|
PR EXC/CURTG CST/B9 TUM TARSAL/METAR W/ILIAC/AGRFT
|
Professional
|
Both
|
$1,752.28
|
|
|
Service Code
|
HCPCS 28106
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$1,090.19 |
| Rate for Payer: Cash Price |
$485.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$484.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$436.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$436.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$460.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$484.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$460.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$484.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$484.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$363.40
|
| Rate for Payer: Healthfirst Commercial |
$484.53
|
| Rate for Payer: Healthfirst Essential Plan |
$1,090.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$460.30
|
| Rate for Payer: Healthfirst QHP |
$484.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$339.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$484.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$411.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$339.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$484.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$363.40
|
| Rate for Payer: SOMOS Essential |
$363.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$484.53
|
|
|
PR EXC/CURTG CYST/TUMOR CARPAL BONES W/ALLOGRAFT
|
Professional
|
Both
|
$2,220.93
|
|
|
Service Code
|
HCPCS 25136
|
| Min. Negotiated Rate |
$420.76 |
| Max. Negotiated Rate |
$1,352.45 |
| Rate for Payer: Cash Price |
$602.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$601.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$540.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$540.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$571.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$601.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$571.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$601.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$601.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$450.82
|
| Rate for Payer: Healthfirst Commercial |
$601.09
|
| Rate for Payer: Healthfirst Essential Plan |
$1,352.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$571.04
|
| Rate for Payer: Healthfirst QHP |
$601.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$420.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$601.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$510.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$420.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$601.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$450.82
|
| Rate for Payer: SOMOS Essential |
$450.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$601.09
|
|
|
PR EXC/CURTG CYST/TUMOR CARPAL BONES W/AUTOGRAFT
|
Professional
|
Both
|
$2,491.69
|
|
|
Service Code
|
HCPCS 25135
|
| Min. Negotiated Rate |
$474.10 |
| Max. Negotiated Rate |
$1,523.88 |
| Rate for Payer: Cash Price |
$679.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$677.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$609.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$609.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$643.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$677.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$643.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$677.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$677.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$507.96
|
| Rate for Payer: Healthfirst Commercial |
$677.28
|
| Rate for Payer: Healthfirst Essential Plan |
$1,523.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$643.42
|
| Rate for Payer: Healthfirst QHP |
$677.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$474.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$677.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$575.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$474.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$677.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$507.96
|
| Rate for Payer: SOMOS Essential |
$507.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$677.28
|
|
|
PR EXC/CURTG CYST/TUMOR RADIUS/ULNA W/ALLOGRAFT
|
Professional
|
Both
|
$2,669.87
|
|
|
Service Code
|
HCPCS 25126
|
| Min. Negotiated Rate |
$504.99 |
| Max. Negotiated Rate |
$1,623.17 |
| Rate for Payer: Cash Price |
$724.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$721.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$649.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$649.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$685.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$721.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$685.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$721.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$721.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$541.06
|
| Rate for Payer: Healthfirst Commercial |
$721.41
|
| Rate for Payer: Healthfirst Essential Plan |
$1,623.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$685.34
|
| Rate for Payer: Healthfirst QHP |
$721.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$504.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$721.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$613.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$504.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$721.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$541.06
|
| Rate for Payer: SOMOS Essential |
$541.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$721.41
|
|
|
PR EXC/CURTG CYST/TUMOR RADIUS/ULNA W/AUTOGRAFT
|
Professional
|
Both
|
$2,652.62
|
|
|
Service Code
|
HCPCS 25125
|
| Min. Negotiated Rate |
$501.77 |
| Max. Negotiated Rate |
$1,612.85 |
| Rate for Payer: Cash Price |
$719.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$716.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$645.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$645.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$680.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$716.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$680.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$716.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$716.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$537.62
|
| Rate for Payer: Healthfirst Commercial |
$716.82
|
| Rate for Payer: Healthfirst Essential Plan |
$1,612.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$680.98
|
| Rate for Payer: Healthfirst QHP |
$716.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$501.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$716.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$609.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$501.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$716.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$537.62
|
| Rate for Payer: SOMOS Essential |
$537.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$716.82
|
|
|
PR EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION
|
Professional
|
Both
|
$1,880.10
|
|
|
Service Code
|
HCPCS 19120
|
| Min. Negotiated Rate |
$352.11 |
| Max. Negotiated Rate |
$1,131.80 |
| Rate for Payer: Cash Price |
$505.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$503.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$452.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$452.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$477.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$503.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$477.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$503.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$503.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$377.26
|
| Rate for Payer: Healthfirst Commercial |
$503.02
|
| Rate for Payer: Healthfirst Essential Plan |
$1,131.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$477.87
|
| Rate for Payer: Healthfirst QHP |
$503.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$352.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$503.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$427.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$352.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$503.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$377.26
|
| Rate for Payer: SOMOS Essential |
$377.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$503.02
|
|
|
PR EXC CYST/ADENOMA THYROID/TRANSECTION ISTHMUS
|
Professional
|
Both
|
$2,963.59
|
|
|
Service Code
|
HCPCS 60200
|
| Min. Negotiated Rate |
$552.92 |
| Max. Negotiated Rate |
$1,777.25 |
| Rate for Payer: Cash Price |
$797.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$789.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$710.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$710.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$750.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$789.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$750.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$789.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$789.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$592.42
|
| Rate for Payer: Healthfirst Commercial |
$789.89
|
| Rate for Payer: Healthfirst Essential Plan |
$1,777.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$750.40
|
| Rate for Payer: Healthfirst QHP |
$789.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$552.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$789.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$671.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$552.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$789.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$592.42
|
| Rate for Payer: SOMOS Essential |
$592.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$789.89
|
|
|
PR EXC DERMOID CYST NOSE COMPLEX UNDER BONE/CRTLG
|
Professional
|
Both
|
$2,860.34
|
|
|
Service Code
|
HCPCS 30125
|
| Min. Negotiated Rate |
$525.90 |
| Max. Negotiated Rate |
$1,690.38 |
| Rate for Payer: Cash Price |
$771.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$751.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$676.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$676.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$713.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$751.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$713.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$751.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$751.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$563.46
|
| Rate for Payer: Healthfirst Commercial |
$751.28
|
| Rate for Payer: Healthfirst Essential Plan |
$1,690.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$713.72
|
| Rate for Payer: Healthfirst QHP |
$751.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$525.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$751.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$638.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$525.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$751.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$563.46
|
| Rate for Payer: SOMOS Essential |
$563.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$751.28
|
|
|
PR EXC/DESTRUCTION OPEN ABDMNL TUMORS 5.1-10.0 CM
|
Professional
|
Both
|
$6,759.10
|
|
|
Service Code
|
HCPCS 49204
|
| Rate for Payer: Cash Price |
$1,812.64
|
|
|
PR EXC/DESTRUCTION OPEN ABDOMINAL TUMORS >10.0 CM
|
Professional
|
Both
|
$7,767.83
|
|
|
Service Code
|
HCPCS 49205
|
| Rate for Payer: Cash Price |
$2,080.66
|
|
|
PR EXC/DSTRJ LINGUAL TONSIL ANY METHOD SPX
|
Professional
|
Both
|
$2,557.77
|
|
|
Service Code
|
HCPCS 42870
|
| Min. Negotiated Rate |
$476.93 |
| Max. Negotiated Rate |
$1,532.99 |
| Rate for Payer: Cash Price |
$690.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$681.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$613.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$613.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$647.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$681.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$647.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$681.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$681.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$511.00
|
| Rate for Payer: Healthfirst Commercial |
$681.33
|
| Rate for Payer: Healthfirst Essential Plan |
$1,532.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$647.26
|
| Rate for Payer: Healthfirst QHP |
$681.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$476.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$681.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$579.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$476.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$681.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$511.00
|
| Rate for Payer: SOMOS Essential |
$511.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$681.33
|
|
|
PR EXC EXCESSIVE SKIN &SUBQ TISSUE FOREARM/HAND
|
Professional
|
Both
|
$3,131.56
|
|
|
Service Code
|
HCPCS 15837
|
| Min. Negotiated Rate |
$591.58 |
| Max. Negotiated Rate |
$1,901.52 |
| Rate for Payer: Cash Price |
$846.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$845.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$760.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$760.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$802.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$845.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$802.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$845.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$845.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$633.84
|
| Rate for Payer: Healthfirst Commercial |
$845.12
|
| Rate for Payer: Healthfirst Essential Plan |
$1,901.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$802.86
|
| Rate for Payer: Healthfirst QHP |
$845.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$591.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$845.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$718.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$591.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$845.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$633.84
|
| Rate for Payer: SOMOS Essential |
$633.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$845.12
|
|
|
PR EXC EXCSV SKIN & SUBQ TISSUE SUBMENTAL FAT PAD
|
Professional
|
Both
|
$2,840.95
|
|
|
Service Code
|
HCPCS 15838
|
| Min. Negotiated Rate |
$536.97 |
| Max. Negotiated Rate |
$1,725.97 |
| Rate for Payer: Cash Price |
$768.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$767.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$690.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$690.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$728.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$767.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$728.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$767.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$767.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$575.33
|
| Rate for Payer: Healthfirst Commercial |
$767.10
|
| Rate for Payer: Healthfirst Essential Plan |
$1,725.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$728.75
|
| Rate for Payer: Healthfirst QHP |
$767.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$536.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$767.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$652.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$536.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$767.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$575.33
|
| Rate for Payer: SOMOS Essential |
$575.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$767.10
|
|
|
PR EXC FIBROUS TUBEROSITIES DENTOALVEOLAR STRUXS
|
Professional
|
Both
|
$879.38
|
|
|
Service Code
|
HCPCS 41822
|
| Min. Negotiated Rate |
$168.39 |
| Max. Negotiated Rate |
$541.26 |
| Rate for Payer: Cash Price |
$238.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$240.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$216.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$216.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$228.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$240.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$228.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$240.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$240.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$180.42
|
| Rate for Payer: Healthfirst Commercial |
$240.56
|
| Rate for Payer: Healthfirst Essential Plan |
$541.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$228.53
|
| Rate for Payer: Healthfirst QHP |
$240.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$168.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$240.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$204.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$168.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$240.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$180.42
|
| Rate for Payer: SOMOS Essential |
$180.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$240.56
|
|
|
PR EXC FLXR TDN W/IMPLTJ SYNTH ROD DLYD TDN GRF H/F
|
Professional
|
Both
|
$3,907.37
|
|
|
Service Code
|
HCPCS 26390
|
| Min. Negotiated Rate |
$723.75 |
| Max. Negotiated Rate |
$2,326.34 |
| Rate for Payer: Cash Price |
$1,050.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,033.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$930.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$930.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$982.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,033.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$982.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,033.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,033.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$775.45
|
| Rate for Payer: Healthfirst Commercial |
$1,033.93
|
| Rate for Payer: Healthfirst Essential Plan |
$2,326.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$982.23
|
| Rate for Payer: Healthfirst QHP |
$1,033.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$723.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,033.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$878.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$723.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,033.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$775.45
|
| Rate for Payer: SOMOS Essential |
$775.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,033.93
|
|
|
PR EXC FRENUM LABIAL/BUCCAL
|
Professional
|
Both
|
$835.87
|
|
|
Service Code
|
HCPCS 40819
|
| Min. Negotiated Rate |
$162.59 |
| Max. Negotiated Rate |
$522.61 |
| Rate for Payer: Cash Price |
$230.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$232.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$209.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$220.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$232.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$220.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$232.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$232.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$174.20
|
| Rate for Payer: Healthfirst Commercial |
$232.27
|
| Rate for Payer: Healthfirst Essential Plan |
$522.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$220.66
|
| Rate for Payer: Healthfirst QHP |
$232.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$162.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$232.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$197.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$162.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$232.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$174.20
|
| Rate for Payer: SOMOS Essential |
$174.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$232.27
|
|
|
PR EXC/FULGURATION CARCINOMA URETHRA
|
Professional
|
Both
|
$1,900.40
|
|
|
Service Code
|
HCPCS 53220
|
| Min. Negotiated Rate |
$362.48 |
| Max. Negotiated Rate |
$1,165.12 |
| Rate for Payer: Cash Price |
$521.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$517.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$466.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$466.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$491.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$517.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$491.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$517.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$517.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$388.37
|
| Rate for Payer: Healthfirst Commercial |
$517.83
|
| Rate for Payer: Healthfirst Essential Plan |
$1,165.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$491.94
|
| Rate for Payer: Healthfirst QHP |
$517.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$362.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$517.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$440.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$362.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$517.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$388.37
|
| Rate for Payer: SOMOS Essential |
$388.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$517.83
|
|
|
PR EXC/FULGURATION URETHRAL CARUNCLE
|
Professional
|
Both
|
$806.37
|
|
|
Service Code
|
HCPCS 53265
|
| Min. Negotiated Rate |
$153.73 |
| Max. Negotiated Rate |
$494.12 |
| Rate for Payer: Cash Price |
$219.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$219.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$197.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$197.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$208.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$219.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$208.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$219.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$219.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$164.71
|
| Rate for Payer: Healthfirst Commercial |
$219.61
|
| Rate for Payer: Healthfirst Essential Plan |
$494.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$208.63
|
| Rate for Payer: Healthfirst QHP |
$219.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$153.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$219.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$186.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$153.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$219.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$164.71
|
| Rate for Payer: SOMOS Essential |
$164.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$219.61
|
|
|
PR EXC/FULGURATION URETHRAL POLYP DSTL URETHRA
|
Professional
|
Both
|
$772.00
|
|
|
Service Code
|
HCPCS 53260
|
| Min. Negotiated Rate |
$146.67 |
| Max. Negotiated Rate |
$471.44 |
| Rate for Payer: Cash Price |
$210.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$209.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$188.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$199.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$209.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$199.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$157.15
|
| Rate for Payer: Healthfirst Commercial |
$209.53
|
| Rate for Payer: Healthfirst Essential Plan |
$471.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$199.05
|
| Rate for Payer: Healthfirst QHP |
$209.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$146.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$209.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$178.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$146.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$209.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$157.15
|
| Rate for Payer: SOMOS Essential |
$157.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$209.53
|
|
|
PR EXCHANGE BILIARY DRG CATHETER PRQ W/IMG GID RS&I
|
Professional
|
Both
|
$536.03
|
|
|
Service Code
|
HCPCS 47536
|
| Min. Negotiated Rate |
$101.95 |
| Max. Negotiated Rate |
$327.71 |
| Rate for Payer: Cash Price |
$145.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$145.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$131.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$131.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$138.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$145.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$138.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$145.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$145.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$109.24
|
| Rate for Payer: Healthfirst Commercial |
$145.65
|
| Rate for Payer: Healthfirst Essential Plan |
$327.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$138.37
|
| Rate for Payer: Healthfirst QHP |
$145.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$101.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$145.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$123.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$101.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$145.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$109.24
|
| Rate for Payer: SOMOS Essential |
$109.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$145.65
|
|
|
PR EXCHANGE INTRAOCULAR LENS
|
Professional
|
Both
|
$3,704.89
|
|
|
Service Code
|
HCPCS 66986
|
| Min. Negotiated Rate |
$703.67 |
| Max. Negotiated Rate |
$2,261.79 |
| Rate for Payer: Cash Price |
$1,020.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,005.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$904.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$904.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$954.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,005.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$954.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,005.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,005.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$753.93
|
| Rate for Payer: Healthfirst Commercial |
$1,005.24
|
| Rate for Payer: Healthfirst Essential Plan |
$2,261.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$954.98
|
| Rate for Payer: Healthfirst QHP |
$1,005.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$703.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,005.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$854.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$703.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,005.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$753.93
|
| Rate for Payer: SOMOS Essential |
$753.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,005.24
|
|
|
PR EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMG GID RS&I
|
Professional
|
Both
|
$410.76
|
|
|
Service Code
|
HCPCS 50435
|
| Min. Negotiated Rate |
$77.22 |
| Max. Negotiated Rate |
$248.20 |
| Rate for Payer: Cash Price |
$111.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$110.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$99.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$99.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$104.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$110.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$104.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.73
|
| Rate for Payer: Healthfirst Commercial |
$110.31
|
| Rate for Payer: Healthfirst Essential Plan |
$248.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$104.79
|
| Rate for Payer: Healthfirst QHP |
$110.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$77.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$110.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$93.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$77.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$110.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.73
|
| Rate for Payer: SOMOS Essential |
$82.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$110.31
|
|
|
PR EXCHNG ABSC/CST DRG CATH RAD GID SPX
|
Professional
|
Both
|
$294.07
|
|
|
Service Code
|
HCPCS 49423
|
| Min. Negotiated Rate |
$54.35 |
| Max. Negotiated Rate |
$174.71 |
| Rate for Payer: Cash Price |
$78.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$77.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$69.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$69.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$73.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$77.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$73.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.24
|
| Rate for Payer: Healthfirst Commercial |
$77.65
|
| Rate for Payer: Healthfirst Essential Plan |
$174.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.77
|
| Rate for Payer: Healthfirst QHP |
$77.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$54.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$77.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$66.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$54.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$77.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$58.24
|
| Rate for Payer: SOMOS Essential |
$58.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$77.65
|
|
|
PR EXC HYDROCELE SPRMATIC CORD UNI SPX
|
Professional
|
Both
|
$1,682.10
|
|
|
Service Code
|
HCPCS 55500
|
| Min. Negotiated Rate |
$317.83 |
| Max. Negotiated Rate |
$1,021.61 |
| Rate for Payer: Cash Price |
$457.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$454.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$408.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$408.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$431.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$454.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$431.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$454.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$454.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$340.54
|
| Rate for Payer: Healthfirst Commercial |
$454.05
|
| Rate for Payer: Healthfirst Essential Plan |
$1,021.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$431.35
|
| Rate for Payer: Healthfirst QHP |
$454.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$317.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$454.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$385.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$317.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$454.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$340.54
|
| Rate for Payer: SOMOS Essential |
$340.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$454.05
|
|
|
PR EXC HYPRPLSTC ALVEOLAR MUCOSA EA QUADRANT SPEC
|
Professional
|
Both
|
$970.55
|
|
|
Service Code
|
HCPCS 41828
|
| Min. Negotiated Rate |
$183.69 |
| Max. Negotiated Rate |
$590.42 |
| Rate for Payer: Cash Price |
$261.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$262.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$236.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$236.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$249.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$262.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$249.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$262.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$262.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$196.81
|
| Rate for Payer: Healthfirst Commercial |
$262.41
|
| Rate for Payer: Healthfirst Essential Plan |
$590.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$249.29
|
| Rate for Payer: Healthfirst QHP |
$262.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$183.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$262.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$223.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$183.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$262.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$196.81
|
| Rate for Payer: SOMOS Essential |
$196.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$262.41
|
|
