|
PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R
|
Professional
|
Both
|
$416.33
|
|
|
Service Code
|
HCPCS 93312 26
|
| Min. Negotiated Rate |
$78.87 |
| Max. Negotiated Rate |
$253.51 |
| Rate for Payer: Amida Care Medicaid |
$253.06
|
| Rate for Payer: Cash Price |
$113.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$112.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$101.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$101.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$107.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$112.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$107.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$84.50
|
| Rate for Payer: Healthfirst Commercial |
$112.67
|
| Rate for Payer: Healthfirst Essential Plan |
$253.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$107.04
|
| Rate for Payer: Healthfirst QHP |
$112.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$112.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$95.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$112.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$84.50
|
| Rate for Payer: SOMOS Essential |
$84.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$112.67
|
|
|
PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R
|
Professional
|
Both
|
$985.32
|
|
|
Service Code
|
HCPCS 93312
|
| Min. Negotiated Rate |
$183.96 |
| Max. Negotiated Rate |
$591.30 |
| Rate for Payer: Amida Care Medicaid |
$253.06
|
| Rate for Payer: Cash Price |
$269.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$262.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$236.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$236.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$249.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$262.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$249.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$262.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$262.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$197.10
|
| Rate for Payer: Healthfirst Commercial |
$262.80
|
| Rate for Payer: Healthfirst Essential Plan |
$591.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$249.66
|
| Rate for Payer: Healthfirst QHP |
$262.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$183.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$262.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$223.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$183.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$262.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$197.10
|
| Rate for Payer: SOMOS Essential |
$197.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$262.80
|
|
|
PR ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP
|
Professional
|
Both
|
$172.17
|
|
|
Service Code
|
HCPCS 93307 26
|
| Min. Negotiated Rate |
$32.45 |
| Max. Negotiated Rate |
$154.43 |
| Rate for Payer: Amida Care Medicaid |
$154.43
|
| Rate for Payer: Cash Price |
$46.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.77
|
| Rate for Payer: Healthfirst Commercial |
$46.36
|
| Rate for Payer: Healthfirst Essential Plan |
$104.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.04
|
| Rate for Payer: Healthfirst QHP |
$46.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.77
|
| Rate for Payer: SOMOS Essential |
$34.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.36
|
|
|
PR ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP
|
Professional
|
Both
|
$406.53
|
|
|
Service Code
|
HCPCS 93307 TC
|
| Min. Negotiated Rate |
$75.59 |
| Max. Negotiated Rate |
$242.96 |
| Rate for Payer: Amida Care Medicaid |
$154.43
|
| Rate for Payer: Cash Price |
$111.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$107.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$97.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$97.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.98
|
| Rate for Payer: Healthfirst Commercial |
$107.98
|
| Rate for Payer: Healthfirst Essential Plan |
$242.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$102.58
|
| Rate for Payer: Healthfirst QHP |
$107.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$107.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$91.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$80.98
|
| Rate for Payer: SOMOS Essential |
$80.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.98
|
|
|
PR ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP
|
Professional
|
Both
|
$578.69
|
|
|
Service Code
|
HCPCS 93307
|
| Min. Negotiated Rate |
$108.04 |
| Max. Negotiated Rate |
$347.26 |
| Rate for Payer: Amida Care Medicaid |
$154.43
|
| Rate for Payer: Cash Price |
$157.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$154.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$138.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$138.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$146.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$154.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$146.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$115.75
|
| Rate for Payer: Healthfirst Commercial |
$154.34
|
| Rate for Payer: Healthfirst Essential Plan |
$347.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$146.62
|
| Rate for Payer: Healthfirst QHP |
$154.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$108.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$154.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$131.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$108.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$154.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$115.75
|
| Rate for Payer: SOMOS Essential |
$115.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$154.34
|
|
|
PR ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD
|
Professional
|
Both
|
$418.01
|
|
|
Service Code
|
HCPCS 93308
|
| Min. Negotiated Rate |
$78.36 |
| Max. Negotiated Rate |
$251.89 |
| Rate for Payer: Amida Care Medicaid |
$91.95
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$111.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$100.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$100.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$106.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$111.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$106.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.96
|
| Rate for Payer: Healthfirst Commercial |
$111.95
|
| Rate for Payer: Healthfirst Essential Plan |
$251.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$106.35
|
| Rate for Payer: Healthfirst QHP |
$111.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$111.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$95.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$111.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.96
|
| Rate for Payer: SOMOS Essential |
$83.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.95
|
|
|
PR ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD
|
Professional
|
Both
|
$97.72
|
|
|
Service Code
|
HCPCS 93308 26
|
| Min. Negotiated Rate |
$18.54 |
| Max. Negotiated Rate |
$91.95 |
| Rate for Payer: Amida Care Medicaid |
$91.95
|
| Rate for Payer: Cash Price |
$26.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.86
|
| Rate for Payer: Healthfirst Commercial |
$26.48
|
| Rate for Payer: Healthfirst Essential Plan |
$59.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.16
|
| Rate for Payer: Healthfirst QHP |
$26.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.86
|
| Rate for Payer: SOMOS Essential |
$19.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.48
|
|
|
PR ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD
|
Professional
|
Both
|
$320.29
|
|
|
Service Code
|
HCPCS 93308 TC
|
| Min. Negotiated Rate |
$59.83 |
| Max. Negotiated Rate |
$192.31 |
| Rate for Payer: Amida Care Medicaid |
$91.95
|
| Rate for Payer: Cash Price |
$88.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$76.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$81.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$81.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.10
|
| Rate for Payer: Healthfirst Commercial |
$85.47
|
| Rate for Payer: Healthfirst Essential Plan |
$192.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$81.20
|
| Rate for Payer: Healthfirst QHP |
$85.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$85.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$72.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.10
|
| Rate for Payer: SOMOS Essential |
$64.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.47
|
|
|
PR ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST
|
Professional
|
Both
|
$777.14
|
|
|
Service Code
|
HCPCS 93350
|
| Min. Negotiated Rate |
$145.13 |
| Max. Negotiated Rate |
$466.49 |
| Rate for Payer: Amida Care Medicaid |
$158.42
|
| Rate for Payer: Cash Price |
$213.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$207.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$186.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$186.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$196.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$207.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$196.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$207.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$207.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$155.50
|
| Rate for Payer: Healthfirst Commercial |
$207.33
|
| Rate for Payer: Healthfirst Essential Plan |
$466.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.96
|
| Rate for Payer: Healthfirst QHP |
$207.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$145.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$207.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$176.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$145.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$207.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$155.50
|
| Rate for Payer: SOMOS Essential |
$155.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$207.33
|
|
|
PR ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST
|
Professional
|
Both
|
$267.12
|
|
|
Service Code
|
HCPCS 93350 26
|
| Min. Negotiated Rate |
$51.06 |
| Max. Negotiated Rate |
$164.14 |
| Rate for Payer: Amida Care Medicaid |
$158.42
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$65.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$69.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.71
|
| Rate for Payer: Healthfirst Commercial |
$72.95
|
| Rate for Payer: Healthfirst Essential Plan |
$164.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.30
|
| Rate for Payer: Healthfirst QHP |
$72.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$72.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.71
|
| Rate for Payer: SOMOS Essential |
$54.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.95
|
|
|
PR ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST
|
Professional
|
Both
|
$510.02
|
|
|
Service Code
|
HCPCS 93350 TC
|
| Min. Negotiated Rate |
$94.06 |
| Max. Negotiated Rate |
$302.33 |
| Rate for Payer: Amida Care Medicaid |
$158.42
|
| Rate for Payer: Cash Price |
$139.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$134.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$120.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$120.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$127.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$134.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$127.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$134.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$134.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$100.78
|
| Rate for Payer: Healthfirst Commercial |
$134.37
|
| Rate for Payer: Healthfirst Essential Plan |
$302.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.65
|
| Rate for Payer: Healthfirst QHP |
$134.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$94.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$134.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$114.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$94.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$134.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$100.78
|
| Rate for Payer: SOMOS Essential |
$100.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$134.37
|
|
|
PR ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D
|
Professional
|
Both
|
$825.76
|
|
|
Service Code
|
HCPCS 93306
|
| Min. Negotiated Rate |
$154.53 |
| Max. Negotiated Rate |
$496.69 |
| Rate for Payer: Amida Care Medicaid |
$213.51
|
| Rate for Payer: Cash Price |
$226.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$220.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$198.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$198.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$209.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$220.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$209.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$220.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$220.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.56
|
| Rate for Payer: Healthfirst Commercial |
$220.75
|
| Rate for Payer: Healthfirst Essential Plan |
$496.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.71
|
| Rate for Payer: Healthfirst QHP |
$220.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$154.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$220.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$187.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$154.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$220.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$165.56
|
| Rate for Payer: SOMOS Essential |
$165.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$220.75
|
|
|
PR ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D
|
Professional
|
Both
|
$558.64
|
|
|
Service Code
|
HCPCS 93306 TC
|
| Min. Negotiated Rate |
$103.46 |
| Max. Negotiated Rate |
$332.55 |
| Rate for Payer: Amida Care Medicaid |
$213.51
|
| Rate for Payer: Cash Price |
$152.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$133.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$110.85
|
| Rate for Payer: Healthfirst Commercial |
$147.80
|
| Rate for Payer: Healthfirst Essential Plan |
$332.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$140.41
|
| Rate for Payer: Healthfirst QHP |
$147.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$103.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$125.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$103.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$110.85
|
| Rate for Payer: SOMOS Essential |
$110.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.80
|
|
|
PR ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D
|
Professional
|
Both
|
$267.12
|
|
|
Service Code
|
HCPCS 93306 26
|
| Min. Negotiated Rate |
$51.06 |
| Max. Negotiated Rate |
$213.51 |
| Rate for Payer: Amida Care Medicaid |
$213.51
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$65.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$69.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.71
|
| Rate for Payer: Healthfirst Commercial |
$72.95
|
| Rate for Payer: Healthfirst Essential Plan |
$164.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.30
|
| Rate for Payer: Healthfirst QHP |
$72.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$72.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.71
|
| Rate for Payer: SOMOS Essential |
$54.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.95
|
|
|
PR ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG
|
Professional
|
Both
|
$653.52
|
|
|
Service Code
|
HCPCS 93351 TC
|
| Min. Negotiated Rate |
$121.83 |
| Max. Negotiated Rate |
$391.59 |
| Rate for Payer: Amida Care Medicaid |
$194.63
|
| Rate for Payer: Cash Price |
$179.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$174.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$156.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$156.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$165.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$174.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$165.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$130.53
|
| Rate for Payer: Healthfirst Commercial |
$174.04
|
| Rate for Payer: Healthfirst Essential Plan |
$391.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$165.34
|
| Rate for Payer: Healthfirst QHP |
$174.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$121.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$174.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$147.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$121.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$174.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$130.53
|
| Rate for Payer: SOMOS Essential |
$130.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$174.04
|
|
|
PR ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG
|
Professional
|
Both
|
$976.78
|
|
|
Service Code
|
HCPCS 93351
|
| Min. Negotiated Rate |
$183.04 |
| Max. Negotiated Rate |
$588.33 |
| Rate for Payer: Amida Care Medicaid |
$194.63
|
| Rate for Payer: Cash Price |
$268.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$261.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$235.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$235.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$248.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$261.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$248.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$261.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$261.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$196.11
|
| Rate for Payer: Healthfirst Commercial |
$261.48
|
| Rate for Payer: Healthfirst Essential Plan |
$588.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$248.41
|
| Rate for Payer: Healthfirst QHP |
$261.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$183.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$261.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$222.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$183.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$261.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$196.11
|
| Rate for Payer: SOMOS Essential |
$196.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$261.48
|
|
|
PR ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG
|
Professional
|
Both
|
$323.30
|
|
|
Service Code
|
HCPCS 93351 26
|
| Min. Negotiated Rate |
$61.21 |
| Max. Negotiated Rate |
$196.74 |
| Rate for Payer: Amida Care Medicaid |
$194.63
|
| Rate for Payer: Cash Price |
$88.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$87.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$78.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$78.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$83.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$87.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$83.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.58
|
| Rate for Payer: Healthfirst Commercial |
$87.44
|
| Rate for Payer: Healthfirst Essential Plan |
$196.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$83.07
|
| Rate for Payer: Healthfirst QHP |
$87.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$61.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$87.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$74.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$61.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$87.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$65.58
|
| Rate for Payer: SOMOS Essential |
$65.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.44
|
|
|
PR ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS
|
Professional
|
Both
|
$1,015.60
|
|
|
Service Code
|
HCPCS 33948
|
| Min. Negotiated Rate |
$190.19 |
| Max. Negotiated Rate |
$611.33 |
| Rate for Payer: Cash Price |
$271.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$271.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$244.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$244.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$258.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$271.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$258.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$271.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$271.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$203.78
|
| Rate for Payer: Healthfirst Commercial |
$271.70
|
| Rate for Payer: Healthfirst Essential Plan |
$611.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$258.12
|
| Rate for Payer: Healthfirst QHP |
$271.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$190.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$271.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$230.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$190.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$271.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$203.78
|
| Rate for Payer: SOMOS Essential |
$203.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$271.70
|
|
|
PR ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL
|
Professional
|
Both
|
$982.59
|
|
|
Service Code
|
HCPCS 33949
|
| Min. Negotiated Rate |
$185.65 |
| Max. Negotiated Rate |
$596.72 |
| Rate for Payer: Cash Price |
$266.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$265.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$238.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$238.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$251.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$265.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$251.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$265.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$265.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$198.91
|
| Rate for Payer: Healthfirst Commercial |
$265.21
|
| Rate for Payer: Healthfirst Essential Plan |
$596.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$251.95
|
| Rate for Payer: Healthfirst QHP |
$265.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$185.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$265.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$225.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$185.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$265.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$198.91
|
| Rate for Payer: SOMOS Essential |
$198.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$265.21
|
|
|
PR ECMO/ECLS ECLS REPOS CENTRAL CNULA 6YRS & OLDER
|
Professional
|
Both
|
$2,166.40
|
|
|
Service Code
|
HCPCS 33964
|
| Min. Negotiated Rate |
$396.45 |
| Max. Negotiated Rate |
$1,274.31 |
| Rate for Payer: Cash Price |
$573.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$566.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$509.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$509.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$538.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$566.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$538.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$566.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$566.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$424.77
|
| Rate for Payer: Healthfirst Commercial |
$566.36
|
| Rate for Payer: Healthfirst Essential Plan |
$1,274.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$538.04
|
| Rate for Payer: Healthfirst QHP |
$566.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$396.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$566.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$481.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$396.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$566.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$424.77
|
| Rate for Payer: SOMOS Essential |
$424.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$566.36
|
|
|
PR ECMO/ECLS INITIATION VENO-ARTERIAL
|
Professional
|
Both
|
$1,496.78
|
|
|
Service Code
|
HCPCS 33947
|
| Min. Negotiated Rate |
$277.24 |
| Max. Negotiated Rate |
$891.11 |
| Rate for Payer: Cash Price |
$398.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$396.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$356.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$356.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$376.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$396.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$376.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$396.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$297.04
|
| Rate for Payer: Healthfirst Commercial |
$396.05
|
| Rate for Payer: Healthfirst Essential Plan |
$891.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$376.25
|
| Rate for Payer: Healthfirst QHP |
$396.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$277.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$396.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$336.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$277.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$396.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$297.04
|
| Rate for Payer: SOMOS Essential |
$297.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$396.05
|
|
|
PR ECMO/ECLS INITIATION VENO-VENOUS
|
Professional
|
Both
|
$1,350.97
|
|
|
Service Code
|
HCPCS 33946
|
| Min. Negotiated Rate |
$249.36 |
| Max. Negotiated Rate |
$801.52 |
| Rate for Payer: Cash Price |
$359.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$356.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$320.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$320.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$338.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$356.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$338.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$356.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$356.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$267.17
|
| Rate for Payer: Healthfirst Commercial |
$356.23
|
| Rate for Payer: Healthfirst Essential Plan |
$801.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$338.42
|
| Rate for Payer: Healthfirst QHP |
$356.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$249.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$356.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$302.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$249.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$356.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$267.17
|
| Rate for Payer: SOMOS Essential |
$267.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$356.23
|
|
|
PR ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER
|
Professional
|
Both
|
$3,698.49
|
|
|
Service Code
|
HCPCS 33956
|
| Min. Negotiated Rate |
$676.23 |
| Max. Negotiated Rate |
$2,173.59 |
| Rate for Payer: Cash Price |
$980.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$966.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$869.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$869.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$917.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$966.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$917.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$966.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$966.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$724.53
|
| Rate for Payer: Healthfirst Commercial |
$966.04
|
| Rate for Payer: Healthfirst Essential Plan |
$2,173.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$917.74
|
| Rate for Payer: Healthfirst QHP |
$966.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$676.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$966.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$821.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$676.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$966.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$724.53
|
| Rate for Payer: SOMOS Essential |
$724.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$966.04
|
|
|
PR ECMO/ECLS INSJ OF CENTRAL CANNULA BIRTH-5 YRS
|
Professional
|
Both
|
$3,633.14
|
|
|
Service Code
|
HCPCS 33955
|
| Min. Negotiated Rate |
$666.04 |
| Max. Negotiated Rate |
$2,140.83 |
| Rate for Payer: Cash Price |
$961.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$951.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$856.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$856.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$903.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$951.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$903.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$951.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$951.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$713.61
|
| Rate for Payer: Healthfirst Commercial |
$951.48
|
| Rate for Payer: Healthfirst Essential Plan |
$2,140.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$903.91
|
| Rate for Payer: Healthfirst QHP |
$951.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$666.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$951.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$808.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$666.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$951.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$713.61
|
| Rate for Payer: SOMOS Essential |
$713.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$951.48
|
|
|
PR ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER OPEN
|
Professional
|
Both
|
$2,096.82
|
|
|
Service Code
|
HCPCS 33954
|
| Min. Negotiated Rate |
$386.30 |
| Max. Negotiated Rate |
$1,241.66 |
| Rate for Payer: Cash Price |
$557.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$551.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$496.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$496.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$524.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$551.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$524.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$551.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$551.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$413.89
|
| Rate for Payer: Healthfirst Commercial |
$551.85
|
| Rate for Payer: Healthfirst Essential Plan |
$1,241.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$524.26
|
| Rate for Payer: Healthfirst QHP |
$551.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$386.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$551.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$469.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$386.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$551.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$413.89
|
| Rate for Payer: SOMOS Essential |
$413.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$551.85
|
|
