|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
Both
|
$626.75
|
|
|
Service Code
|
HCPCS 11442
|
| Min. Negotiated Rate |
$119.75 |
| Max. Negotiated Rate |
$384.91 |
| Rate for Payer: Cash Price |
$172.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$171.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$153.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$171.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$171.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$128.30
|
| Rate for Payer: Healthfirst Commercial |
$171.07
|
| Rate for Payer: Healthfirst Essential Plan |
$384.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$162.52
|
| Rate for Payer: Healthfirst QHP |
$171.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$119.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$171.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$145.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$119.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$171.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$128.30
|
| Rate for Payer: SOMOS Essential |
$128.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$171.07
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Professional
|
Both
|
$763.14
|
|
|
Service Code
|
HCPCS 11443
|
| Min. Negotiated Rate |
$146.24 |
| Max. Negotiated Rate |
$470.07 |
| Rate for Payer: Cash Price |
$209.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$208.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$188.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$198.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$208.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$198.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$208.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$208.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$156.69
|
| Rate for Payer: Healthfirst Commercial |
$208.92
|
| Rate for Payer: Healthfirst Essential Plan |
$470.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$198.47
|
| Rate for Payer: Healthfirst QHP |
$208.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$146.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$208.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$177.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$146.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$208.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$156.69
|
| Rate for Payer: SOMOS Essential |
$156.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$208.92
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Professional
|
Both
|
$964.11
|
|
|
Service Code
|
HCPCS 11444
|
| Min. Negotiated Rate |
$185.19 |
| Max. Negotiated Rate |
$595.24 |
| Rate for Payer: Cash Price |
$262.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$264.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$238.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$238.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$251.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$264.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$251.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$264.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$198.41
|
| Rate for Payer: Healthfirst Commercial |
$264.55
|
| Rate for Payer: Healthfirst Essential Plan |
$595.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$251.32
|
| Rate for Payer: Healthfirst QHP |
$264.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$185.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$264.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$224.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$185.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$264.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$198.41
|
| Rate for Payer: SOMOS Essential |
$198.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$264.55
|
|
|
PR EXC B9 TUM/CST MAXL XTR-ORAL OSTEOT&PRTL MAXLC
|
Professional
|
Both
|
$4,875.01
|
|
|
Service Code
|
HCPCS 21049
|
| Min. Negotiated Rate |
$920.07 |
| Max. Negotiated Rate |
$2,957.38 |
| Rate for Payer: Cash Price |
$1,319.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,314.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,182.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,182.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,248.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,314.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,248.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,314.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,314.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$985.79
|
| Rate for Payer: Healthfirst Commercial |
$1,314.39
|
| Rate for Payer: Healthfirst Essential Plan |
$2,957.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,248.67
|
| Rate for Payer: Healthfirst QHP |
$1,314.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$920.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,314.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,117.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$920.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,314.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$985.79
|
| Rate for Payer: SOMOS Essential |
$985.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,314.39
|
|
|
PR EXC B9 TUM/CST MNDBL XTR-ORAL OSTEOT&PRTL MNDB
|
Professional
|
Both
|
$5,134.40
|
|
|
Service Code
|
HCPCS 21047
|
| Min. Negotiated Rate |
$969.44 |
| Max. Negotiated Rate |
$3,116.07 |
| Rate for Payer: Cash Price |
$1,388.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,384.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,246.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,246.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,315.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,384.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,315.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,384.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,384.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,038.69
|
| Rate for Payer: Healthfirst Commercial |
$1,384.92
|
| Rate for Payer: Healthfirst Essential Plan |
$3,116.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,315.67
|
| Rate for Payer: Healthfirst QHP |
$1,384.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$969.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,384.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,177.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$969.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,384.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,038.69
|
| Rate for Payer: SOMOS Essential |
$1,038.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,384.92
|
|
|
PR EXC BARTHOLINS GLAND/CYST
|
Professional
|
Both
|
$1,378.97
|
|
|
Service Code
|
HCPCS 56740
|
| Min. Negotiated Rate |
$255.59 |
| Max. Negotiated Rate |
$821.54 |
| Rate for Payer: Cash Price |
$371.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$365.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$328.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$328.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$346.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$365.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$346.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$365.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$365.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$273.85
|
| Rate for Payer: Healthfirst Commercial |
$365.13
|
| Rate for Payer: Healthfirst Essential Plan |
$821.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$346.87
|
| Rate for Payer: Healthfirst QHP |
$365.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$255.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$365.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$310.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$255.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$365.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$273.85
|
| Rate for Payer: SOMOS Essential |
$273.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$365.13
|
|
|
PR EXC BENIGN TUM CRANIAL BONE W/O OPTIC NRV DCMPRN
|
Professional
|
Both
|
$9,570.75
|
|
|
Service Code
|
HCPCS 61563
|
| Min. Negotiated Rate |
$1,748.64 |
| Max. Negotiated Rate |
$5,620.64 |
| Rate for Payer: Cash Price |
$2,523.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,498.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,248.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,248.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,373.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,498.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,373.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,498.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,498.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,873.55
|
| Rate for Payer: Healthfirst Commercial |
$2,498.06
|
| Rate for Payer: Healthfirst Essential Plan |
$5,620.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,373.16
|
| Rate for Payer: Healthfirst QHP |
$2,498.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,748.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,498.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,123.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,748.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,498.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,873.55
|
| Rate for Payer: SOMOS Essential |
$1,873.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,498.06
|
|
|
PR EXC BENIGN TUM CRANIAL BONE W/OPTIC NRV DCMPRN
|
Professional
|
Both
|
$11,622.17
|
|
|
Service Code
|
HCPCS 61564
|
| Min. Negotiated Rate |
$2,122.46 |
| Max. Negotiated Rate |
$6,822.18 |
| Rate for Payer: Cash Price |
$3,060.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,032.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,728.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,728.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,880.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,032.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,880.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,032.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,032.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,274.06
|
| Rate for Payer: Healthfirst Commercial |
$3,032.08
|
| Rate for Payer: Healthfirst Essential Plan |
$6,822.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,880.48
|
| Rate for Payer: Healthfirst QHP |
$3,032.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,122.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,032.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,577.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,122.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,032.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,274.06
|
| Rate for Payer: SOMOS Essential |
$2,274.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,032.08
|
|
|
PR EXC BENIGN TUMOR/CYST MAXL INTRA-ORAL OSTEOT
|
Professional
|
Both
|
$4,192.27
|
|
|
Service Code
|
HCPCS 21048
|
| Min. Negotiated Rate |
$798.93 |
| Max. Negotiated Rate |
$2,567.99 |
| Rate for Payer: Cash Price |
$1,142.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,141.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,027.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,027.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,084.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,141.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,084.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,141.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,141.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$856.00
|
| Rate for Payer: Healthfirst Commercial |
$1,141.33
|
| Rate for Payer: Healthfirst Essential Plan |
$2,567.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,084.26
|
| Rate for Payer: Healthfirst QHP |
$1,141.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$798.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,141.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$970.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$798.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,141.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$856.00
|
| Rate for Payer: SOMOS Essential |
$856.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,141.33
|
|
|
PR EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG
|
Professional
|
Both
|
$1,518.37
|
|
|
Service Code
|
HCPCS 21030
|
| Min. Negotiated Rate |
$292.47 |
| Max. Negotiated Rate |
$940.07 |
| Rate for Payer: Cash Price |
$415.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$417.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$376.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$376.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$396.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$417.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$396.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$417.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$417.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$313.36
|
| Rate for Payer: Healthfirst Commercial |
$417.81
|
| Rate for Payer: Healthfirst Essential Plan |
$940.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$396.92
|
| Rate for Payer: Healthfirst QHP |
$417.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$292.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$417.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$355.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$292.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$417.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$313.36
|
| Rate for Payer: SOMOS Essential |
$313.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$417.81
|
|
|
PR EXC BENIGN TUMOR/CYST MNDBL INTRA-ORAL OSTEOT
|
Professional
|
Both
|
$4,162.38
|
|
|
Service Code
|
HCPCS 21046
|
| Min. Negotiated Rate |
$789.38 |
| Max. Negotiated Rate |
$2,537.30 |
| Rate for Payer: Cash Price |
$1,133.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,127.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,014.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,014.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,071.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,127.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,071.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,127.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,127.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$845.77
|
| Rate for Payer: Healthfirst Commercial |
$1,127.69
|
| Rate for Payer: Healthfirst Essential Plan |
$2,537.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,071.31
|
| Rate for Payer: Healthfirst QHP |
$1,127.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$789.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,127.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$958.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$789.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,127.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$845.77
|
| Rate for Payer: SOMOS Essential |
$845.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,127.69
|
|
|
PR EXC BILE DUX TUM W/WO PRIM RPR INTRAHEPATC
|
Professional
|
Both
|
$9,034.97
|
|
|
Service Code
|
HCPCS 47712
|
| Min. Negotiated Rate |
$1,665.37 |
| Max. Negotiated Rate |
$5,352.98 |
| Rate for Payer: Cash Price |
$2,400.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,379.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,141.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,141.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,260.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,379.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,260.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,379.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,379.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,784.33
|
| Rate for Payer: Healthfirst Commercial |
$2,379.10
|
| Rate for Payer: Healthfirst Essential Plan |
$5,352.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,260.14
|
| Rate for Payer: Healthfirst QHP |
$2,379.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,665.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,379.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,022.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,665.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,379.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,784.33
|
| Rate for Payer: SOMOS Essential |
$1,784.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,379.10
|
|
|
PR EXC BILE DUX TUM W/WO PRIM RPR XTRHEPATC
|
Professional
|
Both
|
$7,028.95
|
|
|
Service Code
|
HCPCS 47711
|
| Min. Negotiated Rate |
$1,292.23 |
| Max. Negotiated Rate |
$4,153.59 |
| Rate for Payer: Cash Price |
$1,871.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,846.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,661.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,661.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,753.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,846.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,753.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,846.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,846.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,384.53
|
| Rate for Payer: Healthfirst Commercial |
$1,846.04
|
| Rate for Payer: Healthfirst Essential Plan |
$4,153.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,753.74
|
| Rate for Payer: Healthfirst QHP |
$1,846.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,292.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,846.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,569.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,292.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,846.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,384.53
|
| Rate for Payer: SOMOS Essential |
$1,384.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,846.04
|
|
|
PR EXC BRANCHIAL CLEFT CYST BELOW SUBQ TISS&/PHRYNX
|
Professional
|
Both
|
$2,354.63
|
|
|
Service Code
|
HCPCS 42815
|
| Min. Negotiated Rate |
$438.31 |
| Max. Negotiated Rate |
$1,408.84 |
| Rate for Payer: Cash Price |
$633.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$626.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$563.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$563.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$594.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$626.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$594.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$626.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$626.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$469.61
|
| Rate for Payer: Healthfirst Commercial |
$626.15
|
| Rate for Payer: Healthfirst Essential Plan |
$1,408.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$594.84
|
| Rate for Payer: Healthfirst QHP |
$626.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$438.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$626.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$532.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$438.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$626.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$469.61
|
| Rate for Payer: SOMOS Essential |
$469.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$626.15
|
|
|
PR EXC BRANCHIAL CLEFT CYST CONFINED SKN&SUBQ TIS
|
Professional
|
Both
|
$1,221.82
|
|
|
Service Code
|
HCPCS 42810
|
| Min. Negotiated Rate |
$232.20 |
| Max. Negotiated Rate |
$746.37 |
| Rate for Payer: Cash Price |
$334.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$331.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$298.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$298.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$315.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$331.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$315.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$331.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$331.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$248.79
|
| Rate for Payer: Healthfirst Commercial |
$331.72
|
| Rate for Payer: Healthfirst Essential Plan |
$746.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$315.13
|
| Rate for Payer: Healthfirst QHP |
$331.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$232.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$331.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$281.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$232.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$331.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$248.79
|
| Rate for Payer: SOMOS Essential |
$248.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$331.72
|
|
|
PR EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Professional
|
Both
|
$2,085.62
|
|
|
Service Code
|
HCPCS 19125
|
| Min. Negotiated Rate |
$390.14 |
| Max. Negotiated Rate |
$1,254.02 |
| Rate for Payer: Cash Price |
$559.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$557.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$501.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$501.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$529.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$557.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$529.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$557.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$418.00
|
| Rate for Payer: Healthfirst Commercial |
$557.34
|
| Rate for Payer: Healthfirst Essential Plan |
$1,254.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$529.47
|
| Rate for Payer: Healthfirst QHP |
$557.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$390.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$557.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$473.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$390.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$557.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$418.00
|
| Rate for Payer: SOMOS Essential |
$418.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$557.34
|
|
|
PR EXC BRST LES PREOP PLMT RAD MARKER OPN EA ADDL
|
Professional
|
Both
|
$722.12
|
|
|
Service Code
|
HCPCS 19126
|
| Min. Negotiated Rate |
$132.51 |
| Max. Negotiated Rate |
$425.93 |
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$189.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$170.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$170.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$179.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$189.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$179.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$189.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$189.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$141.97
|
| Rate for Payer: Healthfirst Commercial |
$189.30
|
| Rate for Payer: Healthfirst Essential Plan |
$425.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$179.84
|
| Rate for Payer: Healthfirst QHP |
$189.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$132.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$189.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$160.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$132.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$189.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$141.97
|
| Rate for Payer: SOMOS Essential |
$141.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$189.30
|
|
|
PR EXC CAROTID BODY TUMOR W EXC CAROTID ARTERY
|
Professional
|
Both
|
$7,336.98
|
|
|
Service Code
|
HCPCS 60605
|
| Min. Negotiated Rate |
$1,342.45 |
| Max. Negotiated Rate |
$4,315.03 |
| Rate for Payer: Cash Price |
$1,942.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,917.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,726.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,726.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,821.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,917.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,821.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,917.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,917.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,438.34
|
| Rate for Payer: Healthfirst Commercial |
$1,917.79
|
| Rate for Payer: Healthfirst Essential Plan |
$4,315.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,821.90
|
| Rate for Payer: Healthfirst QHP |
$1,917.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,342.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,917.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,630.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,342.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,917.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,438.34
|
| Rate for Payer: SOMOS Essential |
$1,438.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,917.79
|
|
|
PR EXC CAROTID BODY TUMOR W/O EXC CAROTID ARTERY
|
Professional
|
Both
|
$6,084.51
|
|
|
Service Code
|
HCPCS 60600
|
| Min. Negotiated Rate |
$1,110.78 |
| Max. Negotiated Rate |
$3,570.37 |
| Rate for Payer: Cash Price |
$1,622.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,586.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,428.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,428.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,507.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,586.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,507.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,586.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,586.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,190.12
|
| Rate for Payer: Healthfirst Commercial |
$1,586.83
|
| Rate for Payer: Healthfirst Essential Plan |
$3,570.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,507.49
|
| Rate for Payer: Healthfirst QHP |
$1,586.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,110.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,586.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,348.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,110.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,586.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,190.12
|
| Rate for Payer: SOMOS Essential |
$1,190.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,586.83
|
|
|
PR EXC CERVICAL STUMP ABDL APPR W/PELVIC FLOOR RPR
|
Professional
|
Both
|
$3,642.66
|
|
|
Service Code
|
HCPCS 57545
|
| Min. Negotiated Rate |
$676.34 |
| Max. Negotiated Rate |
$2,173.95 |
| Rate for Payer: Cash Price |
$980.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$966.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$869.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$869.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$917.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$966.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$917.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$966.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$966.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$724.65
|
| Rate for Payer: Healthfirst Commercial |
$966.20
|
| Rate for Payer: Healthfirst Essential Plan |
$2,173.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$917.89
|
| Rate for Payer: Healthfirst QHP |
$966.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$676.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$966.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$821.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$676.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$966.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$724.65
|
| Rate for Payer: SOMOS Essential |
$724.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$966.20
|
|
|
PR EXC CHALAZION ANES REQ HOSPIZATION SINGLE/MULT
|
Professional
|
Both
|
$1,518.44
|
|
|
Service Code
|
HCPCS 67808
|
| Min. Negotiated Rate |
$290.39 |
| Max. Negotiated Rate |
$933.41 |
| Rate for Payer: Cash Price |
$419.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$414.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$373.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$373.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$394.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$414.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$394.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$414.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$414.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$311.14
|
| Rate for Payer: Healthfirst Commercial |
$414.85
|
| Rate for Payer: Healthfirst Essential Plan |
$933.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$394.11
|
| Rate for Payer: Healthfirst QHP |
$414.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$290.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$414.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$352.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$290.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$414.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$311.14
|
| Rate for Payer: SOMOS Essential |
$311.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$414.85
|
|
|
PR EXC COARCJ AORTA W/L SUBCLAV ART/PROSTC GUSSET
|
Professional
|
Both
|
$5,672.38
|
|
|
Service Code
|
HCPCS 33851
|
| Min. Negotiated Rate |
$1,049.10 |
| Max. Negotiated Rate |
$3,372.10 |
| Rate for Payer: Cash Price |
$1,511.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,498.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,348.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,348.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,423.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,498.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,423.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,498.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,498.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,124.03
|
| Rate for Payer: Healthfirst Commercial |
$1,498.71
|
| Rate for Payer: Healthfirst Essential Plan |
$3,372.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,423.77
|
| Rate for Payer: Healthfirst QHP |
$1,498.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,049.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,498.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,273.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,049.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,498.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,124.03
|
| Rate for Payer: SOMOS Essential |
$1,124.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,498.71
|
|
|
PR EXC COARCJ AORTA W/WO PDA W/DIRECT ANASTOMOSIS
|
Professional
|
Both
|
$5,525.31
|
|
|
Service Code
|
HCPCS 33840
|
| Min. Negotiated Rate |
$1,021.42 |
| Max. Negotiated Rate |
$3,283.13 |
| Rate for Payer: Cash Price |
$1,471.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,459.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,313.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,313.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,386.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,459.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,386.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,459.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,459.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,094.38
|
| Rate for Payer: Healthfirst Commercial |
$1,459.17
|
| Rate for Payer: Healthfirst Essential Plan |
$3,283.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,386.21
|
| Rate for Payer: Healthfirst QHP |
$1,459.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,021.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,459.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,240.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,021.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,459.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,094.38
|
| Rate for Payer: SOMOS Essential |
$1,094.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,459.17
|
|
|
PR EXC COCCYGEAL PR ULC W/COCCYGECTOMY W/FLAP CLSR
|
Professional
|
Both
|
$3,490.59
|
|
|
Service Code
|
HCPCS 15922
|
| Min. Negotiated Rate |
$657.48 |
| Max. Negotiated Rate |
$2,113.34 |
| Rate for Payer: Cash Price |
$942.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$939.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$845.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$845.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$892.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$939.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$892.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$939.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$939.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$704.45
|
| Rate for Payer: Healthfirst Commercial |
$939.26
|
| Rate for Payer: Healthfirst Essential Plan |
$2,113.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$892.30
|
| Rate for Payer: Healthfirst QHP |
$939.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$657.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$939.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$798.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$657.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$939.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$704.45
|
| Rate for Payer: SOMOS Essential |
$704.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$939.26
|
|
|
PR EXC COCCYGEAL PR ULC W/COCCYGECTOMY W/PRIM SUTR
|
Professional
|
Both
|
$2,847.43
|
|
|
Service Code
|
HCPCS 15920
|
| Min. Negotiated Rate |
$534.71 |
| Max. Negotiated Rate |
$1,718.71 |
| Rate for Payer: Cash Price |
$755.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$763.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$687.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$687.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$725.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$763.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$725.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$763.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$763.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$572.90
|
| Rate for Payer: Healthfirst Commercial |
$763.87
|
| Rate for Payer: Healthfirst Essential Plan |
$1,718.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$725.68
|
| Rate for Payer: Healthfirst QHP |
$763.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$534.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$763.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$649.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$534.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$763.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$572.90
|
| Rate for Payer: SOMOS Essential |
$572.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$763.87
|
|
