|
PR EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM
|
Professional
|
Both
|
$1,467.66
|
|
|
Service Code
|
HCPCS 26115
|
| Min. Negotiated Rate |
$280.48 |
| Max. Negotiated Rate |
$901.55 |
| Rate for Payer: Cash Price |
$400.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$400.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$360.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$360.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$380.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$400.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$380.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$400.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$400.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$300.52
|
| Rate for Payer: Healthfirst Commercial |
$400.69
|
| Rate for Payer: Healthfirst Essential Plan |
$901.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$380.66
|
| Rate for Payer: Healthfirst QHP |
$400.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$280.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$400.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$340.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$280.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$400.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$300.52
|
| Rate for Payer: SOMOS Essential |
$300.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$400.69
|
|
|
PR EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM
|
Professional
|
Both
|
$2,320.50
|
|
|
Service Code
|
HCPCS 26116
|
| Min. Negotiated Rate |
$441.21 |
| Max. Negotiated Rate |
$1,418.17 |
| Rate for Payer: Cash Price |
$630.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$630.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$567.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$567.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$598.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$630.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$598.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$630.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$630.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$472.73
|
| Rate for Payer: Healthfirst Commercial |
$630.30
|
| Rate for Payer: Healthfirst Essential Plan |
$1,418.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$598.78
|
| Rate for Payer: Healthfirst QHP |
$630.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$441.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$630.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$535.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$441.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$630.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$472.73
|
| Rate for Payer: SOMOS Essential |
$472.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$630.30
|
|
|
PR EXC URACHAL CYST/SINUS W/WO UMBILICAL HERNIA RPR
|
Professional
|
Both
|
$2,673.93
|
|
|
Service Code
|
HCPCS 51500
|
| Min. Negotiated Rate |
$510.73 |
| Max. Negotiated Rate |
$1,641.62 |
| Rate for Payer: Cash Price |
$732.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$729.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$656.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$656.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$693.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$729.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$693.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$729.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$547.21
|
| Rate for Payer: Healthfirst Commercial |
$729.61
|
| Rate for Payer: Healthfirst Essential Plan |
$1,641.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$693.13
|
| Rate for Payer: Healthfirst QHP |
$729.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$510.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$729.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$620.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$510.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$729.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$547.21
|
| Rate for Payer: SOMOS Essential |
$547.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$729.61
|
|
|
PR EXC URETHRAL DIVERTICULUM SPX FEMALE
|
Professional
|
Both
|
$2,578.14
|
|
|
Service Code
|
HCPCS 53230
|
| Min. Negotiated Rate |
$490.90 |
| Max. Negotiated Rate |
$1,577.88 |
| Rate for Payer: Cash Price |
$706.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$701.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$631.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$631.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$666.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$701.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$666.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$701.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$701.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$525.96
|
| Rate for Payer: Healthfirst Commercial |
$701.28
|
| Rate for Payer: Healthfirst Essential Plan |
$1,577.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$666.22
|
| Rate for Payer: Healthfirst QHP |
$701.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$490.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$701.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$596.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$490.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$701.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$525.96
|
| Rate for Payer: SOMOS Essential |
$525.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$701.28
|
|
|
PR EXC URETHRAL DIVERTICULUM SPX MALE
|
Professional
|
Both
|
$2,659.37
|
|
|
Service Code
|
HCPCS 53235
|
| Min. Negotiated Rate |
$508.03 |
| Max. Negotiated Rate |
$1,632.96 |
| Rate for Payer: Cash Price |
$729.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$725.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$653.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$653.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$689.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$725.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$689.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$725.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$725.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$544.32
|
| Rate for Payer: Healthfirst Commercial |
$725.76
|
| Rate for Payer: Healthfirst Essential Plan |
$1,632.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$689.47
|
| Rate for Payer: Healthfirst QHP |
$725.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$508.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$725.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$616.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$508.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$725.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$544.32
|
| Rate for Payer: SOMOS Essential |
$544.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$725.76
|
|
|
PR EXC VARICOCELE/LIGATION SPERMATIC VEINS ABDL
|
Professional
|
Both
|
$1,811.60
|
|
|
Service Code
|
HCPCS 55535
|
| Min. Negotiated Rate |
$345.90 |
| Max. Negotiated Rate |
$1,111.84 |
| Rate for Payer: Cash Price |
$497.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$494.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$444.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$444.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$469.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$494.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$469.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$494.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$494.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$370.61
|
| Rate for Payer: Healthfirst Commercial |
$494.15
|
| Rate for Payer: Healthfirst Essential Plan |
$1,111.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$469.44
|
| Rate for Payer: Healthfirst QHP |
$494.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$345.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$494.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$420.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$345.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$494.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$370.61
|
| Rate for Payer: SOMOS Essential |
$370.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$494.15
|
|
|
PR EXC VARICOCELE/LIGATION SPERMATIC VEINS SPX
|
Professional
|
Both
|
$1,487.99
|
|
|
Service Code
|
HCPCS 55530
|
| Min. Negotiated Rate |
$284.04 |
| Max. Negotiated Rate |
$912.98 |
| Rate for Payer: Cash Price |
$408.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$405.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$365.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$365.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$385.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$405.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$385.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$405.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$405.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$304.33
|
| Rate for Payer: Healthfirst Commercial |
$405.77
|
| Rate for Payer: Healthfirst Essential Plan |
$912.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$385.48
|
| Rate for Payer: Healthfirst QHP |
$405.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$284.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$405.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$344.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$284.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$405.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$304.33
|
| Rate for Payer: SOMOS Essential |
$304.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$405.77
|
|
|
PR EXC VARICOCELE/LIGATION VEINS W/HERNIA RPR
|
Professional
|
Both
|
$2,511.43
|
|
|
Service Code
|
HCPCS 55540
|
| Min. Negotiated Rate |
$468.66 |
| Max. Negotiated Rate |
$1,506.40 |
| Rate for Payer: Cash Price |
$672.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$669.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$602.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$602.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$636.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$669.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$636.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$669.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$669.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$502.13
|
| Rate for Payer: Healthfirst Commercial |
$669.51
|
| Rate for Payer: Healthfirst Essential Plan |
$1,506.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$636.03
|
| Rate for Payer: Healthfirst QHP |
$669.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$468.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$669.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$569.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$468.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$669.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$502.13
|
| Rate for Payer: SOMOS Essential |
$502.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$669.51
|
|
|
PR EXC XTNSR TDN W/IMPLTJ SYNTH ROD DLYD GRF H/F EA
|
Professional
|
Both
|
$3,786.30
|
|
|
Service Code
|
HCPCS 26415
|
| Min. Negotiated Rate |
$700.84 |
| Max. Negotiated Rate |
$2,252.70 |
| Rate for Payer: Cash Price |
$1,018.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,001.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$901.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$901.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$951.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,001.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$951.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,001.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,001.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$750.90
|
| Rate for Payer: Healthfirst Commercial |
$1,001.20
|
| Rate for Payer: Healthfirst Essential Plan |
$2,252.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$951.14
|
| Rate for Payer: Healthfirst QHP |
$1,001.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$700.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,001.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$851.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$700.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,001.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$750.90
|
| Rate for Payer: SOMOS Essential |
$750.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,001.20
|
|
|
PR EXC XTRPARENCHYMAL LESION TESTIS
|
Professional
|
Both
|
$2,258.31
|
|
|
Service Code
|
HCPCS 54512
|
| Min. Negotiated Rate |
$432.07 |
| Max. Negotiated Rate |
$1,388.79 |
| Rate for Payer: Cash Price |
$620.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$617.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$555.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$555.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$586.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$617.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$586.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$617.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$617.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$462.93
|
| Rate for Payer: Healthfirst Commercial |
$617.24
|
| Rate for Payer: Healthfirst Essential Plan |
$1,388.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$586.38
|
| Rate for Payer: Healthfirst QHP |
$617.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$432.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$617.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$524.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$432.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$617.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$462.93
|
| Rate for Payer: SOMOS Essential |
$462.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$617.24
|
|
|
PR EXENTERATION ORBIT REMVL ORBITAL CONTENTS ONLY
|
Professional
|
Both
|
$5,503.23
|
|
|
Service Code
|
HCPCS 65110
|
| Min. Negotiated Rate |
$1,033.11 |
| Max. Negotiated Rate |
$3,320.71 |
| Rate for Payer: Cash Price |
$1,506.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,475.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,328.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,328.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,402.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,475.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,402.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,475.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,475.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,106.90
|
| Rate for Payer: Healthfirst Commercial |
$1,475.87
|
| Rate for Payer: Healthfirst Essential Plan |
$3,320.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,402.08
|
| Rate for Payer: Healthfirst QHP |
$1,475.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,033.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,475.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,254.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,033.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,475.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,106.90
|
| Rate for Payer: SOMOS Essential |
$1,106.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,475.87
|
|
|
PR EXENTERATION ORBIT RMVL ORBIT CONTENTS & BONE
|
Professional
|
Both
|
$6,289.40
|
|
|
Service Code
|
HCPCS 65112
|
| Min. Negotiated Rate |
$1,183.92 |
| Max. Negotiated Rate |
$3,805.45 |
| Rate for Payer: Cash Price |
$1,723.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,691.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,522.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,522.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,606.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,691.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,606.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,691.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,691.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,268.48
|
| Rate for Payer: Healthfirst Commercial |
$1,691.31
|
| Rate for Payer: Healthfirst Essential Plan |
$3,805.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,606.74
|
| Rate for Payer: Healthfirst QHP |
$1,691.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,183.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,691.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,437.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,183.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,691.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,268.48
|
| Rate for Payer: SOMOS Essential |
$1,268.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,691.31
|
|
|
PR EXISION OF SUBLINGUAL GLAND
|
Professional
|
Both
|
$1,581.72
|
|
|
Service Code
|
HCPCS 42450
|
| Min. Negotiated Rate |
$298.22 |
| Max. Negotiated Rate |
$958.57 |
| Rate for Payer: Cash Price |
$429.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$426.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$383.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$383.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$404.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$426.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$404.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$426.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$426.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$319.52
|
| Rate for Payer: Healthfirst Commercial |
$426.03
|
| Rate for Payer: Healthfirst Essential Plan |
$958.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$404.73
|
| Rate for Payer: Healthfirst QHP |
$426.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$298.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$426.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$362.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$298.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$426.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$319.52
|
| Rate for Payer: SOMOS Essential |
$319.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$426.03
|
|
|
PR EXNTJ ORBIT RMVL ORB CNTS W/MUSC/MYOQ FLAP
|
Professional
|
Both
|
$6,568.49
|
|
|
Service Code
|
HCPCS 65114
|
| Min. Negotiated Rate |
$1,234.97 |
| Max. Negotiated Rate |
$3,969.56 |
| Rate for Payer: Cash Price |
$1,797.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,764.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,587.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,587.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,676.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,764.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,676.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,764.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,764.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,323.19
|
| Rate for Payer: Healthfirst Commercial |
$1,764.25
|
| Rate for Payer: Healthfirst Essential Plan |
$3,969.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,676.04
|
| Rate for Payer: Healthfirst QHP |
$1,764.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,234.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,764.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,499.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,234.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,764.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,323.19
|
| Rate for Payer: SOMOS Essential |
$1,323.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,764.25
|
|
|
PR EXPL CONGENITAL ATRESIA BILE DUCTS
|
Professional
|
Both
|
$4,792.27
|
|
|
Service Code
|
HCPCS 47700
|
| Min. Negotiated Rate |
$886.93 |
| Max. Negotiated Rate |
$2,850.84 |
| Rate for Payer: Cash Price |
$1,278.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,267.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,140.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,140.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,203.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,267.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,203.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,267.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,267.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$950.28
|
| Rate for Payer: Healthfirst Commercial |
$1,267.04
|
| Rate for Payer: Healthfirst Essential Plan |
$2,850.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,203.69
|
| Rate for Payer: Healthfirst QHP |
$1,267.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$886.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,267.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,076.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$886.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,267.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$950.28
|
| Rate for Payer: SOMOS Essential |
$950.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,267.04
|
|
|
PR EXPLORATION EPIDIDYMIS W/WO BIOPSY
|
Professional
|
Both
|
$1,519.53
|
|
|
Service Code
|
HCPCS 54865
|
| Min. Negotiated Rate |
$291.32 |
| Max. Negotiated Rate |
$936.38 |
| Rate for Payer: Cash Price |
$417.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$416.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$374.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$374.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$395.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$416.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$395.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$416.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$416.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$312.13
|
| Rate for Payer: Healthfirst Commercial |
$416.17
|
| Rate for Payer: Healthfirst Essential Plan |
$936.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$395.36
|
| Rate for Payer: Healthfirst QHP |
$416.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$291.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$416.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$353.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$291.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$416.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$312.13
|
| Rate for Payer: SOMOS Essential |
$312.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$416.17
|
|
|
PR EXPLORATION N/FLWD SURG LOWER EXTREMITY ARTERY
|
Professional
|
Both
|
$1,846.71
|
|
|
Service Code
|
HCPCS 35703
|
| Min. Negotiated Rate |
$341.56 |
| Max. Negotiated Rate |
$1,097.89 |
| Rate for Payer: Cash Price |
$489.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$487.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$439.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$439.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$463.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$487.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$463.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$487.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$487.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$365.96
|
| Rate for Payer: Healthfirst Commercial |
$487.95
|
| Rate for Payer: Healthfirst Essential Plan |
$1,097.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$463.55
|
| Rate for Payer: Healthfirst QHP |
$487.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$341.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$487.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$414.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$341.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$487.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$365.96
|
| Rate for Payer: SOMOS Essential |
$365.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$487.95
|
|
|
PR EXPLORATION N/FLWD SURG NECK ARTERY
|
Professional
|
Both
|
$1,904.84
|
|
|
Service Code
|
HCPCS 35701
|
| Min. Negotiated Rate |
$354.86 |
| Max. Negotiated Rate |
$1,140.62 |
| Rate for Payer: Cash Price |
$508.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$506.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$456.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$456.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$481.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$506.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$481.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$506.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$506.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$380.20
|
| Rate for Payer: Healthfirst Commercial |
$506.94
|
| Rate for Payer: Healthfirst Essential Plan |
$1,140.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$481.59
|
| Rate for Payer: Healthfirst QHP |
$506.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$354.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$506.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$430.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$354.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$506.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$380.20
|
| Rate for Payer: SOMOS Essential |
$380.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$506.94
|
|
|
PR EXPLORATION N/FLWD SURG UPPER EXTREMITY ARTERY
|
Professional
|
Both
|
$1,818.32
|
|
|
Service Code
|
HCPCS 35702
|
| Min. Negotiated Rate |
$336.06 |
| Max. Negotiated Rate |
$1,080.20 |
| Rate for Payer: Cash Price |
$482.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$480.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$432.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$432.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$456.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$480.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$456.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$480.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$480.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$360.07
|
| Rate for Payer: Healthfirst Commercial |
$480.09
|
| Rate for Payer: Healthfirst Essential Plan |
$1,080.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$456.09
|
| Rate for Payer: Healthfirst QHP |
$480.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$336.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$480.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$408.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$336.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$480.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$360.07
|
| Rate for Payer: SOMOS Essential |
$360.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$480.09
|
|
|
PR EXPLORATION PENETRATING WOUND SPX CHEST
|
Professional
|
Both
|
$945.46
|
|
|
Service Code
|
HCPCS 20101
|
| Min. Negotiated Rate |
$175.32 |
| Max. Negotiated Rate |
$563.53 |
| Rate for Payer: Cash Price |
$252.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$250.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$225.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$225.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$237.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$250.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$237.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$250.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$187.84
|
| Rate for Payer: Healthfirst Commercial |
$250.46
|
| Rate for Payer: Healthfirst Essential Plan |
$563.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$237.94
|
| Rate for Payer: Healthfirst QHP |
$250.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$175.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$250.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$212.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$175.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$250.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$187.84
|
| Rate for Payer: SOMOS Essential |
$187.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$250.46
|
|
|
PR EXPLORATION PENETRATING WOUND SPX EXTREMITY
|
Professional
|
Both
|
$1,509.10
|
|
|
Service Code
|
HCPCS 20103
|
| Min. Negotiated Rate |
$282.90 |
| Max. Negotiated Rate |
$909.32 |
| Rate for Payer: Cash Price |
$408.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$404.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$363.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$363.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$383.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$404.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$383.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$404.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$404.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$303.11
|
| Rate for Payer: Healthfirst Commercial |
$404.14
|
| Rate for Payer: Healthfirst Essential Plan |
$909.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$383.93
|
| Rate for Payer: Healthfirst QHP |
$404.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$282.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$404.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$343.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$282.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$404.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$303.11
|
| Rate for Payer: SOMOS Essential |
$303.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$404.14
|
|
|
PR EXPLORATION PENETRATING WOUND SPX NECK
|
Professional
|
Both
|
$2,648.03
|
|
|
Service Code
|
HCPCS 20100
|
| Min. Negotiated Rate |
$493.86 |
| Max. Negotiated Rate |
$1,587.42 |
| Rate for Payer: Cash Price |
$712.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$705.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$634.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$634.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$670.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$705.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$670.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$705.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$705.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$529.14
|
| Rate for Payer: Healthfirst Commercial |
$705.52
|
| Rate for Payer: Healthfirst Essential Plan |
$1,587.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$670.24
|
| Rate for Payer: Healthfirst QHP |
$705.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$493.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$705.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$599.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$493.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$705.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$529.14
|
| Rate for Payer: SOMOS Essential |
$529.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$705.52
|
|
|
PR EXPLORATION SPINAL FUSION
|
Professional
|
Both
|
$3,776.33
|
|
|
Service Code
|
HCPCS 22830
|
| Min. Negotiated Rate |
$704.62 |
| Max. Negotiated Rate |
$2,264.85 |
| Rate for Payer: Cash Price |
$1,012.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,006.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$905.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$905.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$956.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,006.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$956.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,006.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,006.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$754.95
|
| Rate for Payer: Healthfirst Commercial |
$1,006.60
|
| Rate for Payer: Healthfirst Essential Plan |
$2,264.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$956.27
|
| Rate for Payer: Healthfirst QHP |
$1,006.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$704.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,006.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$855.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$704.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,006.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$754.95
|
| Rate for Payer: SOMOS Essential |
$754.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,006.60
|
|
|
PR EXPLORATORY LAPAROTOMY CELIOTOMY W/WO BIOPSY SPX
|
Professional
|
Both
|
$3,443.79
|
|
|
Service Code
|
HCPCS 49000
|
| Min. Negotiated Rate |
$641.00 |
| Max. Negotiated Rate |
$2,060.35 |
| Rate for Payer: Cash Price |
$920.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$915.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$824.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$824.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$869.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$915.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$869.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$915.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$915.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$686.78
|
| Rate for Payer: Healthfirst Commercial |
$915.71
|
| Rate for Payer: Healthfirst Essential Plan |
$2,060.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$869.92
|
| Rate for Payer: Healthfirst QHP |
$915.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$641.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$915.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$778.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$641.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$915.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$686.78
|
| Rate for Payer: SOMOS Essential |
$686.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$915.71
|
|
|
PR EXPL ORBIT TRANSCRANIAL APPROACH W/RMVL LESION
|
Professional
|
Both
|
$9,741.83
|
|
|
Service Code
|
HCPCS 61333
|
| Min. Negotiated Rate |
$1,779.18 |
| Max. Negotiated Rate |
$5,718.80 |
| Rate for Payer: Cash Price |
$2,566.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,541.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,287.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,287.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,414.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,541.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,414.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,541.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,541.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,906.27
|
| Rate for Payer: Healthfirst Commercial |
$2,541.69
|
| Rate for Payer: Healthfirst Essential Plan |
$5,718.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,414.61
|
| Rate for Payer: Healthfirst QHP |
$2,541.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,779.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,541.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,160.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,779.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,541.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,906.27
|
| Rate for Payer: SOMOS Essential |
$1,906.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,541.69
|
|
