|
PR INCISION FLEXOR TENDON SHEATH WRIST
|
Professional
|
Both
|
$1,534.61
|
|
|
Service Code
|
HCPCS 25001
|
| Min. Negotiated Rate |
$296.01 |
| Max. Negotiated Rate |
$951.46 |
| Rate for Payer: Cash Price |
$421.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$422.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$380.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$380.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$401.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$422.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$401.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$422.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$422.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$317.15
|
| Rate for Payer: Healthfirst Commercial |
$422.87
|
| Rate for Payer: Healthfirst Essential Plan |
$951.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$401.73
|
| Rate for Payer: Healthfirst QHP |
$422.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$296.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$422.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$359.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$296.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$422.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$317.15
|
| Rate for Payer: SOMOS Essential |
$317.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$422.87
|
|
|
PR INCISION LABIAL FRENUM FRENOTOMY
|
Professional
|
Both
|
$123.10
|
|
|
Service Code
|
HCPCS 40806
|
| Min. Negotiated Rate |
$24.42 |
| Max. Negotiated Rate |
$78.50 |
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.17
|
| Rate for Payer: Healthfirst Commercial |
$34.89
|
| Rate for Payer: Healthfirst Essential Plan |
$78.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.15
|
| Rate for Payer: Healthfirst QHP |
$34.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.17
|
| Rate for Payer: SOMOS Essential |
$26.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.89
|
|
|
PR INCISION LEG/ANKLE
|
Professional
|
Both
|
$2,601.20
|
|
|
Service Code
|
HCPCS 27607
|
| Min. Negotiated Rate |
$494.63 |
| Max. Negotiated Rate |
$1,589.89 |
| Rate for Payer: Cash Price |
$711.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$706.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$635.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$635.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$671.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$706.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$671.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$706.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$706.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$529.97
|
| Rate for Payer: Healthfirst Commercial |
$706.62
|
| Rate for Payer: Healthfirst Essential Plan |
$1,589.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$671.29
|
| Rate for Payer: Healthfirst QHP |
$706.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$494.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$706.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$600.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$494.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$706.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$529.97
|
| Rate for Payer: SOMOS Essential |
$529.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$706.62
|
|
|
PR INCISION LINGUAL FRENUM FRENOTOMY
|
Professional
|
Both
|
$478.80
|
|
|
Service Code
|
HCPCS 41010
|
| Min. Negotiated Rate |
$89.39 |
| Max. Negotiated Rate |
$287.32 |
| Rate for Payer: Cash Price |
$129.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$114.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$114.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$121.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$121.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.78
|
| Rate for Payer: Healthfirst Commercial |
$127.70
|
| Rate for Payer: Healthfirst Essential Plan |
$287.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$121.31
|
| Rate for Payer: Healthfirst QHP |
$127.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$89.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$127.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$108.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$89.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$95.78
|
| Rate for Payer: SOMOS Essential |
$95.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.70
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMP
|
Professional
|
Both
|
$784.98
|
|
|
Service Code
|
HCPCS 10121
|
| Min. Negotiated Rate |
$148.70 |
| Max. Negotiated Rate |
$477.97 |
| Rate for Payer: Cash Price |
$214.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$212.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$191.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$191.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$201.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$212.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$201.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$212.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$159.32
|
| Rate for Payer: Healthfirst Commercial |
$212.43
|
| Rate for Payer: Healthfirst Essential Plan |
$477.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$201.81
|
| Rate for Payer: Healthfirst QHP |
$212.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$148.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$212.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$180.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$148.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$212.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$159.32
|
| Rate for Payer: SOMOS Essential |
$159.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$212.43
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Professional
|
Both
|
$450.87
|
|
|
Service Code
|
HCPCS 10120
|
| Min. Negotiated Rate |
$85.63 |
| Max. Negotiated Rate |
$275.24 |
| Rate for Payer: Cash Price |
$123.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$122.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$110.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$116.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$122.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$116.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.75
|
| Rate for Payer: Healthfirst Commercial |
$122.33
|
| Rate for Payer: Healthfirst Essential Plan |
$275.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$116.21
|
| Rate for Payer: Healthfirst QHP |
$122.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$85.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$122.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$103.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$85.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$122.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$91.75
|
| Rate for Payer: SOMOS Essential |
$91.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.33
|
|
|
PR INCISION & SUBCUTANEOUS PLMT CRANIAL BONE GRAF
|
Professional
|
Both
|
$423.64
|
|
|
Service Code
|
HCPCS 61316
|
| Min. Negotiated Rate |
$77.09 |
| Max. Negotiated Rate |
$247.79 |
| Rate for Payer: Cash Price |
$110.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$110.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$99.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$99.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$104.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$110.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$104.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.60
|
| Rate for Payer: Healthfirst Commercial |
$110.13
|
| Rate for Payer: Healthfirst Essential Plan |
$247.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$104.62
|
| Rate for Payer: Healthfirst QHP |
$110.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$77.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$110.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$93.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$77.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$110.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.60
|
| Rate for Payer: SOMOS Essential |
$82.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$110.13
|
|
|
PR INCISION THROMBOSED HEMORRHOID EXTERNAL
|
Professional
|
Both
|
$481.18
|
|
|
Service Code
|
HCPCS 46083
|
| Min. Negotiated Rate |
$91.37 |
| Max. Negotiated Rate |
$293.69 |
| Rate for Payer: Cash Price |
$130.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$130.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$117.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$117.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$124.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$130.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$124.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.90
|
| Rate for Payer: Healthfirst Commercial |
$130.53
|
| Rate for Payer: Healthfirst Essential Plan |
$293.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$124.00
|
| Rate for Payer: Healthfirst QHP |
$130.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$91.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$130.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$110.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$91.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$130.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$97.90
|
| Rate for Payer: SOMOS Essential |
$97.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.53
|
|
|
PR INDOCYANINE-GREEN ANGRPH W/MULTIFRAME I&R UNI/BI
|
Professional
|
Both
|
$814.84
|
|
|
Service Code
|
HCPCS 92240
|
| Min. Negotiated Rate |
$156.21 |
| Max. Negotiated Rate |
$614.61 |
| Rate for Payer: Amida Care Medicaid |
$156.21
|
| Rate for Payer: Cash Price |
$219.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$273.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$245.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$245.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$259.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$273.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$259.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$273.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$273.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$204.87
|
| Rate for Payer: Healthfirst Commercial |
$273.16
|
| Rate for Payer: Healthfirst Essential Plan |
$614.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$259.50
|
| Rate for Payer: Healthfirst QHP |
$273.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$191.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$273.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$232.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$191.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$273.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$204.87
|
| Rate for Payer: SOMOS Essential |
$204.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$273.16
|
|
|
PR INDOCYANINE-GREEN ANGRPH W/MULTIFRAME I&R UNI/BI
|
Professional
|
Both
|
$619.43
|
|
|
Service Code
|
HCPCS 92240 TC
|
| Min. Negotiated Rate |
$154.76 |
| Max. Negotiated Rate |
$497.45 |
| Rate for Payer: Amida Care Medicaid |
$156.21
|
| Rate for Payer: Cash Price |
$167.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$221.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$198.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$198.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$210.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$221.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$210.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$221.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$221.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.82
|
| Rate for Payer: Healthfirst Commercial |
$221.09
|
| Rate for Payer: Healthfirst Essential Plan |
$497.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$210.04
|
| Rate for Payer: Healthfirst QHP |
$221.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$154.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$221.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$187.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$154.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$221.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$165.82
|
| Rate for Payer: SOMOS Essential |
$165.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$221.09
|
|
|
PR INDOCYANINE-GREEN ANGRPH W/MULTIFRAME I&R UNI/BI
|
Professional
|
Both
|
$195.41
|
|
|
Service Code
|
HCPCS 92240 26
|
| Min. Negotiated Rate |
$36.45 |
| Max. Negotiated Rate |
$156.21 |
| Rate for Payer: Amida Care Medicaid |
$156.21
|
| Rate for Payer: Cash Price |
$52.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.05
|
| Rate for Payer: Healthfirst Commercial |
$52.07
|
| Rate for Payer: Healthfirst Essential Plan |
$117.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.47
|
| Rate for Payer: Healthfirst QHP |
$52.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.05
|
| Rate for Payer: SOMOS Essential |
$39.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.07
|
|
|
PR INDUCE ABORT 1/> AMNIOT NJXS DLVR FETUS D&C
|
Professional
|
Both
|
$1,979.15
|
|
|
Service Code
|
HCPCS 59851
|
| Min. Negotiated Rate |
$363.83 |
| Max. Negotiated Rate |
$1,169.46 |
| Rate for Payer: Cash Price |
$527.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$519.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$467.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$467.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$493.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$519.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$493.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$519.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$519.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$389.82
|
| Rate for Payer: Healthfirst Commercial |
$519.76
|
| Rate for Payer: Healthfirst Essential Plan |
$1,169.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$493.77
|
| Rate for Payer: Healthfirst QHP |
$519.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$363.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$519.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$441.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$363.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$519.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$389.82
|
| Rate for Payer: SOMOS Essential |
$389.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$519.76
|
|
|
PR INDUCE ABORT 1/> AMNIOT NJXS DLVR FETUS HYSTOTM
|
Professional
|
Both
|
$2,728.85
|
|
|
Service Code
|
HCPCS 59852
|
| Min. Negotiated Rate |
$498.41 |
| Max. Negotiated Rate |
$1,602.05 |
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$712.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$640.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$640.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$676.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$712.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$676.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$712.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$712.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$534.01
|
| Rate for Payer: Healthfirst Commercial |
$712.02
|
| Rate for Payer: Healthfirst Essential Plan |
$1,602.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$676.42
|
| Rate for Payer: Healthfirst QHP |
$712.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$498.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$712.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$605.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$498.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$712.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$534.01
|
| Rate for Payer: SOMOS Essential |
$534.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$712.02
|
|
|
PR INDUCED ABORT 1/> VAG SUPP DLVR FETUS D&C &/EVAC
|
Professional
|
Both
|
$2,316.16
|
|
|
Service Code
|
HCPCS 59856
|
| Min. Negotiated Rate |
$423.65 |
| Max. Negotiated Rate |
$1,361.72 |
| Rate for Payer: Cash Price |
$614.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$605.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$544.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$544.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$574.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$605.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$574.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$605.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$605.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$453.91
|
| Rate for Payer: Healthfirst Commercial |
$605.21
|
| Rate for Payer: Healthfirst Essential Plan |
$1,361.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$574.95
|
| Rate for Payer: Healthfirst QHP |
$605.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$423.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$605.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$514.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$423.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$605.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$453.91
|
| Rate for Payer: SOMOS Essential |
$453.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$605.21
|
|
|
PR INDUCED ABORT 1/> VAG SUPPOS DLVR FETUS HYSTOT
|
Professional
|
Both
|
$2,703.89
|
|
|
Service Code
|
HCPCS 59857
|
| Min. Negotiated Rate |
$493.73 |
| Max. Negotiated Rate |
$1,586.99 |
| Rate for Payer: Cash Price |
$715.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$705.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$634.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$634.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$670.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$705.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$670.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$705.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$705.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$529.00
|
| Rate for Payer: Healthfirst Commercial |
$705.33
|
| Rate for Payer: Healthfirst Essential Plan |
$1,586.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$670.06
|
| Rate for Payer: Healthfirst QHP |
$705.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$493.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$705.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$599.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$493.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$705.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$529.00
|
| Rate for Payer: SOMOS Essential |
$529.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$705.33
|
|
|
PR INDUCED ABORT 1/> VAG SUPPOSITORIES DLVR FETUS
|
Professional
|
Both
|
$1,977.43
|
|
|
Service Code
|
HCPCS 59855
|
| Min. Negotiated Rate |
$361.43 |
| Max. Negotiated Rate |
$1,161.74 |
| Rate for Payer: Cash Price |
$525.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$516.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$464.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$464.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$490.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$516.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$490.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$516.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$516.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$387.25
|
| Rate for Payer: Healthfirst Commercial |
$516.33
|
| Rate for Payer: Healthfirst Essential Plan |
$1,161.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$490.51
|
| Rate for Payer: Healthfirst QHP |
$516.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$361.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$516.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$438.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$361.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$516.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$387.25
|
| Rate for Payer: SOMOS Essential |
$387.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$516.33
|
|
|
PR INDUCED ABORTION 1/> AMNIOTIC INJX W/D&C/EVACJ
|
Professional
|
Both
|
$1,815.80
|
|
|
Service Code
|
HCPCS 59850
|
| Min. Negotiated Rate |
$334.28 |
| Max. Negotiated Rate |
$1,074.46 |
| Rate for Payer: Cash Price |
$483.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$477.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$429.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$429.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$453.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$477.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$453.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$477.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$477.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$358.15
|
| Rate for Payer: Healthfirst Commercial |
$477.54
|
| Rate for Payer: Healthfirst Essential Plan |
$1,074.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$453.66
|
| Rate for Payer: Healthfirst QHP |
$477.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$334.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$477.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$405.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$334.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$477.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$358.15
|
| Rate for Payer: SOMOS Essential |
$358.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$477.54
|
|
|
PR INDUCED ABORTION DILATION AND CURETTAGE
|
Professional
|
Both
|
$1,025.75
|
|
|
Service Code
|
HCPCS 59840
|
| Min. Negotiated Rate |
$187.33 |
| Max. Negotiated Rate |
$602.14 |
| Rate for Payer: Cash Price |
$273.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$267.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$240.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$254.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$267.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$254.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$267.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$267.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$200.72
|
| Rate for Payer: Healthfirst Commercial |
$267.62
|
| Rate for Payer: Healthfirst Essential Plan |
$602.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$254.24
|
| Rate for Payer: Healthfirst QHP |
$267.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$187.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$267.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$227.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$187.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$267.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$200.72
|
| Rate for Payer: SOMOS Essential |
$200.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$267.62
|
|
|
PR INDUCED ABORTION DILATION & EVACUATION
|
Professional
|
Both
|
$1,726.66
|
|
|
Service Code
|
HCPCS 59841
|
| Min. Negotiated Rate |
$317.45 |
| Max. Negotiated Rate |
$1,020.38 |
| Rate for Payer: Cash Price |
$459.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$453.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$408.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$408.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$430.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$453.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$430.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$453.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$453.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$340.12
|
| Rate for Payer: Healthfirst Commercial |
$453.50
|
| Rate for Payer: Healthfirst Essential Plan |
$1,020.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$430.82
|
| Rate for Payer: Healthfirst QHP |
$453.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$317.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$453.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$385.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$317.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$453.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$340.12
|
| Rate for Payer: SOMOS Essential |
$340.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$453.50
|
|
|
PR INDUCTION ARRHYTHMIA ELECTRICAL PACING
|
Professional
|
Both
|
$1,743.74
|
|
|
Service Code
|
HCPCS 93618
|
| Min. Negotiated Rate |
$309.91 |
| Max. Negotiated Rate |
$309.91 |
| Rate for Payer: Amida Care Medicaid |
$309.91
|
|
|
PR INDUCTION ARRHYTHMIA ELECTRICAL PACING
|
Professional
|
Both
|
$935.20
|
|
|
Service Code
|
HCPCS 93618 26
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$546.41 |
| Rate for Payer: Amida Care Medicaid |
$309.91
|
| Rate for Payer: Cash Price |
$245.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$242.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$218.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$218.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$230.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$242.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$230.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$242.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$242.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$182.14
|
| Rate for Payer: Healthfirst Commercial |
$242.85
|
| Rate for Payer: Healthfirst Essential Plan |
$546.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$230.71
|
| Rate for Payer: Healthfirst QHP |
$242.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$170.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$242.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$206.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$170.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$242.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$182.14
|
| Rate for Payer: SOMOS Essential |
$182.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$242.85
|
|
|
PR INDUCTION ARRHYTHMIA ELECTRICAL PACING
|
Professional
|
Both
|
$808.54
|
|
|
Service Code
|
HCPCS 93618 TC
|
| Min. Negotiated Rate |
$309.91 |
| Max. Negotiated Rate |
$309.91 |
| Rate for Payer: Amida Care Medicaid |
$309.91
|
|
|
PR INFRATEMPO MID CRANIAL FOSSA W/WO DCOMPR&/MOBI
|
Professional
|
Both
|
$13,724.10
|
|
|
Service Code
|
HCPCS 61591
|
| Min. Negotiated Rate |
$2,547.14 |
| Max. Negotiated Rate |
$8,187.23 |
| Rate for Payer: Cash Price |
$3,665.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,638.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,274.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,274.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,456.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,638.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,456.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,638.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,638.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,729.08
|
| Rate for Payer: Healthfirst Commercial |
$3,638.77
|
| Rate for Payer: Healthfirst Essential Plan |
$8,187.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,456.83
|
| Rate for Payer: Healthfirst QHP |
$3,638.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,547.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,638.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,092.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,547.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,638.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,729.08
|
| Rate for Payer: SOMOS Essential |
$2,729.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,638.77
|
|
|
PR INFRATEMPORAL MID CRANIAL FOSSA W/WO DISARTICLTN
|
Professional
|
Both
|
$13,346.52
|
|
|
Service Code
|
HCPCS 61590
|
| Min. Negotiated Rate |
$2,456.95 |
| Max. Negotiated Rate |
$7,897.34 |
| Rate for Payer: Cash Price |
$3,569.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,509.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,158.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,158.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,334.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,509.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,334.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,509.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,509.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,632.45
|
| Rate for Payer: Healthfirst Commercial |
$3,509.93
|
| Rate for Payer: Healthfirst Essential Plan |
$7,897.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,334.43
|
| Rate for Payer: Healthfirst QHP |
$3,509.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,456.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,509.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,983.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,456.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,509.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,632.45
|
| Rate for Payer: SOMOS Essential |
$2,632.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,509.93
|
|
|
PR INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES
|
Professional
|
Both
|
$269.75
|
|
|
Service Code
|
HCPCS 95079
|
| Min. Negotiated Rate |
$35.69 |
| Max. Negotiated Rate |
$165.44 |
| Rate for Payer: Amida Care Medicaid |
$35.69
|
| Rate for Payer: Cash Price |
$74.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$66.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$66.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$69.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.15
|
| Rate for Payer: Healthfirst Commercial |
$73.53
|
| Rate for Payer: Healthfirst Essential Plan |
$165.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.85
|
| Rate for Payer: Healthfirst QHP |
$73.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$73.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$55.15
|
| Rate for Payer: SOMOS Essential |
$55.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.53
|
|
