|
PR MANOMETRIC STDS THRU TUBE/NDWELLG URTRL CATH
|
Professional
|
Both
|
$476.18
|
|
|
Service Code
|
HCPCS 50396
|
| Min. Negotiated Rate |
$89.98 |
| Max. Negotiated Rate |
$289.21 |
| Rate for Payer: Cash Price |
$129.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$128.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$115.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$115.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$122.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$128.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$122.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$128.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.41
|
| Rate for Payer: Healthfirst Commercial |
$128.54
|
| Rate for Payer: Healthfirst Essential Plan |
$289.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$122.11
|
| Rate for Payer: Healthfirst QHP |
$128.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$89.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$128.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$109.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$89.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$128.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$96.41
|
| Rate for Payer: SOMOS Essential |
$96.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$128.54
|
|
|
PR MANOMETRIC STDS THRU URTROST/NDWELLG URTRL CATH
|
Professional
|
Both
|
$367.75
|
|
|
Service Code
|
HCPCS 50686
|
| Min. Negotiated Rate |
$70.56 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$100.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$90.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$90.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$95.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$100.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$95.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.60
|
| Rate for Payer: Healthfirst Commercial |
$100.80
|
| Rate for Payer: Healthfirst Essential Plan |
$226.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$95.76
|
| Rate for Payer: Healthfirst QHP |
$100.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$70.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$100.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$85.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$70.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$100.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$75.60
|
| Rate for Payer: SOMOS Essential |
$75.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$100.80
|
|
|
PR MANUAL PREP AND INSERTION DEEP DRUG DELIVERY DEV
|
Professional
|
Both
|
$368.13
|
|
|
Service Code
|
HCPCS 20700
|
| Min. Negotiated Rate |
$68.12 |
| Max. Negotiated Rate |
$218.97 |
| Rate for Payer: Cash Price |
$99.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$97.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$87.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$92.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$97.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$92.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.99
|
| Rate for Payer: Healthfirst Commercial |
$97.32
|
| Rate for Payer: Healthfirst Essential Plan |
$218.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$92.45
|
| Rate for Payer: Healthfirst QHP |
$97.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$97.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$82.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$97.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.99
|
| Rate for Payer: SOMOS Essential |
$72.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$97.32
|
|
|
PR MANUAL PREP&INSJ I-ARTIC DRUG DELIVERY DEVICE
|
Professional
|
Both
|
$642.29
|
|
|
Service Code
|
HCPCS 20704
|
| Min. Negotiated Rate |
$122.70 |
| Max. Negotiated Rate |
$394.38 |
| Rate for Payer: Cash Price |
$175.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$175.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$157.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$157.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$166.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$175.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$166.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$131.46
|
| Rate for Payer: Healthfirst Commercial |
$175.28
|
| Rate for Payer: Healthfirst Essential Plan |
$394.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$166.52
|
| Rate for Payer: Healthfirst QHP |
$175.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$122.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$175.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$148.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$122.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$175.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$131.46
|
| Rate for Payer: SOMOS Essential |
$131.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$175.28
|
|
|
PR MANUAL PREP&INSJ INTRAMEDULLARY DRUG DLVR DEVICE
|
Professional
|
Both
|
$625.45
|
|
|
Service Code
|
HCPCS 20702
|
| Min. Negotiated Rate |
$116.70 |
| Max. Negotiated Rate |
$375.10 |
| Rate for Payer: Cash Price |
$166.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$166.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$150.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$150.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$158.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$166.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$158.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$166.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$166.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$125.03
|
| Rate for Payer: Healthfirst Commercial |
$166.71
|
| Rate for Payer: Healthfirst Essential Plan |
$375.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$158.37
|
| Rate for Payer: Healthfirst QHP |
$166.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$116.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$166.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$141.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$116.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$166.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$125.03
|
| Rate for Payer: SOMOS Essential |
$125.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$166.71
|
|
|
PR MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES
|
Professional
|
Both
|
$109.80
|
|
|
Service Code
|
HCPCS 97140
|
| Min. Negotiated Rate |
$21.67 |
| Max. Negotiated Rate |
$69.66 |
| Rate for Payer: Cash Price |
$30.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.22
|
| Rate for Payer: Healthfirst Commercial |
$30.96
|
| Rate for Payer: Healthfirst Essential Plan |
$69.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.41
|
| Rate for Payer: Healthfirst QHP |
$30.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$30.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.22
|
| Rate for Payer: SOMOS Essential |
$23.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.96
|
|
|
PR MARSUPIALIZATION BARTHOLINS GLAND CYST
|
Professional
|
Both
|
$788.13
|
|
|
Service Code
|
HCPCS 56440
|
| Min. Negotiated Rate |
$148.66 |
| Max. Negotiated Rate |
$477.83 |
| Rate for Payer: Cash Price |
$214.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$212.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$191.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$191.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$201.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$212.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$201.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$212.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$159.28
|
| Rate for Payer: Healthfirst Commercial |
$212.37
|
| Rate for Payer: Healthfirst Essential Plan |
$477.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$201.75
|
| Rate for Payer: Healthfirst QHP |
$212.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$148.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$212.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$180.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$148.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$212.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$159.28
|
| Rate for Payer: SOMOS Essential |
$159.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$212.37
|
|
|
PR MARSUPIALIZATION CST/ABSC LVR
|
Professional
|
Both
|
$5,123.16
|
|
|
Service Code
|
HCPCS 47300
|
| Min. Negotiated Rate |
$947.33 |
| Max. Negotiated Rate |
$3,044.99 |
| Rate for Payer: Cash Price |
$1,367.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,353.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,218.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,218.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,285.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,353.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,285.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,353.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,353.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,015.00
|
| Rate for Payer: Healthfirst Commercial |
$1,353.33
|
| Rate for Payer: Healthfirst Essential Plan |
$3,044.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,285.66
|
| Rate for Payer: Healthfirst QHP |
$1,353.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$947.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,353.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,150.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$947.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,353.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,015.00
|
| Rate for Payer: SOMOS Essential |
$1,015.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,353.33
|
|
|
PR MARSUPIALIZATION PANCREATIC CYST
|
Professional
|
Both
|
$5,202.79
|
|
|
Service Code
|
HCPCS 48500
|
| Min. Negotiated Rate |
$962.41 |
| Max. Negotiated Rate |
$3,093.46 |
| Rate for Payer: Cash Price |
$1,386.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,374.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,237.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,237.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,306.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,374.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,306.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,374.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,374.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,031.15
|
| Rate for Payer: Healthfirst Commercial |
$1,374.87
|
| Rate for Payer: Healthfirst Essential Plan |
$3,093.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,306.13
|
| Rate for Payer: Healthfirst QHP |
$1,374.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$962.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,374.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,168.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$962.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,374.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,031.15
|
| Rate for Payer: SOMOS Essential |
$1,031.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,374.87
|
|
|
PR MARSUPIALIZATION SUBLNGL SALIVARY CST RANULA
|
Professional
|
Both
|
$1,004.08
|
|
|
Service Code
|
HCPCS 42409
|
| Min. Negotiated Rate |
$191.49 |
| Max. Negotiated Rate |
$615.49 |
| Rate for Payer: Cash Price |
$274.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$273.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$246.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$246.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$259.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$273.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$259.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$273.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$273.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$205.16
|
| Rate for Payer: Healthfirst Commercial |
$273.55
|
| Rate for Payer: Healthfirst Essential Plan |
$615.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$259.87
|
| Rate for Payer: Healthfirst QHP |
$273.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$191.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$273.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$232.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$191.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$273.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$205.16
|
| Rate for Payer: SOMOS Essential |
$205.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$273.55
|
|
|
PR MARSUPIALIZATION URTL DIVERTICULUM MALE/FEMALE
|
Professional
|
Both
|
$1,787.91
|
|
|
Service Code
|
HCPCS 53240
|
| Min. Negotiated Rate |
$341.46 |
| Max. Negotiated Rate |
$1,097.55 |
| Rate for Payer: Cash Price |
$491.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$487.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$439.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$439.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$463.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$487.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$463.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$487.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$487.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$365.85
|
| Rate for Payer: Healthfirst Commercial |
$487.80
|
| Rate for Payer: Healthfirst Essential Plan |
$1,097.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$463.41
|
| Rate for Payer: Healthfirst QHP |
$487.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$341.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$487.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$414.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$341.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$487.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$365.85
|
| Rate for Payer: SOMOS Essential |
$365.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$487.80
|
|
|
PR MASTECTOMY GYNECOMASTIA
|
Professional
|
Both
|
$1,937.29
|
|
|
Service Code
|
HCPCS 19300
|
| Min. Negotiated Rate |
$362.77 |
| Max. Negotiated Rate |
$1,166.06 |
| Rate for Payer: Cash Price |
$518.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$518.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$466.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$466.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$492.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$518.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$492.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$518.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$518.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$388.69
|
| Rate for Payer: Healthfirst Commercial |
$518.25
|
| Rate for Payer: Healthfirst Essential Plan |
$1,166.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$492.34
|
| Rate for Payer: Healthfirst QHP |
$518.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$362.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$518.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$440.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$362.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$518.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$388.69
|
| Rate for Payer: SOMOS Essential |
$388.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$518.25
|
|
|
PR MASTECTOMY PARTIAL
|
Professional
|
Both
|
$2,979.45
|
|
|
Service Code
|
HCPCS 19301
|
| Min. Negotiated Rate |
$553.13 |
| Max. Negotiated Rate |
$1,777.93 |
| Rate for Payer: Cash Price |
$797.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$790.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$711.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$711.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$750.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$790.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$750.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$790.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$790.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$592.64
|
| Rate for Payer: Healthfirst Commercial |
$790.19
|
| Rate for Payer: Healthfirst Essential Plan |
$1,777.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$750.68
|
| Rate for Payer: Healthfirst QHP |
$790.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$553.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$790.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$671.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$553.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$790.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$592.64
|
| Rate for Payer: SOMOS Essential |
$592.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$790.19
|
|
|
PR MASTECTOMY PARTIAL W/AXILLARY LYMPHADENECTOMY
|
Professional
|
Both
|
$4,093.60
|
|
|
Service Code
|
HCPCS 19302
|
| Min. Negotiated Rate |
$760.51 |
| Max. Negotiated Rate |
$2,444.51 |
| Rate for Payer: Cash Price |
$1,095.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,086.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$977.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$977.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,032.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,086.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,032.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,086.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,086.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$814.84
|
| Rate for Payer: Healthfirst Commercial |
$1,086.45
|
| Rate for Payer: Healthfirst Essential Plan |
$2,444.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,032.13
|
| Rate for Payer: Healthfirst QHP |
$1,086.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$760.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,086.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$923.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$760.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,086.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$814.84
|
| Rate for Payer: SOMOS Essential |
$814.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,086.45
|
|
|
PR MASTECTOMY SIMPLE COMPLETE
|
Professional
|
Both
|
$4,321.84
|
|
|
Service Code
|
HCPCS 19303
|
| Min. Negotiated Rate |
$804.22 |
| Max. Negotiated Rate |
$2,585.00 |
| Rate for Payer: Cash Price |
$1,156.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,148.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,034.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,034.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,091.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,148.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,091.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,148.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,148.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$861.67
|
| Rate for Payer: Healthfirst Commercial |
$1,148.89
|
| Rate for Payer: Healthfirst Essential Plan |
$2,585.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,091.45
|
| Rate for Payer: Healthfirst QHP |
$1,148.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$804.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,148.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$976.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$804.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,148.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$861.67
|
| Rate for Payer: SOMOS Essential |
$861.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,148.89
|
|
|
PR MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN
|
Professional
|
Both
|
$5,324.03
|
|
|
Service Code
|
HCPCS 19307
|
| Min. Negotiated Rate |
$987.74 |
| Max. Negotiated Rate |
$3,174.86 |
| Rate for Payer: Cash Price |
$1,423.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,411.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,269.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,269.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,340.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,411.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,340.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,411.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,411.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,058.29
|
| Rate for Payer: Healthfirst Commercial |
$1,411.05
|
| Rate for Payer: Healthfirst Essential Plan |
$3,174.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,340.50
|
| Rate for Payer: Healthfirst QHP |
$1,411.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$987.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,411.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,199.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$987.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,411.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,058.29
|
| Rate for Payer: SOMOS Essential |
$1,058.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,411.05
|
|
|
PR MASTOIDECTOMY COMPLETE
|
Professional
|
Both
|
$4,097.07
|
|
|
Service Code
|
HCPCS 69502
|
| Min. Negotiated Rate |
$759.96 |
| Max. Negotiated Rate |
$2,442.74 |
| Rate for Payer: Cash Price |
$1,106.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,085.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$977.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$977.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,031.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,085.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,031.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,085.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,085.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$814.25
|
| Rate for Payer: Healthfirst Commercial |
$1,085.66
|
| Rate for Payer: Healthfirst Essential Plan |
$2,442.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,031.38
|
| Rate for Payer: Healthfirst QHP |
$1,085.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$759.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,085.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$922.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$759.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,085.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$814.25
|
| Rate for Payer: SOMOS Essential |
$814.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,085.66
|
|
|
PR MASTOIDECTOMY MODIFIED RADICAL
|
Professional
|
Both
|
$5,346.53
|
|
|
Service Code
|
HCPCS 69505
|
| Min. Negotiated Rate |
$993.10 |
| Max. Negotiated Rate |
$3,192.12 |
| Rate for Payer: Cash Price |
$1,439.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,418.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,276.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,276.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,347.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,418.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,347.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,418.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,418.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,064.04
|
| Rate for Payer: Healthfirst Commercial |
$1,418.72
|
| Rate for Payer: Healthfirst Essential Plan |
$3,192.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,347.78
|
| Rate for Payer: Healthfirst QHP |
$1,418.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$993.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,418.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,205.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$993.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,418.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,064.04
|
| Rate for Payer: SOMOS Essential |
$1,064.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,418.72
|
|
|
PR MASTOIDECTOMY RADICAL
|
Professional
|
Both
|
$5,466.69
|
|
|
Service Code
|
HCPCS 69511
|
| Min. Negotiated Rate |
$1,015.71 |
| Max. Negotiated Rate |
$3,264.77 |
| Rate for Payer: Cash Price |
$1,473.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,451.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,305.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,305.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,378.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,451.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,378.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,451.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,451.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,088.26
|
| Rate for Payer: Healthfirst Commercial |
$1,451.01
|
| Rate for Payer: Healthfirst Essential Plan |
$3,264.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,378.46
|
| Rate for Payer: Healthfirst QHP |
$1,451.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,015.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,451.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,233.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,015.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,451.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,088.26
|
| Rate for Payer: SOMOS Essential |
$1,088.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,451.01
|
|
|
PR MASTOID OBLITERATION SEPARATE PROCEDURE
|
Professional
|
Both
|
$4,101.02
|
|
|
Service Code
|
HCPCS 69670
|
| Min. Negotiated Rate |
$760.45 |
| Max. Negotiated Rate |
$2,444.31 |
| Rate for Payer: Cash Price |
$1,107.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,086.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$977.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$977.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,032.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,086.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,032.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,086.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,086.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$814.77
|
| Rate for Payer: Healthfirst Commercial |
$1,086.36
|
| Rate for Payer: Healthfirst Essential Plan |
$2,444.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,032.04
|
| Rate for Payer: Healthfirst QHP |
$1,086.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$760.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,086.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$923.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$760.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,086.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$814.77
|
| Rate for Payer: SOMOS Essential |
$814.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,086.36
|
|
|
PR MASTOPEXY
|
Professional
|
Both
|
$3,483.90
|
|
|
Service Code
|
HCPCS 19316
|
| Min. Negotiated Rate |
$654.45 |
| Max. Negotiated Rate |
$2,103.59 |
| Rate for Payer: Cash Price |
$939.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$934.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$841.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$841.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$888.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$934.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$888.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$934.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$934.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$701.20
|
| Rate for Payer: Healthfirst Commercial |
$934.93
|
| Rate for Payer: Healthfirst Essential Plan |
$2,103.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$888.18
|
| Rate for Payer: Healthfirst QHP |
$934.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$654.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$934.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$794.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$654.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$934.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$701.20
|
| Rate for Payer: SOMOS Essential |
$701.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$934.93
|
|
|
PR MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP
|
Professional
|
Both
|
$1,398.85
|
|
|
Service Code
|
HCPCS 19020
|
| Min. Negotiated Rate |
$262.10 |
| Max. Negotiated Rate |
$842.47 |
| Rate for Payer: Cash Price |
$378.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$374.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$336.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$336.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$355.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$374.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$355.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$374.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$374.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$280.82
|
| Rate for Payer: Healthfirst Commercial |
$374.43
|
| Rate for Payer: Healthfirst Essential Plan |
$842.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$355.71
|
| Rate for Payer: Healthfirst QHP |
$374.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$262.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$374.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$318.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$262.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$374.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$280.82
|
| Rate for Payer: SOMOS Essential |
$280.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$374.43
|
|
|
PR MAST RAD W/PECTORAL MUSC AX INT MAM LYMPH NODES
|
Professional
|
Both
|
$5,512.54
|
|
|
Service Code
|
HCPCS 19306
|
| Min. Negotiated Rate |
$1,024.13 |
| Max. Negotiated Rate |
$3,291.84 |
| Rate for Payer: Cash Price |
$1,474.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,463.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,316.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,316.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,389.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,463.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,389.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,463.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,463.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,097.28
|
| Rate for Payer: Healthfirst Commercial |
$1,463.04
|
| Rate for Payer: Healthfirst Essential Plan |
$3,291.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,389.89
|
| Rate for Payer: Healthfirst QHP |
$1,463.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,024.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,463.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,243.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,024.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,463.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,097.28
|
| Rate for Payer: SOMOS Essential |
$1,097.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,463.04
|
|
|
PR MAST RAD W/PECTORAL MUSCLES AXILLARY LYMPH NODES
|
Professional
|
Both
|
$5,194.77
|
|
|
Service Code
|
HCPCS 19305
|
| Min. Negotiated Rate |
$959.71 |
| Max. Negotiated Rate |
$3,084.77 |
| Rate for Payer: Cash Price |
$1,385.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,371.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,233.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,233.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,302.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,371.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,302.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,371.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,371.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,028.26
|
| Rate for Payer: Healthfirst Commercial |
$1,371.01
|
| Rate for Payer: Healthfirst Essential Plan |
$3,084.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,302.46
|
| Rate for Payer: Healthfirst QHP |
$1,371.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$959.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,371.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,165.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$959.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,371.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,028.26
|
| Rate for Payer: SOMOS Essential |
$1,028.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,371.01
|
|
|
PR MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ
|
Professional
|
Both
|
$11.87
|
|
|
Service Code
|
HCPCS 94200 26
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$18.38 |
| Rate for Payer: Amida Care Medicaid |
$18.38
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Healthfirst Commercial |
$3.12
|
| Rate for Payer: Healthfirst Essential Plan |
$7.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.96
|
| Rate for Payer: Healthfirst QHP |
$3.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.34
|
| Rate for Payer: SOMOS Essential |
$2.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.12
|
|
