|
PR LARYNGOSCOPY FLX/RGD TELESCOPIC W/STROBOSCOPY
|
Professional
|
Both
|
$509.43
|
|
|
Service Code
|
HCPCS 31579
|
| Min. Negotiated Rate |
$96.37 |
| Max. Negotiated Rate |
$309.76 |
| Rate for Payer: Cash Price |
$138.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$137.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$123.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$130.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$137.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$130.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.25
|
| Rate for Payer: Healthfirst Commercial |
$137.67
|
| Rate for Payer: Healthfirst Essential Plan |
$309.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.79
|
| Rate for Payer: Healthfirst QHP |
$137.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$96.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$137.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$117.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$96.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$137.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$103.25
|
| Rate for Payer: SOMOS Essential |
$103.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.67
|
|
|
PR LARYNGOSCOPY FLX RMVL FOREIGN BODY(S)
|
Professional
|
Both
|
$577.19
|
|
|
Service Code
|
HCPCS 31577
|
| Min. Negotiated Rate |
$107.85 |
| Max. Negotiated Rate |
$346.66 |
| Rate for Payer: Cash Price |
$154.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$154.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$138.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$138.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$146.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$154.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$146.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$115.55
|
| Rate for Payer: Healthfirst Commercial |
$154.07
|
| Rate for Payer: Healthfirst Essential Plan |
$346.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$146.37
|
| Rate for Payer: Healthfirst QHP |
$154.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$107.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$154.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$130.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$107.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$154.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$115.55
|
| Rate for Payer: SOMOS Essential |
$115.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$154.07
|
|
|
PR LARYNGOSCOPY FOREIGN BODY RMVL MICRO/TELESCOPE
|
Professional
|
Both
|
$904.19
|
|
|
Service Code
|
HCPCS 31531
|
| Min. Negotiated Rate |
$168.88 |
| Max. Negotiated Rate |
$542.81 |
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$241.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$217.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$217.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$229.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$241.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$229.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$241.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$241.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$180.94
|
| Rate for Payer: Healthfirst Commercial |
$241.25
|
| Rate for Payer: Healthfirst Essential Plan |
$542.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$229.19
|
| Rate for Payer: Healthfirst QHP |
$241.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$168.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$241.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$205.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$168.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$241.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$180.94
|
| Rate for Payer: SOMOS Essential |
$180.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$241.25
|
|
|
PR LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX
|
Professional
|
Both
|
$210.42
|
|
|
Service Code
|
HCPCS 31505
|
| Min. Negotiated Rate |
$40.02 |
| Max. Negotiated Rate |
$128.63 |
| Rate for Payer: Cash Price |
$57.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$57.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$51.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$54.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$57.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$54.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.88
|
| Rate for Payer: Healthfirst Commercial |
$57.17
|
| Rate for Payer: Healthfirst Essential Plan |
$128.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$54.31
|
| Rate for Payer: Healthfirst QHP |
$57.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$57.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.88
|
| Rate for Payer: SOMOS Essential |
$42.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57.17
|
|
|
PR LARYNGOSCOPY INDIRECT W/BIOPSY
|
Professional
|
Both
|
$518.49
|
|
|
Service Code
|
HCPCS 31510
|
| Min. Negotiated Rate |
$98.08 |
| Max. Negotiated Rate |
$315.27 |
| Rate for Payer: Cash Price |
$140.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$140.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$126.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$133.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$140.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$133.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.09
|
| Rate for Payer: Healthfirst Commercial |
$140.12
|
| Rate for Payer: Healthfirst Essential Plan |
$315.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.11
|
| Rate for Payer: Healthfirst QHP |
$140.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$140.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$119.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$140.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.09
|
| Rate for Payer: SOMOS Essential |
$105.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$140.12
|
|
|
PR LARYNGOSCOPY INDIRECT W/REMOVAL FOREIGN BODY
|
Professional
|
Both
|
$572.57
|
|
|
Service Code
|
HCPCS 31511
|
| Min. Negotiated Rate |
$107.72 |
| Max. Negotiated Rate |
$346.25 |
| Rate for Payer: Cash Price |
$156.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$153.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$138.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$138.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$146.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$153.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$146.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$153.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$153.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$115.42
|
| Rate for Payer: Healthfirst Commercial |
$153.89
|
| Rate for Payer: Healthfirst Essential Plan |
$346.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$146.20
|
| Rate for Payer: Healthfirst QHP |
$153.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$107.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$153.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$130.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$107.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$153.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$115.42
|
| Rate for Payer: SOMOS Essential |
$115.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$153.89
|
|
|
PR LARYNGOSCOPY INDIRECT W/REMOVAL LESION
|
Professional
|
Both
|
$552.79
|
|
|
Service Code
|
HCPCS 31512
|
| Min. Negotiated Rate |
$104.03 |
| Max. Negotiated Rate |
$334.39 |
| Rate for Payer: Cash Price |
$150.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$148.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$133.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$141.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$148.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$141.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$148.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$148.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$111.47
|
| Rate for Payer: Healthfirst Commercial |
$148.62
|
| Rate for Payer: Healthfirst Essential Plan |
$334.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$141.19
|
| Rate for Payer: Healthfirst QHP |
$148.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$104.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$148.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$126.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$104.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$148.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$111.47
|
| Rate for Payer: SOMOS Essential |
$111.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$148.62
|
|
|
PR LARYNGOSCOPY INDIRECT W/VOCAL CORD INJECTION
|
Professional
|
Both
|
$558.01
|
|
|
Service Code
|
HCPCS 31513
|
| Min. Negotiated Rate |
$105.30 |
| Max. Negotiated Rate |
$338.47 |
| Rate for Payer: Cash Price |
$152.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$150.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$135.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$142.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$142.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.82
|
| Rate for Payer: Healthfirst Commercial |
$150.43
|
| Rate for Payer: Healthfirst Essential Plan |
$338.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$142.91
|
| Rate for Payer: Healthfirst QHP |
$150.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$150.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$127.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$112.82
|
| Rate for Payer: SOMOS Essential |
$112.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150.43
|
|
|
PR LARYNGOSCOPY W/BIOPSY MICROSCOPE/TELESCOPE
|
Professional
|
Both
|
$898.98
|
|
|
Service Code
|
HCPCS 31536
|
| Min. Negotiated Rate |
$168.27 |
| Max. Negotiated Rate |
$540.86 |
| Rate for Payer: Cash Price |
$242.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$240.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$216.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$216.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$228.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$240.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$228.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$240.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$240.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$180.28
|
| Rate for Payer: Healthfirst Commercial |
$240.38
|
| Rate for Payer: Healthfirst Essential Plan |
$540.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$228.36
|
| Rate for Payer: Healthfirst QHP |
$240.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$168.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$240.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$204.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$168.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$240.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$180.28
|
| Rate for Payer: SOMOS Essential |
$180.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$240.38
|
|
|
PR LARYNGOSCOPY W/FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$853.27
|
|
|
Service Code
|
HCPCS 31530
|
| Min. Negotiated Rate |
$159.98 |
| Max. Negotiated Rate |
$514.22 |
| Rate for Payer: Cash Price |
$229.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$228.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$205.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$205.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$217.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$228.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$217.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$228.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$228.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$171.41
|
| Rate for Payer: Healthfirst Commercial |
$228.54
|
| Rate for Payer: Healthfirst Essential Plan |
$514.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$217.11
|
| Rate for Payer: Healthfirst QHP |
$228.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$159.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$228.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$194.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$159.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$228.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$171.41
|
| Rate for Payer: SOMOS Essential |
$171.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$228.54
|
|
|
PR LARYNGOSCOPY W/WO TRACHEOSCOPY ASPIRATION
|
Professional
|
Both
|
$476.42
|
|
|
Service Code
|
HCPCS 31515
|
| Min. Negotiated Rate |
$89.87 |
| Max. Negotiated Rate |
$288.86 |
| Rate for Payer: Cash Price |
$128.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$128.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$115.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$115.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$121.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$128.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$121.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$128.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.28
|
| Rate for Payer: Healthfirst Commercial |
$128.38
|
| Rate for Payer: Healthfirst Essential Plan |
$288.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$121.96
|
| Rate for Payer: Healthfirst QHP |
$128.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$89.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$128.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$109.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$89.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$128.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$96.28
|
| Rate for Payer: SOMOS Essential |
$96.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$128.38
|
|
|
PR LARYNGOSCOPY W/WO TRACHEOSCOPY DILATION SUBSQ
|
Professional
|
Both
|
$684.15
|
|
|
Service Code
|
HCPCS 31529
|
| Min. Negotiated Rate |
$129.32 |
| Max. Negotiated Rate |
$415.69 |
| Rate for Payer: Cash Price |
$186.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$166.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$166.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$184.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$138.56
|
| Rate for Payer: Healthfirst Commercial |
$184.75
|
| Rate for Payer: Healthfirst Essential Plan |
$415.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$175.51
|
| Rate for Payer: Healthfirst QHP |
$184.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$129.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$184.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$157.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$129.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.56
|
| Rate for Payer: SOMOS Essential |
$138.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.75
|
|
|
PR LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN
|
Professional
|
Both
|
$680.75
|
|
|
Service Code
|
HCPCS 31525
|
| Min. Negotiated Rate |
$128.93 |
| Max. Negotiated Rate |
$414.43 |
| Rate for Payer: Cash Price |
$185.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$165.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$165.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$174.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$174.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$184.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$138.14
|
| Rate for Payer: Healthfirst Commercial |
$184.19
|
| Rate for Payer: Healthfirst Essential Plan |
$414.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$174.98
|
| Rate for Payer: Healthfirst QHP |
$184.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$128.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$184.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$156.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$128.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.14
|
| Rate for Payer: SOMOS Essential |
$138.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.19
|
|
|
PR LARYNGOSCOPY W/WO TRACHEOSCOPY DX NEWBORN
|
Professional
|
Both
|
$666.40
|
|
|
Service Code
|
HCPCS 31520
|
| Min. Negotiated Rate |
$126.43 |
| Max. Negotiated Rate |
$406.37 |
| Rate for Payer: Cash Price |
$181.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$180.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$162.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$162.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$171.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$171.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$180.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$135.46
|
| Rate for Payer: Healthfirst Commercial |
$180.61
|
| Rate for Payer: Healthfirst Essential Plan |
$406.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$171.58
|
| Rate for Payer: Healthfirst QHP |
$180.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$126.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$180.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$153.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$126.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$135.46
|
| Rate for Payer: SOMOS Essential |
$135.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.61
|
|
|
PR LARYNGOSCOPY W/WO TRACHEOSCOPY INSERT OBTURATOR
|
Professional
|
Both
|
$831.57
|
|
|
Service Code
|
HCPCS 31527
|
| Min. Negotiated Rate |
$157.12 |
| Max. Negotiated Rate |
$505.01 |
| Rate for Payer: Cash Price |
$224.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$224.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$202.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$202.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$213.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$224.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$213.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$224.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$224.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$168.34
|
| Rate for Payer: Healthfirst Commercial |
$224.45
|
| Rate for Payer: Healthfirst Essential Plan |
$505.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$213.23
|
| Rate for Payer: Healthfirst QHP |
$224.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$157.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$224.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$190.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$157.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$224.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$168.34
|
| Rate for Payer: SOMOS Essential |
$168.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$224.45
|
|
|
PR LARYNGOSCOPY W/WO TRACHEOSCOPY W/DILATION IN
|
Professional
|
Both
|
$618.28
|
|
|
Service Code
|
HCPCS 31528
|
| Min. Negotiated Rate |
$116.31 |
| Max. Negotiated Rate |
$373.86 |
| Rate for Payer: Cash Price |
$167.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$166.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$149.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$149.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$157.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$166.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$157.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$166.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$166.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$124.62
|
| Rate for Payer: Healthfirst Commercial |
$166.16
|
| Rate for Payer: Healthfirst Essential Plan |
$373.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$157.85
|
| Rate for Payer: Healthfirst QHP |
$166.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$116.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$166.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$141.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$116.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$166.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$124.62
|
| Rate for Payer: SOMOS Essential |
$124.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$166.16
|
|
|
PR LARYNGOSCOPY W/WO TRACHEOSCOPY W/MICRO/TELESCOPE
|
Professional
|
Both
|
$670.39
|
|
|
Service Code
|
HCPCS 31526
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$408.04 |
| Rate for Payer: Cash Price |
$181.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$181.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$163.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$163.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$172.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$181.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$172.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$181.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$181.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$136.01
|
| Rate for Payer: Healthfirst Commercial |
$181.35
|
| Rate for Payer: Healthfirst Essential Plan |
$408.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$172.28
|
| Rate for Payer: Healthfirst QHP |
$181.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$126.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$181.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$154.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$126.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$181.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$136.01
|
| Rate for Payer: SOMOS Essential |
$136.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$181.35
|
|
|
PR LARYNGOTOMY W/RMVL TUMOR/LARYNGOCELE CORDECTOMY
|
Professional
|
Both
|
$5,416.92
|
|
|
Service Code
|
HCPCS 31300
|
| Min. Negotiated Rate |
$1,009.37 |
| Max. Negotiated Rate |
$3,244.41 |
| Rate for Payer: Cash Price |
$1,461.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,441.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,297.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,297.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,369.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,441.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,369.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,441.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,441.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,081.47
|
| Rate for Payer: Healthfirst Commercial |
$1,441.96
|
| Rate for Payer: Healthfirst Essential Plan |
$3,244.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,369.86
|
| Rate for Payer: Healthfirst QHP |
$1,441.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,009.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,441.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,225.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,009.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,441.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,081.47
|
| Rate for Payer: SOMOS Essential |
$1,081.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,441.96
|
|
|
PR LASER COAGULATION OF PROSTATE FOR URINE FLOW
|
Professional
|
Both
|
$2,720.76
|
|
|
Service Code
|
HCPCS 52647
|
| Min. Negotiated Rate |
$520.61 |
| Max. Negotiated Rate |
$1,673.39 |
| Rate for Payer: Cash Price |
$746.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$743.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$669.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$669.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$706.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$743.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$706.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$743.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$743.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$557.80
|
| Rate for Payer: Healthfirst Commercial |
$743.73
|
| Rate for Payer: Healthfirst Essential Plan |
$1,673.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$706.54
|
| Rate for Payer: Healthfirst QHP |
$743.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$520.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$743.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$632.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$520.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$743.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$557.80
|
| Rate for Payer: SOMOS Essential |
$557.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$743.73
|
|
|
PR LASER ENUCLEATION PROSTATE W/MORCELLATION
|
Professional
|
Both
|
$3,455.59
|
|
|
Service Code
|
HCPCS 52649
|
| Min. Negotiated Rate |
$657.56 |
| Max. Negotiated Rate |
$2,113.58 |
| Rate for Payer: Cash Price |
$945.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$939.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$845.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$845.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$892.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$939.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$892.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$939.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$939.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$704.53
|
| Rate for Payer: Healthfirst Commercial |
$939.37
|
| Rate for Payer: Healthfirst Essential Plan |
$2,113.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$892.40
|
| Rate for Payer: Healthfirst QHP |
$939.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$657.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$939.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$798.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$657.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$939.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$704.53
|
| Rate for Payer: SOMOS Essential |
$704.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$939.37
|
|
|
PR LASER VAPORIZATION OF PROSTATE FOR URINE FLOW
|
Professional
|
Both
|
$2,901.75
|
|
|
Service Code
|
HCPCS 52648
|
| Min. Negotiated Rate |
$553.32 |
| Max. Negotiated Rate |
$1,778.51 |
| Rate for Payer: Cash Price |
$795.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$790.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$711.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$711.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$750.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$790.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$750.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$790.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$790.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$592.84
|
| Rate for Payer: Healthfirst Commercial |
$790.45
|
| Rate for Payer: Healthfirst Essential Plan |
$1,778.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$750.93
|
| Rate for Payer: Healthfirst QHP |
$790.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$553.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$790.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$671.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$553.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$790.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$592.84
|
| Rate for Payer: SOMOS Essential |
$592.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$790.45
|
|
|
PR LATERAL CANTHOPEXY
|
Professional
|
Both
|
$1,701.88
|
|
|
Service Code
|
HCPCS 21282
|
| Min. Negotiated Rate |
$324.52 |
| Max. Negotiated Rate |
$1,043.10 |
| Rate for Payer: Cash Price |
$467.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$463.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$417.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$417.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$440.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$463.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$440.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$463.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$463.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$347.70
|
| Rate for Payer: Healthfirst Commercial |
$463.60
|
| Rate for Payer: Healthfirst Essential Plan |
$1,043.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$440.42
|
| Rate for Payer: Healthfirst QHP |
$463.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$324.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$463.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$394.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$324.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$463.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$347.70
|
| Rate for Payer: SOMOS Essential |
$347.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$463.60
|
|
|
PR LATERAL RETINACULAR RELEASE OPEN
|
Professional
|
Both
|
$2,018.80
|
|
|
Service Code
|
HCPCS 27425
|
| Min. Negotiated Rate |
$384.08 |
| Max. Negotiated Rate |
$1,234.53 |
| Rate for Payer: Cash Price |
$550.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$548.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$493.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$493.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$521.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$548.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$521.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$548.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$548.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$411.51
|
| Rate for Payer: Healthfirst Commercial |
$548.68
|
| Rate for Payer: Healthfirst Essential Plan |
$1,234.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$521.25
|
| Rate for Payer: Healthfirst QHP |
$548.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$384.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$548.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$466.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$384.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$548.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$411.51
|
| Rate for Payer: SOMOS Essential |
$411.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$548.68
|
|
|
PR LAVAGE CANNULATION MAXILLARY SINUS
|
Professional
|
Both
|
$478.42
|
|
|
Service Code
|
HCPCS 31000
|
| Min. Negotiated Rate |
$90.20 |
| Max. Negotiated Rate |
$289.94 |
| Rate for Payer: Cash Price |
$130.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$128.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$115.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$115.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$122.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$128.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$122.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$128.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.64
|
| Rate for Payer: Healthfirst Commercial |
$128.86
|
| Rate for Payer: Healthfirst Essential Plan |
$289.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$122.42
|
| Rate for Payer: Healthfirst QHP |
$128.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$90.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$128.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$109.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$90.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$128.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$96.64
|
| Rate for Payer: SOMOS Essential |
$96.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$128.86
|
|
|
PR LAVAGE CANNULATION SPHENOID SINUS
|
Professional
|
Both
|
$823.17
|
|
|
Service Code
|
HCPCS 31002
|
| Min. Negotiated Rate |
$149.66 |
| Max. Negotiated Rate |
$481.05 |
| Rate for Payer: Cash Price |
$220.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$213.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$192.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$192.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$203.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$213.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$203.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$213.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$213.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$160.35
|
| Rate for Payer: Healthfirst Commercial |
$213.80
|
| Rate for Payer: Healthfirst Essential Plan |
$481.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$203.11
|
| Rate for Payer: Healthfirst QHP |
$213.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$149.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$213.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$181.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$149.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$213.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$160.35
|
| Rate for Payer: SOMOS Essential |
$160.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$213.80
|
|
