|
PR INJECTION ANKLE ARTHROGRAPHY
|
Professional
|
Both
|
$214.90
|
|
|
Service Code
|
HCPCS 27648
|
| Min. Negotiated Rate |
$41.32 |
| Max. Negotiated Rate |
$132.82 |
| Rate for Payer: Cash Price |
$59.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$59.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.27
|
| Rate for Payer: Healthfirst Commercial |
$59.03
|
| Rate for Payer: Healthfirst Essential Plan |
$132.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.08
|
| Rate for Payer: Healthfirst QHP |
$59.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.27
|
| Rate for Payer: SOMOS Essential |
$44.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.03
|
|
|
PR INJECTION CONTRAST MEDIUM DACRYOCYSTOGRAPY
|
Professional
|
Both
|
$214.24
|
|
|
Service Code
|
HCPCS 68850
|
| Min. Negotiated Rate |
$40.36 |
| Max. Negotiated Rate |
$129.74 |
| Rate for Payer: Cash Price |
$58.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$57.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$51.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$54.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$57.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$54.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.24
|
| Rate for Payer: Healthfirst Commercial |
$57.66
|
| Rate for Payer: Healthfirst Essential Plan |
$129.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$54.78
|
| Rate for Payer: Healthfirst QHP |
$57.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$57.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$49.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$43.24
|
| Rate for Payer: SOMOS Essential |
$43.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57.66
|
|
|
PR INJECTION CORPORA CAVERNOSOGRAPY
|
Professional
|
Both
|
$335.09
|
|
|
Service Code
|
HCPCS 54230
|
| Min. Negotiated Rate |
$63.96 |
| Max. Negotiated Rate |
$205.58 |
| Rate for Payer: Cash Price |
$91.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$91.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$86.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$91.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$86.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$91.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.53
|
| Rate for Payer: Healthfirst Commercial |
$91.37
|
| Rate for Payer: Healthfirst Essential Plan |
$205.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$86.80
|
| Rate for Payer: Healthfirst QHP |
$91.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$91.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$77.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$91.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$68.53
|
| Rate for Payer: SOMOS Essential |
$68.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$91.37
|
|
|
PR INJECTION ELBOW ARTHROGRAPHY
|
Professional
|
Both
|
$277.13
|
|
|
Service Code
|
HCPCS 24220
|
| Min. Negotiated Rate |
$51.62 |
| Max. Negotiated Rate |
$165.91 |
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$66.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$66.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.30
|
| Rate for Payer: Healthfirst Commercial |
$73.74
|
| Rate for Payer: Healthfirst Essential Plan |
$165.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.05
|
| Rate for Payer: Healthfirst QHP |
$73.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$73.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$55.30
|
| Rate for Payer: SOMOS Essential |
$55.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.74
|
|
|
PR INJECTION ENZYME PALMAR FASCIAL CORD
|
Professional
|
Both
|
$287.91
|
|
|
Service Code
|
HCPCS 20527
|
| Min. Negotiated Rate |
$53.91 |
| Max. Negotiated Rate |
$173.29 |
| Rate for Payer: Cash Price |
$77.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$77.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$69.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$69.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$73.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$77.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$73.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.77
|
| Rate for Payer: Healthfirst Commercial |
$77.02
|
| Rate for Payer: Healthfirst Essential Plan |
$173.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.17
|
| Rate for Payer: Healthfirst QHP |
$77.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$77.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$65.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$77.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$57.77
|
| Rate for Payer: SOMOS Essential |
$57.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$77.02
|
|
|
PR INJECTION EPIDURAL BLOOD/CLOT PATCH
|
Professional
|
Both
|
$468.93
|
|
|
Service Code
|
HCPCS 62273
|
| Min. Negotiated Rate |
$88.92 |
| Max. Negotiated Rate |
$285.82 |
| Rate for Payer: Cash Price |
$128.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$114.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$114.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$120.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$120.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.27
|
| Rate for Payer: Healthfirst Commercial |
$127.03
|
| Rate for Payer: Healthfirst Essential Plan |
$285.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$120.68
|
| Rate for Payer: Healthfirst QHP |
$127.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$88.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$127.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$107.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$88.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$95.27
|
| Rate for Payer: SOMOS Essential |
$95.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.03
|
|
|
PR INJECTION HIP ARTHROGRAPHY W/ANESTHESIA
|
Professional
|
Both
|
$350.14
|
|
|
Service Code
|
HCPCS 27095
|
| Min. Negotiated Rate |
$65.25 |
| Max. Negotiated Rate |
$209.75 |
| Rate for Payer: Cash Price |
$93.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$93.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$88.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$93.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$88.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.92
|
| Rate for Payer: Healthfirst Commercial |
$93.22
|
| Rate for Payer: Healthfirst Essential Plan |
$209.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$88.56
|
| Rate for Payer: Healthfirst QHP |
$93.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$65.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$93.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$79.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$65.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$93.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.92
|
| Rate for Payer: SOMOS Essential |
$69.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$93.22
|
|
|
PR INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA
|
Professional
|
Both
|
$289.84
|
|
|
Service Code
|
HCPCS 27093
|
| Min. Negotiated Rate |
$53.76 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Cash Price |
$76.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$76.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$69.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$69.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$76.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.60
|
| Rate for Payer: Healthfirst Commercial |
$76.80
|
| Rate for Payer: Healthfirst Essential Plan |
$172.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.96
|
| Rate for Payer: Healthfirst QHP |
$76.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$76.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$65.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$76.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$57.60
|
| Rate for Payer: SOMOS Essential |
$57.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76.80
|
|
|
PR INJECTION INTRALESIONAL >7 LESIONS
|
Professional
|
Both
|
$189.67
|
|
|
Service Code
|
HCPCS 11901
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$113.67 |
| Rate for Payer: Cash Price |
$51.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$50.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$45.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$50.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$47.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.89
|
| Rate for Payer: Healthfirst Commercial |
$50.52
|
| Rate for Payer: Healthfirst Essential Plan |
$113.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.99
|
| Rate for Payer: Healthfirst QHP |
$50.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$50.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$42.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$37.89
|
| Rate for Payer: SOMOS Essential |
$37.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.52
|
|
|
PR INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS
|
Professional
|
Both
|
$126.11
|
|
|
Service Code
|
HCPCS 11900
|
| Min. Negotiated Rate |
$23.13 |
| Max. Negotiated Rate |
$74.34 |
| Rate for Payer: Cash Price |
$34.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.78
|
| Rate for Payer: Healthfirst Commercial |
$33.04
|
| Rate for Payer: Healthfirst Essential Plan |
$74.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.39
|
| Rate for Payer: Healthfirst QHP |
$33.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.78
|
| Rate for Payer: SOMOS Essential |
$24.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.04
|
|
|
PR INJECTION INTRAOPERATIVE PANCREATOGRAPHY
|
Professional
|
Both
|
$483.25
|
|
|
Service Code
|
HCPCS 48400
|
| Min. Negotiated Rate |
$88.49 |
| Max. Negotiated Rate |
$284.44 |
| Rate for Payer: Cash Price |
$126.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$126.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$113.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$120.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$126.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$120.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.81
|
| Rate for Payer: Healthfirst Commercial |
$126.42
|
| Rate for Payer: Healthfirst Essential Plan |
$284.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$120.10
|
| Rate for Payer: Healthfirst QHP |
$126.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$88.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$126.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$107.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$88.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$126.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$94.81
|
| Rate for Payer: SOMOS Essential |
$94.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$126.42
|
|
|
PR INJECTION MEDICATION/OTHER SUBST TENON CAPSULE
|
Professional
|
Both
|
$193.73
|
|
|
Service Code
|
HCPCS 67515
|
| Min. Negotiated Rate |
$36.28 |
| Max. Negotiated Rate |
$116.62 |
| Rate for Payer: Cash Price |
$52.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$51.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.87
|
| Rate for Payer: Healthfirst Commercial |
$51.83
|
| Rate for Payer: Healthfirst Essential Plan |
$116.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.24
|
| Rate for Payer: Healthfirst QHP |
$51.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$51.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.87
|
| Rate for Payer: SOMOS Essential |
$38.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.83
|
|
|
PR INJECTION PEYRONIE DISEASE
|
Professional
|
Both
|
$367.08
|
|
|
Service Code
|
HCPCS 54200
|
| Min. Negotiated Rate |
$71.84 |
| Max. Negotiated Rate |
$230.92 |
| Rate for Payer: Cash Price |
$102.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$102.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$92.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$97.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$102.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$97.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$76.97
|
| Rate for Payer: Healthfirst Commercial |
$102.63
|
| Rate for Payer: Healthfirst Essential Plan |
$230.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$97.50
|
| Rate for Payer: Healthfirst QHP |
$102.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$71.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$102.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$87.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$71.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$76.97
|
| Rate for Payer: SOMOS Essential |
$76.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.63
|
|
|
PR INJECTION PROCEDURE LYMPHANGIOGRAPHY
|
Professional
|
Both
|
$351.44
|
|
|
Service Code
|
HCPCS 38790
|
| Min. Negotiated Rate |
$66.39 |
| Max. Negotiated Rate |
$213.39 |
| Rate for Payer: Cash Price |
$94.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$94.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$85.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$85.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$90.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$94.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$90.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$94.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$94.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$71.13
|
| Rate for Payer: Healthfirst Commercial |
$94.84
|
| Rate for Payer: Healthfirst Essential Plan |
$213.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$90.10
|
| Rate for Payer: Healthfirst QHP |
$94.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$66.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$94.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$80.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$66.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$94.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$71.13
|
| Rate for Payer: SOMOS Essential |
$71.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$94.84
|
|
|
PR INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR
|
Professional
|
Both
|
$352.84
|
|
|
Service Code
|
HCPCS 62284
|
| Min. Negotiated Rate |
$64.98 |
| Max. Negotiated Rate |
$208.87 |
| Rate for Payer: Cash Price |
$93.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$88.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$88.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.62
|
| Rate for Payer: Healthfirst Commercial |
$92.83
|
| Rate for Payer: Healthfirst Essential Plan |
$208.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$88.19
|
| Rate for Payer: Healthfirst QHP |
$92.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.62
|
| Rate for Payer: SOMOS Essential |
$69.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.83
|
|
|
PR INJECTION PROCEDURE SIALOGRAPHY
|
Professional
|
Both
|
$252.77
|
|
|
Service Code
|
HCPCS 42550
|
| Min. Negotiated Rate |
$47.83 |
| Max. Negotiated Rate |
$153.74 |
| Rate for Payer: Cash Price |
$67.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$68.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.25
|
| Rate for Payer: Healthfirst Commercial |
$68.33
|
| Rate for Payer: Healthfirst Essential Plan |
$153.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$64.91
|
| Rate for Payer: Healthfirst QHP |
$68.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$68.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$68.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.25
|
| Rate for Payer: SOMOS Essential |
$51.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.33
|
|
|
PR INJECTION PROCEDURE SPLENOPORTOGRAPY
|
Professional
|
Both
|
$531.58
|
|
|
Service Code
|
HCPCS 38200
|
| Min. Negotiated Rate |
$99.97 |
| Max. Negotiated Rate |
$321.32 |
| Rate for Payer: Cash Price |
$144.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$142.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$128.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$128.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$135.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$142.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$135.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$107.11
|
| Rate for Payer: Healthfirst Commercial |
$142.81
|
| Rate for Payer: Healthfirst Essential Plan |
$321.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$135.67
|
| Rate for Payer: Healthfirst QHP |
$142.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$99.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$142.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$121.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$99.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$142.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$107.11
|
| Rate for Payer: SOMOS Essential |
$107.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$142.81
|
|
|
PR INJECTION PX CHEMONUCLEOLYSIS 1/MLT LUMBAR
|
Professional
|
Both
|
$2,414.86
|
|
|
Service Code
|
HCPCS 62292
|
| Min. Negotiated Rate |
$463.68 |
| Max. Negotiated Rate |
$1,490.40 |
| Rate for Payer: Cash Price |
$668.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$662.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$596.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$596.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$629.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$662.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$629.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$662.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$662.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$496.80
|
| Rate for Payer: Healthfirst Commercial |
$662.40
|
| Rate for Payer: Healthfirst Essential Plan |
$1,490.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$629.28
|
| Rate for Payer: Healthfirst QHP |
$662.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$463.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$662.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$563.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$463.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$662.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$496.80
|
| Rate for Payer: SOMOS Essential |
$496.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$662.40
|
|
|
PR INJECTION PX DISCOGRAPHY EACH LEVEL LUMBAR
|
Professional
|
Both
|
$647.99
|
|
|
Service Code
|
HCPCS 62290
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$393.75 |
| Rate for Payer: Cash Price |
$174.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$175.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$157.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$157.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$166.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$175.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$166.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$131.25
|
| Rate for Payer: Healthfirst Commercial |
$175.00
|
| Rate for Payer: Healthfirst Essential Plan |
$393.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$166.25
|
| Rate for Payer: Healthfirst QHP |
$175.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$122.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$175.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$148.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$122.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$175.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$131.25
|
| Rate for Payer: SOMOS Essential |
$131.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$175.00
|
|
|
PR INJECTION PX DISCOGRPHY EA LVL CERVICAL/THORACIC
|
Professional
|
Both
|
$598.19
|
|
|
Service Code
|
HCPCS 62291
|
| Min. Negotiated Rate |
$110.45 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: Cash Price |
$158.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$142.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$142.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$149.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$149.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$118.33
|
| Rate for Payer: Healthfirst Commercial |
$157.78
|
| Rate for Payer: Healthfirst Essential Plan |
$355.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$149.89
|
| Rate for Payer: Healthfirst QHP |
$157.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$110.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$157.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$134.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$110.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$118.33
|
| Rate for Payer: SOMOS Essential |
$118.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.78
|
|
|
PR INJECTION PX ONLY MAMMARY DUCTOGRAM/GALACTOGRAM
|
Professional
|
Both
|
$318.64
|
|
|
Service Code
|
HCPCS 19030
|
| Min. Negotiated Rate |
$58.60 |
| Max. Negotiated Rate |
$188.37 |
| Rate for Payer: Cash Price |
$84.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$83.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$75.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$75.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$79.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$83.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$79.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.79
|
| Rate for Payer: Healthfirst Commercial |
$83.72
|
| Rate for Payer: Healthfirst Essential Plan |
$188.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$79.53
|
| Rate for Payer: Healthfirst QHP |
$83.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$83.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$71.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$83.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62.79
|
| Rate for Payer: SOMOS Essential |
$62.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$83.72
|
|
|
PR INJECTION PX PRQ TX EXTREMITY PSEUDOANEURYSM
|
Professional
|
Both
|
$442.58
|
|
|
Service Code
|
HCPCS 36002
|
| Min. Negotiated Rate |
$82.10 |
| Max. Negotiated Rate |
$263.88 |
| Rate for Payer: Cash Price |
$118.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$117.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$105.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$105.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$111.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$117.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$111.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$117.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$117.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$87.96
|
| Rate for Payer: Healthfirst Commercial |
$117.28
|
| Rate for Payer: Healthfirst Essential Plan |
$263.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$111.42
|
| Rate for Payer: Healthfirst QHP |
$117.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$117.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$99.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$117.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$87.96
|
| Rate for Payer: SOMOS Essential |
$87.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$117.28
|
|
|
PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Professional
|
Both
|
$330.47
|
|
|
Service Code
|
HCPCS 36471
|
| Min. Negotiated Rate |
$60.68 |
| Max. Negotiated Rate |
$195.03 |
| Rate for Payer: Cash Price |
$87.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$86.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$78.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$78.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$82.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$86.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$82.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.01
|
| Rate for Payer: Healthfirst Commercial |
$86.68
|
| Rate for Payer: Healthfirst Essential Plan |
$195.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$82.35
|
| Rate for Payer: Healthfirst QHP |
$86.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$60.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$86.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$73.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$60.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$65.01
|
| Rate for Payer: SOMOS Essential |
$65.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.68
|
|
|
PR INJECTION SCLEROSANT SINGLE INCMPTNT VEIN
|
Professional
|
Both
|
$172.06
|
|
|
Service Code
|
HCPCS 36470
|
| Min. Negotiated Rate |
$31.25 |
| Max. Negotiated Rate |
$100.46 |
| Rate for Payer: Cash Price |
$44.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$44.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.49
|
| Rate for Payer: Healthfirst Commercial |
$44.65
|
| Rate for Payer: Healthfirst Essential Plan |
$100.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.42
|
| Rate for Payer: Healthfirst QHP |
$44.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.49
|
| Rate for Payer: SOMOS Essential |
$33.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.65
|
|
|
PR INJECTION SCLEROSING SOLUTION HEMORRHOIDS
|
Professional
|
Both
|
$799.37
|
|
|
Service Code
|
HCPCS 46500
|
| Min. Negotiated Rate |
$150.91 |
| Max. Negotiated Rate |
$485.08 |
| Rate for Payer: Cash Price |
$216.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$215.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$194.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$194.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$204.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$215.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$204.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$215.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$215.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$161.69
|
| Rate for Payer: Healthfirst Commercial |
$215.59
|
| Rate for Payer: Healthfirst Essential Plan |
$485.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$204.81
|
| Rate for Payer: Healthfirst QHP |
$215.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$150.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$215.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$183.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$150.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$215.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$161.69
|
| Rate for Payer: SOMOS Essential |
$161.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$215.59
|
|
