.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.07
|
| Rate for Payer: SOMOS Essential |
$41.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.76
|
|
|
PR VENOUS ANASTOMOSIS OPEN CAVAL-MESENTERIC
|
Professional
|
Both
|
$9,989.00
|
|
|
Service Code
|
HCPCS 37160
|
| Min. Negotiated Rate |
$1,842.05 |
| Max. Negotiated Rate |
$5,920.88 |
| Rate for Payer: Cash Price |
$2,655.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,631.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,368.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,368.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,499.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,631.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,499.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,631.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,631.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,973.62
|
| Rate for Payer: Healthfirst Commercial |
$2,631.50
|
| Rate for Payer: Healthfirst Essential Plan |
$5,920.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,499.93
|
| Rate for Payer: Healthfirst QHP |
$2,631.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,842.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,631.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,236.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,842.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,631.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,973.62
|
| Rate for Payer: SOMOS Essential |
$1,973.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,631.50
|
|
|
PR VENOUS ANASTOMOSIS OPEN PORTOCAVAL
|
Professional
|
Both
|
$10,482.68
|
|
|
Service Code
|
HCPCS 37140
|
| Min. Negotiated Rate |
$1,933.15 |
| Max. Negotiated Rate |
$6,213.71 |
| Rate for Payer: Cash Price |
$2,786.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,761.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,485.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,485.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,623.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,761.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,623.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,761.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,761.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,071.24
|
| Rate for Payer: Healthfirst Commercial |
$2,761.65
|
| Rate for Payer: Healthfirst Essential Plan |
$6,213.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,623.57
|
| Rate for Payer: Healthfirst QHP |
$2,761.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,933.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,761.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,347.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,933.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,761.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,071.24
|
| Rate for Payer: SOMOS Essential |
$2,071.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,761.65
|
|
|
PR VENOUS ANASTOMOSIS OPEN RENOPORTAL
|
Professional
|
Both
|
$9,725.07
|
|
|
Service Code
|
HCPCS 37145
|
| Min. Negotiated Rate |
$1,794.23 |
| Max. Negotiated Rate |
$5,767.18 |
| Rate for Payer: Cash Price |
$2,585.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,563.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,306.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,306.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,435.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,563.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,435.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,563.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,563.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,922.39
|
| Rate for Payer: Healthfirst Commercial |
$2,563.19
|
| Rate for Payer: Healthfirst Essential Plan |
$5,767.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,435.03
|
| Rate for Payer: Healthfirst QHP |
$2,563.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,794.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,563.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,178.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,794.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,563.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,922.39
|
| Rate for Payer: SOMOS Essential |
$1,922.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,563.19
|
|
|
PR VENOUS ANASTOMOSIS OPEN SPLENORENAL DISTAL
|
Professional
|
Both
|
$10,482.68
|
|
|
Service Code
|
HCPCS 37181
|
| Min. Negotiated Rate |
$1,933.15 |
| Max. Negotiated Rate |
$6,213.71 |
| Rate for Payer: Cash Price |
$2,786.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,761.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,485.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,485.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,623.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,761.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,623.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,761.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,761.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,071.24
|
| Rate for Payer: Healthfirst Commercial |
$2,761.65
|
| Rate for Payer: Healthfirst Essential Plan |
$6,213.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,623.57
|
| Rate for Payer: Healthfirst QHP |
$2,761.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,933.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,761.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,347.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,933.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,761.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,071.24
|
| Rate for Payer: SOMOS Essential |
$2,071.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,761.65
|
|
|
PR VENOUS ANASTOMOSIS OPEN SPLENORENAL PROXIMAL
|
Professional
|
Both
|
$9,597.98
|
|
|
Service Code
|
HCPCS 37180
|
| Min. Negotiated Rate |
$1,771.12 |
| Max. Negotiated Rate |
$5,692.88 |
| Rate for Payer: Cash Price |
$2,552.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,530.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,277.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,277.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,403.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,530.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,403.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,530.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,530.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,897.63
|
| Rate for Payer: Healthfirst Commercial |
$2,530.17
|
| Rate for Payer: Healthfirst Essential Plan |
$5,692.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,403.66
|
| Rate for Payer: Healthfirst QHP |
$2,530.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,771.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,530.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,150.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,771.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,530.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,897.63
|
| Rate for Payer: SOMOS Essential |
$1,897.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,530.17
|
|
|
PR VENOUS VALVE TRANSPOSITION ANY VEIN DONOR
|
Professional
|
Both
|
$4,544.23
|
|
|
Service Code
|
HCPCS 34510
|
| Min. Negotiated Rate |
$835.22 |
| Max. Negotiated Rate |
$2,684.63 |
| Rate for Payer: Cash Price |
$1,204.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,193.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,073.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,073.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,133.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,193.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,133.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,193.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,193.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$894.88
|
| Rate for Payer: Healthfirst Commercial |
$1,193.17
|
| Rate for Payer: Healthfirst Essential Plan |
$2,684.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,133.51
|
| Rate for Payer: Healthfirst QHP |
$1,193.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$835.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,193.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,014.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$835.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,193.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$894.88
|
| Rate for Payer: SOMOS Essential |
$894.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,193.17
|
|
|
PR VENTILATING TUBE RMVL REQUIRING GENERAL ANES
|
Professional
|
Both
|
$256.03
|
|
|
Service Code
|
HCPCS 69424
|
| Min. Negotiated Rate |
$49.28 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Cash Price |
$70.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$63.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$63.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$66.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$66.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.80
|
| Rate for Payer: Healthfirst Commercial |
$70.40
|
| Rate for Payer: Healthfirst Essential Plan |
$158.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$66.88
|
| Rate for Payer: Healthfirst QHP |
$70.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$49.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$70.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$59.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$49.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$52.80
|
| Rate for Payer: SOMOS Essential |
$52.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.40
|
|
|
PR VENTILATION ASSIST & MGMT INPATIENT 1ST DAY
|
Professional
|
Both
|
$373.38
|
|
|
Service Code
|
HCPCS 94002
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$226.28 |
| Rate for Payer: Cash Price |
$101.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$100.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$90.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$90.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$95.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$100.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$95.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.43
|
| Rate for Payer: Healthfirst Commercial |
$100.57
|
| Rate for Payer: Healthfirst Essential Plan |
$226.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$95.54
|
| Rate for Payer: Healthfirst QHP |
$100.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$70.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$100.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$85.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$70.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$100.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$75.43
|
| Rate for Payer: SOMOS Essential |
$75.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$100.57
|
|
|
PR VENTILATION ASSIST & MGMT INPATIENT EA SBSQ DA
|
Professional
|
Both
|
$260.61
|
|
|
Service Code
|
HCPCS 94003
|
| Min. Negotiated Rate |
$49.64 |
| Max. Negotiated Rate |
$159.57 |
| Rate for Payer: Cash Price |
$71.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$63.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$63.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$67.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$67.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.19
|
| Rate for Payer: Healthfirst Commercial |
$70.92
|
| Rate for Payer: Healthfirst Essential Plan |
$159.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$67.37
|
| Rate for Payer: Healthfirst QHP |
$70.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$49.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$70.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$60.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$49.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$53.19
|
| Rate for Payer: SOMOS Essential |
$53.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.92
|
|
|
PR VENTILATION ASSIST & MGMT NURSING FAC PR DAY
|
Professional
|
Both
|
$193.13
|
|
|
Service Code
|
HCPCS 94004
|
| Min. Negotiated Rate |
$36.11 |
| Max. Negotiated Rate |
$116.08 |
| Rate for Payer: Cash Price |
$52.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$51.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.69
|
| Rate for Payer: Healthfirst Commercial |
$51.59
|
| Rate for Payer: Healthfirst Essential Plan |
$116.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.01
|
| Rate for Payer: Healthfirst QHP |
$51.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$51.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.69
|
| Rate for Payer: SOMOS Essential |
$38.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.59
|
|
|
PR VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/INJ
|
Professional
|
Both
|
$479.26
|
|
|
Service Code
|
HCPCS 61026
|
| Min. Negotiated Rate |
$95.81 |
| Max. Negotiated Rate |
$307.96 |
| Rate for Payer: Cash Price |
$133.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$136.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$123.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$130.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$136.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$130.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.65
|
| Rate for Payer: Healthfirst Commercial |
$136.87
|
| Rate for Payer: Healthfirst Essential Plan |
$307.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.03
|
| Rate for Payer: Healthfirst QHP |
$136.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$95.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$136.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$116.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$95.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$136.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.65
|
| Rate for Payer: SOMOS Essential |
$102.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$136.87
|
|
|
PR VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/O NJX
|
Professional
|
Both
|
$500.61
|
|
|
Service Code
|
HCPCS 61020
|
| Min. Negotiated Rate |
$91.73 |
| Max. Negotiated Rate |
$294.84 |
| Rate for Payer: Cash Price |
$133.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$131.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$117.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$117.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$124.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$131.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$124.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$131.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$98.28
|
| Rate for Payer: Healthfirst Commercial |
$131.04
|
| Rate for Payer: Healthfirst Essential Plan |
$294.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$124.49
|
| Rate for Payer: Healthfirst QHP |
$131.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$91.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$131.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$111.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$91.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$131.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$98.28
|
| Rate for Payer: SOMOS Essential |
$98.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$131.04
|
|
