|
PR CARE MAN HOME CARE PLAN 30 M
|
Professional
|
Both
|
$308.98
|
|
|
Service Code
|
HCPCS G0086
|
| Min. Negotiated Rate |
$58.11 |
| Max. Negotiated Rate |
$186.77 |
| Rate for Payer: Cash Price |
$84.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$83.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$78.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$83.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$78.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.26
|
| Rate for Payer: Healthfirst Commercial |
$83.01
|
| Rate for Payer: Healthfirst Essential Plan |
$186.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$78.86
|
| Rate for Payer: Healthfirst QHP |
$83.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$83.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$83.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62.26
|
| Rate for Payer: SOMOS Essential |
$62.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$83.01
|
|
|
PR CARE MAN HOME CARE PLAN 60 M
|
Professional
|
Both
|
$430.50
|
|
|
Service Code
|
HCPCS G0087
|
| Min. Negotiated Rate |
$81.26 |
| Max. Negotiated Rate |
$261.18 |
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$116.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$104.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$104.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$110.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$116.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$110.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$116.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$116.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$87.06
|
| Rate for Payer: Healthfirst Commercial |
$116.08
|
| Rate for Payer: Healthfirst Essential Plan |
$261.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.28
|
| Rate for Payer: Healthfirst QHP |
$116.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$81.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$116.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$98.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$81.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$116.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$87.06
|
| Rate for Payer: SOMOS Essential |
$87.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$116.08
|
|
|
PR CARE MAN H V EXT PT 20 MI
|
Professional
|
Both
|
$190.82
|
|
|
Service Code
|
HCPCS G0081
|
| Min. Negotiated Rate |
$36.99 |
| Max. Negotiated Rate |
$118.89 |
| Rate for Payer: Cash Price |
$53.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.63
|
| Rate for Payer: Healthfirst Commercial |
$52.84
|
| Rate for Payer: Healthfirst Essential Plan |
$118.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.20
|
| Rate for Payer: Healthfirst QHP |
$52.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.63
|
| Rate for Payer: SOMOS Essential |
$39.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.84
|
|
|
PR CARE MAN H V EXT PT 30 M
|
Professional
|
Both
|
$313.60
|
|
|
Service Code
|
HCPCS G0082
|
| Min. Negotiated Rate |
$60.37 |
| Max. Negotiated Rate |
$194.04 |
| Rate for Payer: Cash Price |
$86.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$86.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$77.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$81.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$86.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$81.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.68
|
| Rate for Payer: Healthfirst Commercial |
$86.24
|
| Rate for Payer: Healthfirst Essential Plan |
$194.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$81.93
|
| Rate for Payer: Healthfirst QHP |
$86.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$60.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$86.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$73.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$60.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.68
|
| Rate for Payer: SOMOS Essential |
$64.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.24
|
|
|
PR CARE MAN H V EXT PT 45 M
|
Professional
|
Both
|
$505.09
|
|
|
Service Code
|
HCPCS G0083
|
| Min. Negotiated Rate |
$95.44 |
| Max. Negotiated Rate |
$306.79 |
| Rate for Payer: Cash Price |
$138.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$136.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$122.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$122.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$129.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$136.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$129.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.26
|
| Rate for Payer: Healthfirst Commercial |
$136.35
|
| Rate for Payer: Healthfirst Essential Plan |
$306.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$129.53
|
| Rate for Payer: Healthfirst QHP |
$136.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$95.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$136.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$115.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$95.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$136.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.26
|
| Rate for Payer: SOMOS Essential |
$102.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$136.35
|
|
|
PR CARE MAN H V EXT PT 60 M
|
Professional
|
Both
|
$716.42
|
|
|
Service Code
|
HCPCS G0084
|
| Min. Negotiated Rate |
$134.42 |
| Max. Negotiated Rate |
$432.07 |
| Rate for Payer: Cash Price |
$195.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$192.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$172.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$182.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$192.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$182.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$192.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$192.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$144.02
|
| Rate for Payer: Healthfirst Commercial |
$192.03
|
| Rate for Payer: Healthfirst Essential Plan |
$432.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$182.43
|
| Rate for Payer: Healthfirst QHP |
$192.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$134.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$192.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$163.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$134.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$192.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$144.02
|
| Rate for Payer: SOMOS Essential |
$144.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$192.03
|
|
|
PR CARE MAN H V EXT PT 75 M
|
Professional
|
Both
|
$846.62
|
|
|
Service Code
|
HCPCS G0085
|
| Min. Negotiated Rate |
$159.99 |
| Max. Negotiated Rate |
$514.24 |
| Rate for Payer: Cash Price |
$232.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$228.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$205.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$205.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$217.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$228.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$217.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$228.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$228.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$171.41
|
| Rate for Payer: Healthfirst Commercial |
$228.55
|
| Rate for Payer: Healthfirst Essential Plan |
$514.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$217.12
|
| Rate for Payer: Healthfirst QHP |
$228.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$159.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$228.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$194.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$159.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$228.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$171.41
|
| Rate for Payer: SOMOS Essential |
$171.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$228.55
|
|
|
PR CARE MGMT SERVICES BEHAVIORAL HLTH COND 20 MINS
|
Professional
|
Both
|
$118.97
|
|
|
Service Code
|
HCPCS 99484
|
| Min. Negotiated Rate |
$32.74 |
| Max. Negotiated Rate |
$105.23 |
| Rate for Payer: Cash Price |
$48.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.08
|
| Rate for Payer: Healthfirst Commercial |
$46.77
|
| Rate for Payer: Healthfirst Essential Plan |
$105.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.43
|
| Rate for Payer: Healthfirst QHP |
$46.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.08
|
| Rate for Payer: SOMOS Essential |
$35.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.77
|
|
|
PR CARINAL RECONSTRUCTION
|
Professional
|
Both
|
$7,907.38
|
|
|
Service Code
|
HCPCS 31766
|
| Min. Negotiated Rate |
$1,456.88 |
| Max. Negotiated Rate |
$4,682.84 |
| Rate for Payer: Cash Price |
$2,102.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,081.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,873.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,873.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,977.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,081.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,977.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,081.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,081.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,560.94
|
| Rate for Payer: Healthfirst Commercial |
$2,081.26
|
| Rate for Payer: Healthfirst Essential Plan |
$4,682.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,977.20
|
| Rate for Payer: Healthfirst QHP |
$2,081.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,456.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,081.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,769.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,456.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,081.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,560.94
|
| Rate for Payer: SOMOS Essential |
$1,560.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,081.26
|
|
|
PR CAR OUTP MEAS DRG CAR CATH EVAL CGEN HRT DEFECT
|
Professional
|
Both
|
$271.81
|
|
|
Service Code
|
HCPCS 93598 26
|
| Min. Negotiated Rate |
$48.69 |
| Max. Negotiated Rate |
$156.49 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$69.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$66.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$69.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$66.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$69.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$69.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.16
|
| Rate for Payer: Healthfirst Commercial |
$69.55
|
| Rate for Payer: Healthfirst Essential Plan |
$156.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$66.07
|
| Rate for Payer: Healthfirst QHP |
$69.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$69.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$59.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$69.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$52.16
|
| Rate for Payer: SOMOS Essential |
$52.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69.55
|
|
|
PR CARPECTOMY 1 BONE
|
Professional
|
Both
|
$2,185.44
|
|
|
Service Code
|
HCPCS 25210
|
| Min. Negotiated Rate |
$415.25 |
| Max. Negotiated Rate |
$1,334.74 |
| Rate for Payer: Cash Price |
$595.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$593.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$533.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$533.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$563.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$593.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$563.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$593.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$593.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$444.92
|
| Rate for Payer: Healthfirst Commercial |
$593.22
|
| Rate for Payer: Healthfirst Essential Plan |
$1,334.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$563.56
|
| Rate for Payer: Healthfirst QHP |
$593.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$415.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$593.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$504.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$415.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$593.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$444.92
|
| Rate for Payer: SOMOS Essential |
$444.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$593.22
|
|
|
PR CARPECTOMY ALL BONES PROXIMAL ROW
|
Professional
|
Both
|
$2,740.82
|
|
|
Service Code
|
HCPCS 25215
|
| Min. Negotiated Rate |
$519.53 |
| Max. Negotiated Rate |
$1,669.93 |
| Rate for Payer: Cash Price |
$743.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$742.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$667.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$667.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$705.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$742.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$705.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$742.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$742.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$556.64
|
| Rate for Payer: Healthfirst Commercial |
$742.19
|
| Rate for Payer: Healthfirst Essential Plan |
$1,669.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$705.08
|
| Rate for Payer: Healthfirst QHP |
$742.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$519.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$742.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$630.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$519.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$742.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$556.64
|
| Rate for Payer: SOMOS Essential |
$556.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$742.19
|
|
|
PR CAR SEAT/BED TEST INFT THRU 12 MO 60 MIN
|
Professional
|
Both
|
$96.95
|
|
|
Service Code
|
HCPCS 94780
|
| Min. Negotiated Rate |
$17.49 |
| Max. Negotiated Rate |
$56.23 |
| Rate for Payer: Cash Price |
$25.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.74
|
| Rate for Payer: Healthfirst Commercial |
$24.99
|
| Rate for Payer: Healthfirst Essential Plan |
$56.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.74
|
| Rate for Payer: Healthfirst QHP |
$24.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.74
|
| Rate for Payer: SOMOS Essential |
$18.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.99
|
|
|
PR CAR SEAT/BED TEST INFT THRU 12 MO EA ADDL 30 MIN
|
Professional
|
Both
|
$32.66
|
|
|
Service Code
|
HCPCS 94781
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.60
|
| Rate for Payer: Healthfirst Commercial |
$8.80
|
| Rate for Payer: Healthfirst Essential Plan |
$19.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.36
|
| Rate for Payer: Healthfirst QHP |
$8.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.60
|
| Rate for Payer: SOMOS Essential |
$6.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.80
|
|
|
PR CARTILAGE GRAFT COSTOCHONDRAL
|
Professional
|
Both
|
$2,105.95
|
|
|
Service Code
|
HCPCS 20910
|
| Min. Negotiated Rate |
$400.75 |
| Max. Negotiated Rate |
$1,288.12 |
| Rate for Payer: Cash Price |
$574.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$572.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$515.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$515.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$543.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$572.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$543.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$572.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$572.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$429.38
|
| Rate for Payer: Healthfirst Commercial |
$572.50
|
| Rate for Payer: Healthfirst Essential Plan |
$1,288.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$543.88
|
| Rate for Payer: Healthfirst QHP |
$572.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$400.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$572.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$486.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$400.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$572.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$429.38
|
| Rate for Payer: SOMOS Essential |
$429.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$572.50
|
|
|
PR CARTILAGE GRAFT NASAL SEPTUM
|
Professional
|
Both
|
$2,087.75
|
|
|
Service Code
|
HCPCS 20912
|
| Min. Negotiated Rate |
$394.60 |
| Max. Negotiated Rate |
$1,268.35 |
| Rate for Payer: Cash Price |
$569.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$563.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$507.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$507.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$535.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$563.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$535.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$563.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$563.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$422.78
|
| Rate for Payer: Healthfirst Commercial |
$563.71
|
| Rate for Payer: Healthfirst Essential Plan |
$1,268.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$535.52
|
| Rate for Payer: Healthfirst QHP |
$563.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$394.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$563.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$479.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$394.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$563.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$422.78
|
| Rate for Payer: SOMOS Essential |
$422.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$563.71
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Professional
|
Both
|
$235.94
|
|
|
Service Code
|
HCPCS G0104
|
| Min. Negotiated Rate |
$45.56 |
| Max. Negotiated Rate |
$146.43 |
| Rate for Payer: Cash Price |
$65.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$65.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$61.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.81
|
| Rate for Payer: Healthfirst Commercial |
$65.08
|
| Rate for Payer: Healthfirst Essential Plan |
$146.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.83
|
| Rate for Payer: Healthfirst QHP |
$65.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.81
|
| Rate for Payer: SOMOS Essential |
$48.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.08
|
|
|
PR CA SCREEN;PELVIC/BREAST EXAM
|
Professional
|
Both
|
$118.65
|
|
|
Service Code
|
HCPCS G0101
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$69.44 |
| Rate for Payer: Cash Price |
$31.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.14
|
| Rate for Payer: Healthfirst Commercial |
$30.86
|
| Rate for Payer: Healthfirst Essential Plan |
$69.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.32
|
| Rate for Payer: Healthfirst QHP |
$30.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$30.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.14
|
| Rate for Payer: SOMOS Essential |
$23.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.86
|
|
|
PR CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX
|
Professional
|
Both
|
$314.58
|
|
|
Service Code
|
HCPCS 31725
|
| Min. Negotiated Rate |
$60.49 |
| Max. Negotiated Rate |
$194.44 |
| Rate for Payer: Cash Price |
$86.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$86.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$77.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$82.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$86.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$82.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.81
|
| Rate for Payer: Healthfirst Commercial |
$86.42
|
| Rate for Payer: Healthfirst Essential Plan |
$194.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$82.10
|
| Rate for Payer: Healthfirst QHP |
$86.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$60.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$86.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$73.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$60.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.81
|
| Rate for Payer: SOMOS Essential |
$64.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.42
|
|
|
PR CATHETER ASPIRATION NASOTRACHEAL SPX
|
Professional
|
Both
|
$196.35
|
|
|
Service Code
|
HCPCS 31720
|
| Min. Negotiated Rate |
$41.90 |
| Max. Negotiated Rate |
$134.66 |
| Rate for Payer: Cash Price |
$53.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$59.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.89
|
| Rate for Payer: Healthfirst Commercial |
$59.85
|
| Rate for Payer: Healthfirst Essential Plan |
$134.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.86
|
| Rate for Payer: Healthfirst QHP |
$59.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.89
|
| Rate for Payer: SOMOS Essential |
$44.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.85
|
|
|
PR CATHETERIZATION UMBILICAL NEWBORN ART DX/THERAPY
|
Professional
|
Both
|
$276.01
|
|
|
Service Code
|
HCPCS 36660
|
| Min. Negotiated Rate |
$51.95 |
| Max. Negotiated Rate |
$166.97 |
| Rate for Payer: Cash Price |
$75.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$74.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$66.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$66.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$74.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.66
|
| Rate for Payer: Healthfirst Commercial |
$74.21
|
| Rate for Payer: Healthfirst Essential Plan |
$166.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.50
|
| Rate for Payer: Healthfirst QHP |
$74.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$74.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$55.66
|
| Rate for Payer: SOMOS Essential |
$55.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.21
|
|
|
PR CATHETERIZATION W/BRONCHIAL BRUSH BIOPSY
|
Professional
|
Both
|
$431.20
|
|
|
Service Code
|
HCPCS 31717
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$259.06 |
| Rate for Payer: Cash Price |
$117.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$115.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$103.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$103.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$109.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$115.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$109.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$115.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$115.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$86.36
|
| Rate for Payer: Healthfirst Commercial |
$115.14
|
| Rate for Payer: Healthfirst Essential Plan |
$259.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$109.38
|
| Rate for Payer: Healthfirst QHP |
$115.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$80.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$115.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$97.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$80.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$115.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$86.36
|
| Rate for Payer: SOMOS Essential |
$86.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$115.14
|
|
|
PR CATHJ UMBILICAL VEIN DX/THER NB
|
Professional
|
Both
|
$215.92
|
|
|
Service Code
|
HCPCS 36510
|
| Min. Negotiated Rate |
$39.91 |
| Max. Negotiated Rate |
$128.27 |
| Rate for Payer: Cash Price |
$58.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$57.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$51.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$54.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$57.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$54.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.76
|
| Rate for Payer: Healthfirst Commercial |
$57.01
|
| Rate for Payer: Healthfirst Essential Plan |
$128.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$54.16
|
| Rate for Payer: Healthfirst QHP |
$57.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$57.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.76
|
| Rate for Payer: SOMOS Essential |
$42.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57.01
|
|
|
PR CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I
|
Professional
|
Both
|
$1,019.97
|
|
|
Service Code
|
HCPCS 93454 26
|
| Min. Negotiated Rate |
$188.75 |
| Max. Negotiated Rate |
$606.71 |
| Rate for Payer: Amida Care Medicaid |
$422.34
|
| Rate for Payer: Cash Price |
$273.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$269.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$242.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$242.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$256.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$269.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$256.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$269.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$269.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$202.24
|
| Rate for Payer: Healthfirst Commercial |
$269.65
|
| Rate for Payer: Healthfirst Essential Plan |
$606.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$256.17
|
| Rate for Payer: Healthfirst QHP |
$269.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$188.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$269.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$229.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$188.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$269.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$202.24
|
| Rate for Payer: SOMOS Essential |
$202.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$269.65
|
|
|
PR CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I
|
Professional
|
Both
|
$3,926.02
|
|
|
Service Code
|
HCPCS 93454
|
| Min. Negotiated Rate |
$422.34 |
| Max. Negotiated Rate |
$2,257.67 |
| Rate for Payer: Amida Care Medicaid |
$422.34
|
| Rate for Payer: Cash Price |
$1,051.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,003.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$903.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$903.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$953.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,003.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$953.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,003.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,003.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$752.56
|
| Rate for Payer: Healthfirst Commercial |
$1,003.41
|
| Rate for Payer: Healthfirst Essential Plan |
$2,257.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$953.24
|
| Rate for Payer: Healthfirst QHP |
$1,003.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$702.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,003.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$852.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$702.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,003.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$752.56
|
| Rate for Payer: SOMOS Essential |
$752.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,003.41
|
|
