|
PR 1ST SET-UP & PRGRMG PHYS/QHP OF WEARABLE CVDFB
|
Professional
|
Both
|
$134.86
|
|
|
Service Code
|
HCPCS 93745 TC
|
| Min. Negotiated Rate |
$61.53 |
| Max. Negotiated Rate |
$61.53 |
| Rate for Payer: Amida Care Medicaid |
$61.53
|
|
|
PR 1ST SET-UP & PRGRMG PHYS/QHP OF WEARABLE CVDFB
|
Professional
|
Both
|
$351.19
|
|
|
Service Code
|
HCPCS 93745
|
| Min. Negotiated Rate |
$61.53 |
| Max. Negotiated Rate |
$61.53 |
| Rate for Payer: Amida Care Medicaid |
$61.53
|
|
|
PR 3D ECHO IMG&PST-PXESSING TEE/TTE CGEN CAR ANOMAL
|
Professional
|
Both
|
$98.00
|
|
|
Service Code
|
HCPCS 93319
|
| Min. Negotiated Rate |
$13.89 |
| Max. Negotiated Rate |
$57.42 |
| Rate for Payer: Amida Care Medicaid |
$13.89
|
| Rate for Payer: Cash Price |
$25.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.14
|
| Rate for Payer: Healthfirst Commercial |
$25.52
|
| Rate for Payer: Healthfirst Essential Plan |
$57.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.24
|
| Rate for Payer: Healthfirst QHP |
$25.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$25.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.14
|
| Rate for Payer: SOMOS Essential |
$19.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.52
|
|
|
PR ABDL LMPHADEC REG CELIAC GSTR PORTAL PRIPNCRTC
|
Professional
|
Both
|
$1,189.06
|
|
|
Service Code
|
HCPCS 38747
|
| Min. Negotiated Rate |
$219.23 |
| Max. Negotiated Rate |
$704.65 |
| Rate for Payer: Cash Price |
$317.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$313.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$281.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$281.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$297.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$313.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$297.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$313.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$313.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$234.88
|
| Rate for Payer: Healthfirst Commercial |
$313.18
|
| Rate for Payer: Healthfirst Essential Plan |
$704.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$297.52
|
| Rate for Payer: Healthfirst QHP |
$313.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$219.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$313.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$266.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$219.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$313.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$234.88
|
| Rate for Payer: SOMOS Essential |
$234.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$313.18
|
|
|
PR ABDOMINO-VAG VESICAL NCK SSP W/WO NDSC CTRL
|
Professional
|
Both
|
$2,443.42
|
|
|
Service Code
|
HCPCS 51845
|
| Min. Negotiated Rate |
$466.61 |
| Max. Negotiated Rate |
$1,499.81 |
| Rate for Payer: Cash Price |
$669.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$666.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$599.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$599.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$633.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$666.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$633.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$666.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$666.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$499.94
|
| Rate for Payer: Healthfirst Commercial |
$666.58
|
| Rate for Payer: Healthfirst Essential Plan |
$1,499.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$633.25
|
| Rate for Payer: Healthfirst QHP |
$666.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$466.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$666.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$566.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$466.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$666.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$499.94
|
| Rate for Payer: SOMOS Essential |
$499.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$666.58
|
|
|
PR ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE
|
Professional
|
Both
|
$436.17
|
|
|
Service Code
|
HCPCS 49083
|
| Min. Negotiated Rate |
$82.70 |
| Max. Negotiated Rate |
$265.81 |
| Rate for Payer: Cash Price |
$118.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$118.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$112.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$118.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$112.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$118.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.61
|
| Rate for Payer: Healthfirst Commercial |
$118.14
|
| Rate for Payer: Healthfirst Essential Plan |
$265.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$112.23
|
| Rate for Payer: Healthfirst QHP |
$118.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$118.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$100.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$118.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.61
|
| Rate for Payer: SOMOS Essential |
$88.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$118.14
|
|
|
PR ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE
|
Professional
|
Both
|
$312.24
|
|
|
Service Code
|
HCPCS 49082
|
| Min. Negotiated Rate |
$58.34 |
| Max. Negotiated Rate |
$187.51 |
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$83.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$75.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$75.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$79.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$83.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$79.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.51
|
| Rate for Payer: Healthfirst Commercial |
$83.34
|
| Rate for Payer: Healthfirst Essential Plan |
$187.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$79.17
|
| Rate for Payer: Healthfirst QHP |
$83.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$83.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$83.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62.51
|
| Rate for Payer: SOMOS Essential |
$62.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$83.34
|
|
|
PR ABLATE L/R ATRIAL FIBRIL W/ISOLATED PULM VEIN
|
Professional
|
Both
|
$1,357.76
|
|
|
Service Code
|
HCPCS 93657
|
| Min. Negotiated Rate |
$214.91 |
| Max. Negotiated Rate |
$795.78 |
| Rate for Payer: Amida Care Medicaid |
$214.91
|
| Rate for Payer: Cash Price |
$356.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$353.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$318.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$318.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$336.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$353.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$336.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$353.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$353.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$265.26
|
| Rate for Payer: Healthfirst Commercial |
$353.68
|
| Rate for Payer: Healthfirst Essential Plan |
$795.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$336.00
|
| Rate for Payer: Healthfirst QHP |
$353.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$247.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$353.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$300.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$247.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$353.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$265.26
|
| Rate for Payer: SOMOS Essential |
$265.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$353.68
|
|
|
PR ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION
|
Professional
|
Both
|
$1,848.49
|
|
|
Service Code
|
HCPCS 47383
|
| Min. Negotiated Rate |
$352.61 |
| Max. Negotiated Rate |
$1,133.39 |
| Rate for Payer: Cash Price |
$497.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$503.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$453.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$453.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$478.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$503.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$478.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$503.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$503.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$377.80
|
| Rate for Payer: Healthfirst Commercial |
$503.73
|
| Rate for Payer: Healthfirst Essential Plan |
$1,133.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$478.54
|
| Rate for Payer: Healthfirst QHP |
$503.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$352.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$503.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$428.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$352.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$503.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$377.80
|
| Rate for Payer: SOMOS Essential |
$377.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$503.73
|
|
|
PR ABLATION ARRHYTHMOGENIC FOCI/PATHWAY W/BYPASS
|
Professional
|
Both
|
$7,243.08
|
|
|
Service Code
|
HCPCS 33251
|
| Min. Negotiated Rate |
$1,334.47 |
| Max. Negotiated Rate |
$4,289.35 |
| Rate for Payer: Cash Price |
$1,927.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,906.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,715.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,715.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,811.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,906.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,811.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,906.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,906.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,429.79
|
| Rate for Payer: Healthfirst Commercial |
$1,906.38
|
| Rate for Payer: Healthfirst Essential Plan |
$4,289.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,811.06
|
| Rate for Payer: Healthfirst QHP |
$1,906.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,334.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,906.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,620.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,334.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,906.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,429.79
|
| Rate for Payer: SOMOS Essential |
$1,429.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,906.38
|
|
|
PR ABLATION ARRHYTHMOGENIC FOCI/PATHWAY W/O BYPASS
|
Professional
|
Both
|
$6,410.43
|
|
|
Service Code
|
HCPCS 33250
|
| Min. Negotiated Rate |
$1,184.92 |
| Max. Negotiated Rate |
$3,808.69 |
| Rate for Payer: Cash Price |
$1,706.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,692.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,523.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,523.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,608.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,692.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,608.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,692.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,692.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,269.56
|
| Rate for Payer: Healthfirst Commercial |
$1,692.75
|
| Rate for Payer: Healthfirst Essential Plan |
$3,808.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,608.11
|
| Rate for Payer: Healthfirst QHP |
$1,692.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,184.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,692.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,438.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,184.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,692.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,269.56
|
| Rate for Payer: SOMOS Essential |
$1,269.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,692.75
|
|
|
PR ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE
|
Professional
|
Both
|
$1,564.57
|
|
|
Service Code
|
HCPCS 20982
|
| Min. Negotiated Rate |
$292.63 |
| Max. Negotiated Rate |
$940.61 |
| Rate for Payer: Cash Price |
$419.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$418.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$376.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$376.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$397.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$418.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$397.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$418.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$418.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$313.54
|
| Rate for Payer: Healthfirst Commercial |
$418.05
|
| Rate for Payer: Healthfirst Essential Plan |
$940.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$397.15
|
| Rate for Payer: Healthfirst QHP |
$418.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$292.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$418.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$355.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$292.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$418.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$313.54
|
| Rate for Payer: SOMOS Essential |
$313.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$418.05
|
|
|
PR ABLATION & RCNSTJ ATRIA EXTNSV W/BYPASS
|
Professional
|
Both
|
$8,484.11
|
|
|
Service Code
|
HCPCS 33256
|
| Min. Negotiated Rate |
$1,565.42 |
| Max. Negotiated Rate |
$5,031.72 |
| Rate for Payer: Cash Price |
$2,254.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,236.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,012.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,012.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,124.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,236.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,124.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,236.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,236.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,677.24
|
| Rate for Payer: Healthfirst Commercial |
$2,236.32
|
| Rate for Payer: Healthfirst Essential Plan |
$5,031.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,124.50
|
| Rate for Payer: Healthfirst QHP |
$2,236.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,565.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,236.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,900.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,565.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,236.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,677.24
|
| Rate for Payer: SOMOS Essential |
$1,677.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,236.32
|
|
|
PR ABLATION & RCNSTJ ATRIA EXTNSV W/O BYPASS
|
Professional
|
Both
|
$7,152.08
|
|
|
Service Code
|
HCPCS 33255
|
| Min. Negotiated Rate |
$1,322.66 |
| Max. Negotiated Rate |
$4,251.42 |
| Rate for Payer: Cash Price |
$1,903.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,889.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,700.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,700.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,795.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,889.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,795.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,889.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,889.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,417.14
|
| Rate for Payer: Healthfirst Commercial |
$1,889.52
|
| Rate for Payer: Healthfirst Essential Plan |
$4,251.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,795.04
|
| Rate for Payer: Healthfirst QHP |
$1,889.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,322.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,889.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,606.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,322.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,889.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,417.14
|
| Rate for Payer: SOMOS Essential |
$1,417.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,889.52
|
|
|
PR ABLATION & RECONSTRUCTION ATRIA LIMITED
|
Professional
|
Both
|
$6,021.89
|
|
|
Service Code
|
HCPCS 33254
|
| Min. Negotiated Rate |
$1,113.20 |
| Max. Negotiated Rate |
$3,578.15 |
| Rate for Payer: Cash Price |
$1,608.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,590.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,431.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,431.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,510.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,590.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,510.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,590.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,590.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,192.72
|
| Rate for Payer: Healthfirst Commercial |
$1,590.29
|
| Rate for Payer: Healthfirst Essential Plan |
$3,578.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,510.78
|
| Rate for Payer: Healthfirst QHP |
$1,590.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,113.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,590.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,351.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,113.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,590.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,192.72
|
| Rate for Payer: SOMOS Essential |
$1,192.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,590.29
|
|
|
PR ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY
|
Professional
|
Both
|
$1,877.54
|
|
|
Service Code
|
HCPCS 50593
|
| Min. Negotiated Rate |
$354.26 |
| Max. Negotiated Rate |
$1,138.70 |
| Rate for Payer: Cash Price |
$508.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$506.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$455.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$455.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$480.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$506.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$480.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$506.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$506.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$379.57
|
| Rate for Payer: Healthfirst Commercial |
$506.09
|
| Rate for Payer: Healthfirst Essential Plan |
$1,138.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$480.79
|
| Rate for Payer: Healthfirst QHP |
$506.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$354.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$506.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$430.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$354.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$506.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$379.57
|
| Rate for Payer: SOMOS Essential |
$379.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$506.09
|
|
|
PR ABLATION THER 1+ PULM TUMORS PERQ CRYOABLATION
|
Professional
|
Both
|
$1,791.09
|
|
|
Service Code
|
HCPCS 32994
|
| Min. Negotiated Rate |
$337.76 |
| Max. Negotiated Rate |
$1,085.67 |
| Rate for Payer: Cash Price |
$484.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$482.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$434.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$434.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$458.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$482.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$458.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$482.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$482.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$361.89
|
| Rate for Payer: Healthfirst Commercial |
$482.52
|
| Rate for Payer: Healthfirst Essential Plan |
$1,085.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$458.39
|
| Rate for Payer: Healthfirst QHP |
$482.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$337.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$482.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$410.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$337.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$482.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$361.89
|
| Rate for Payer: SOMOS Essential |
$361.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$482.52
|
|
|
PR ABLATION THER 1+ PULM TUMORS PERQ RADIOFREQUENCY
|
Professional
|
Both
|
$1,802.05
|
|
|
Service Code
|
HCPCS 32998
|
| Min. Negotiated Rate |
$337.49 |
| Max. Negotiated Rate |
$1,084.79 |
| Rate for Payer: Cash Price |
$485.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$482.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$433.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$433.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$458.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$482.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$458.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$482.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$482.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$361.60
|
| Rate for Payer: Healthfirst Commercial |
$482.13
|
| Rate for Payer: Healthfirst Essential Plan |
$1,084.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$458.02
|
| Rate for Payer: Healthfirst QHP |
$482.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$337.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$482.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$409.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$337.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$482.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$361.60
|
| Rate for Payer: SOMOS Essential |
$361.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$482.13
|
|
|
PR ABLATJ BONE TUMOR CRYO PERQ W/IMG GDN WHEN PRFMD
|
Professional
|
Both
|
$1,414.81
|
|
|
Service Code
|
HCPCS 20983
|
| Min. Negotiated Rate |
$268.72 |
| Max. Negotiated Rate |
$863.75 |
| Rate for Payer: Cash Price |
$383.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$383.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$345.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$345.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$364.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$383.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$364.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$383.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$287.92
|
| Rate for Payer: Healthfirst Commercial |
$383.89
|
| Rate for Payer: Healthfirst Essential Plan |
$863.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$364.70
|
| Rate for Payer: Healthfirst QHP |
$383.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$268.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$383.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$326.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$268.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$383.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$287.92
|
| Rate for Payer: SOMOS Essential |
$287.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$383.89
|
|
|
PR ABLTJ 1/> LVR TUM PRQ RF
|
Professional
|
Both
|
$3,027.89
|
|
|
Service Code
|
HCPCS 47382
|
| Min. Negotiated Rate |
$569.94 |
| Max. Negotiated Rate |
$1,831.95 |
| Rate for Payer: Cash Price |
$815.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$814.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$732.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$732.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$773.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$814.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$773.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$814.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$814.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$610.65
|
| Rate for Payer: Healthfirst Commercial |
$814.20
|
| Rate for Payer: Healthfirst Essential Plan |
$1,831.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$773.49
|
| Rate for Payer: Healthfirst QHP |
$814.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$569.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$814.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$692.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$569.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$814.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$610.65
|
| Rate for Payer: SOMOS Essential |
$610.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$814.20
|
|
|
PR ABLTJ 1/> RENAL TUMOR PRQ UNI RADIOFREQUENCY
|
Professional
|
Both
|
$1,406.48
|
|
|
Service Code
|
HCPCS 50592
|
| Min. Negotiated Rate |
$265.14 |
| Max. Negotiated Rate |
$852.23 |
| Rate for Payer: Cash Price |
$381.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$378.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$340.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$340.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$359.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$378.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$359.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$378.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$378.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$284.08
|
| Rate for Payer: Healthfirst Commercial |
$378.77
|
| Rate for Payer: Healthfirst Essential Plan |
$852.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$359.83
|
| Rate for Payer: Healthfirst QHP |
$378.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$265.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$378.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$321.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$265.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$378.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$284.08
|
| Rate for Payer: SOMOS Essential |
$284.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$378.77
|
|
|
PR ABLTJ CRYOSURGICAL W/US GID EA FIBROADENOMA
|
Professional
|
Both
|
$945.46
|
|
|
Service Code
|
HCPCS 19105
|
| Min. Negotiated Rate |
$175.30 |
| Max. Negotiated Rate |
$563.47 |
| Rate for Payer: Cash Price |
$252.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$250.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$225.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$225.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$237.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$250.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$237.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$250.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$187.82
|
| Rate for Payer: Healthfirst Commercial |
$250.43
|
| Rate for Payer: Healthfirst Essential Plan |
$563.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$237.91
|
| Rate for Payer: Healthfirst QHP |
$250.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$175.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$250.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$212.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$175.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$250.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$187.82
|
| Rate for Payer: SOMOS Essential |
$187.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$250.43
|
|
|
PR ABLTJ OPN 1/> LVR TUM CRYOSURG
|
Professional
|
Both
|
$6,705.37
|
|
|
Service Code
|
HCPCS 47381
|
| Min. Negotiated Rate |
$1,240.88 |
| Max. Negotiated Rate |
$3,988.55 |
| Rate for Payer: Cash Price |
$1,784.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,772.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,595.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,595.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,684.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,772.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,684.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,772.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,772.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,329.52
|
| Rate for Payer: Healthfirst Commercial |
$1,772.69
|
| Rate for Payer: Healthfirst Essential Plan |
$3,988.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,684.06
|
| Rate for Payer: Healthfirst QHP |
$1,772.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,240.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,772.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,506.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,240.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,772.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,329.52
|
| Rate for Payer: SOMOS Essential |
$1,329.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,772.69
|
|
|
PR ABLTJ OPN 1/> LVR TUM RF
|
Professional
|
Both
|
$6,501.36
|
|
|
Service Code
|
HCPCS 47380
|
| Min. Negotiated Rate |
$1,203.70 |
| Max. Negotiated Rate |
$3,869.03 |
| Rate for Payer: Cash Price |
$1,734.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,719.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,547.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,547.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,633.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,719.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,633.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,719.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,719.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,289.68
|
| Rate for Payer: Healthfirst Commercial |
$1,719.57
|
| Rate for Payer: Healthfirst Essential Plan |
$3,869.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,633.59
|
| Rate for Payer: Healthfirst QHP |
$1,719.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,203.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,719.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,461.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,203.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,719.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,289.68
|
| Rate for Payer: SOMOS Essential |
$1,289.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,719.57
|
|
|
PR ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL
|
Professional
|
Both
|
$881.79
|
|
|
Service Code
|
HCPCS 30802
|
| Min. Negotiated Rate |
$162.42 |
| Max. Negotiated Rate |
$522.07 |
| Rate for Payer: Cash Price |
$238.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$232.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$208.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$208.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$220.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$232.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$220.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$232.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$232.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$174.02
|
| Rate for Payer: Healthfirst Commercial |
$232.03
|
| Rate for Payer: Healthfirst Essential Plan |
$522.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$220.43
|
| Rate for Payer: Healthfirst QHP |
$232.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$162.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$232.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$197.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$162.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$232.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$174.02
|
| Rate for Payer: SOMOS Essential |
$174.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$232.03
|
|
