|
PR MUSC MYOQ/FSCQ FLAP HEAD&NECK W/NAMED VASC PEDCL
|
Professional
|
Both
|
$4,450.81
|
|
|
Service Code
|
HCPCS 15733
|
| Min. Negotiated Rate |
$836.40 |
| Max. Negotiated Rate |
$2,688.43 |
| Rate for Payer: Cash Price |
$1,202.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,194.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,075.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,075.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,135.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,194.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,135.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,194.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,194.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$896.14
|
| Rate for Payer: Healthfirst Commercial |
$1,194.86
|
| Rate for Payer: Healthfirst Essential Plan |
$2,688.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,135.12
|
| Rate for Payer: Healthfirst QHP |
$1,194.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$836.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,194.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,015.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$836.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,194.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$896.14
|
| Rate for Payer: SOMOS Essential |
$896.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,194.86
|
|
|
PR MYELOGRAPHY VIA LUMBAR INJECTION RS&I 2+ REGIONS
|
Professional
|
Both
|
$504.04
|
|
|
Service Code
|
HCPCS 62305
|
| Min. Negotiated Rate |
$94.99 |
| Max. Negotiated Rate |
$305.32 |
| Rate for Payer: Cash Price |
$136.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$135.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$122.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$122.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$128.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$135.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$128.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$135.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$101.78
|
| Rate for Payer: Healthfirst Commercial |
$135.70
|
| Rate for Payer: Healthfirst Essential Plan |
$305.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$128.91
|
| Rate for Payer: Healthfirst QHP |
$135.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$94.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$135.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$115.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$94.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$135.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$101.78
|
| Rate for Payer: SOMOS Essential |
$101.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$135.70
|
|
|
PR MYELOGRAPHY VIA LUMBAR INJECTION RS&I CERVICAL
|
Professional
|
Both
|
$492.21
|
|
|
Service Code
|
HCPCS 62302
|
| Min. Negotiated Rate |
$92.30 |
| Max. Negotiated Rate |
$296.66 |
| Rate for Payer: Cash Price |
$132.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$131.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$118.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$118.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$125.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$131.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$125.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$131.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$98.89
|
| Rate for Payer: Healthfirst Commercial |
$131.85
|
| Rate for Payer: Healthfirst Essential Plan |
$296.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.26
|
| Rate for Payer: Healthfirst QHP |
$131.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$131.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$112.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$92.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$131.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$98.89
|
| Rate for Payer: SOMOS Essential |
$98.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$131.85
|
|
|
PR MYELOGRAPHY VIA LUMBAR INJECTION RS&I THORACIC
|
Professional
|
Both
|
$492.21
|
|
|
Service Code
|
HCPCS 62303
|
| Min. Negotiated Rate |
$92.30 |
| Max. Negotiated Rate |
$296.66 |
| Rate for Payer: Cash Price |
$132.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$131.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$118.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$118.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$125.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$131.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$125.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$131.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$98.89
|
| Rate for Payer: Healthfirst Commercial |
$131.85
|
| Rate for Payer: Healthfirst Essential Plan |
$296.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.26
|
| Rate for Payer: Healthfirst QHP |
$131.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$131.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$112.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$92.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$131.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$98.89
|
| Rate for Payer: SOMOS Essential |
$98.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$131.85
|
|
|
PR MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL
|
Professional
|
Both
|
$485.77
|
|
|
Service Code
|
HCPCS 62304
|
| Min. Negotiated Rate |
$91.06 |
| Max. Negotiated Rate |
$292.68 |
| Rate for Payer: Cash Price |
$131.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$130.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$117.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$117.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$123.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$130.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$123.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.56
|
| Rate for Payer: Healthfirst Commercial |
$130.08
|
| Rate for Payer: Healthfirst Essential Plan |
$292.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$123.58
|
| Rate for Payer: Healthfirst QHP |
$130.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$91.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$130.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$110.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$91.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$130.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$97.56
|
| Rate for Payer: SOMOS Essential |
$97.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.08
|
|
|
PR MYOCARDIAL RESECTION
|
Professional
|
Both
|
$11,612.06
|
|
|
Service Code
|
HCPCS 33542
|
| Min. Negotiated Rate |
$2,144.67 |
| Max. Negotiated Rate |
$6,893.60 |
| Rate for Payer: Cash Price |
$3,083.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,063.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,757.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,757.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,910.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,063.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,910.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,063.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,063.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,297.86
|
| Rate for Payer: Healthfirst Commercial |
$3,063.82
|
| Rate for Payer: Healthfirst Essential Plan |
$6,893.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,910.63
|
| Rate for Payer: Healthfirst QHP |
$3,063.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,144.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,063.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,604.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,144.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,063.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,297.86
|
| Rate for Payer: SOMOS Essential |
$2,297.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,063.82
|
|
|
PR MYOCRD STRAIN IMG SPECKLE TRCK ASSMT MYOCRD MECH
|
Professional
|
Both
|
$47.04
|
|
|
Service Code
|
HCPCS 93356
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Cash Price |
$12.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.75
|
| Rate for Payer: Healthfirst Commercial |
$13.00
|
| Rate for Payer: Healthfirst Essential Plan |
$29.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.35
|
| Rate for Payer: Healthfirst QHP |
$13.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.75
|
| Rate for Payer: SOMOS Essential |
$9.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.00
|
|
|
PR MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR
|
Professional
|
Both
|
$2,482.59
|
|
|
Service Code
|
HCPCS 58145
|
| Min. Negotiated Rate |
$457.46 |
| Max. Negotiated Rate |
$1,470.42 |
| Rate for Payer: Cash Price |
$672.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$653.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$588.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$588.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$620.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$653.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$620.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$653.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$653.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$490.14
|
| Rate for Payer: Healthfirst Commercial |
$653.52
|
| Rate for Payer: Healthfirst Essential Plan |
$1,470.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$620.84
|
| Rate for Payer: Healthfirst QHP |
$653.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$457.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$653.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$555.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$457.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$653.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$490.14
|
| Rate for Payer: SOMOS Essential |
$490.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$653.52
|
|
|
PR MYOMECTOMY 1-4 MYOMAS W/250 GM/< ABDOMINAL APPR
|
Professional
|
Both
|
$4,093.15
|
|
|
Service Code
|
HCPCS 58140
|
| Min. Negotiated Rate |
$747.31 |
| Max. Negotiated Rate |
$2,402.05 |
| Rate for Payer: Cash Price |
$1,084.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,067.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$960.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$960.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,014.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,067.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,014.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,067.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,067.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$800.68
|
| Rate for Payer: Healthfirst Commercial |
$1,067.58
|
| Rate for Payer: Healthfirst Essential Plan |
$2,402.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,014.20
|
| Rate for Payer: Healthfirst QHP |
$1,067.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$747.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,067.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$907.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$747.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,067.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$800.68
|
| Rate for Payer: SOMOS Essential |
$800.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,067.58
|
|
|
PR MYOMECTOMY 5/> MYOMAS &/>250 GM ABDOMINA
|
Professional
|
Both
|
$5,039.51
|
|
|
Service Code
|
HCPCS 58146
|
| Min. Negotiated Rate |
$935.45 |
| Max. Negotiated Rate |
$3,006.79 |
| Rate for Payer: Cash Price |
$1,355.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,336.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,202.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,202.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,269.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,336.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,269.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,336.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,336.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,002.26
|
| Rate for Payer: Healthfirst Commercial |
$1,336.35
|
| Rate for Payer: Healthfirst Essential Plan |
$3,006.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,269.53
|
| Rate for Payer: Healthfirst QHP |
$1,336.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$935.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,336.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,135.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$935.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,336.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,002.26
|
| Rate for Payer: SOMOS Essential |
$1,002.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,336.35
|
|
|
PR MYRINGOPLASTY
|
Professional
|
Both
|
$2,144.87
|
|
|
Service Code
|
HCPCS 69620
|
| Min. Negotiated Rate |
$403.57 |
| Max. Negotiated Rate |
$1,297.19 |
| Rate for Payer: Cash Price |
$582.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$576.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$518.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$518.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$547.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$576.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$547.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$576.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$576.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$432.40
|
| Rate for Payer: Healthfirst Commercial |
$576.53
|
| Rate for Payer: Healthfirst Essential Plan |
$1,297.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$547.70
|
| Rate for Payer: Healthfirst QHP |
$576.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$403.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$576.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$490.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$403.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$576.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$432.40
|
| Rate for Payer: SOMOS Essential |
$432.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$576.53
|
|
|
PR MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ
|
Professional
|
Both
|
$519.51
|
|
|
Service Code
|
HCPCS 69420
|
| Min. Negotiated Rate |
$98.72 |
| Max. Negotiated Rate |
$317.32 |
| Rate for Payer: Cash Price |
$142.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$141.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$126.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$133.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$141.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$133.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$141.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$141.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.77
|
| Rate for Payer: Healthfirst Commercial |
$141.03
|
| Rate for Payer: Healthfirst Essential Plan |
$317.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.98
|
| Rate for Payer: Healthfirst QHP |
$141.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$141.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$119.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$141.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.77
|
| Rate for Payer: SOMOS Essential |
$105.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$141.03
|
|
|
PR MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ ANES
|
Professional
|
Both
|
$657.90
|
|
|
Service Code
|
HCPCS 69421
|
| Min. Negotiated Rate |
$123.30 |
| Max. Negotiated Rate |
$396.31 |
| Rate for Payer: Cash Price |
$178.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$176.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$158.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$158.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$167.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$176.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$167.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$176.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$176.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$132.10
|
| Rate for Payer: Healthfirst Commercial |
$176.14
|
| Rate for Payer: Healthfirst Essential Plan |
$396.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$167.33
|
| Rate for Payer: Healthfirst QHP |
$176.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$123.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$176.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$149.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$123.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$176.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$132.10
|
| Rate for Payer: SOMOS Essential |
$132.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$176.14
|
|
|
PR NARCOSYNTHESIS PSYC DX&THER PURPOSES
|
Professional
|
Both
|
$484.86
|
|
|
Service Code
|
HCPCS 90865
|
| Min. Negotiated Rate |
$92.09 |
| Max. Negotiated Rate |
$296.01 |
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$131.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$118.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$118.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$124.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$131.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$124.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$131.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$98.67
|
| Rate for Payer: Healthfirst Commercial |
$131.56
|
| Rate for Payer: Healthfirst Essential Plan |
$296.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$124.98
|
| Rate for Payer: Healthfirst QHP |
$131.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$131.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$111.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$92.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$131.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$98.67
|
| Rate for Payer: SOMOS Essential |
$98.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$131.56
|
|
|
PR NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX
|
Professional
|
Both
|
$279.16
|
|
|
Service Code
|
HCPCS 31231
|
| Min. Negotiated Rate |
$51.65 |
| Max. Negotiated Rate |
$166.03 |
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$66.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$66.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.34
|
| Rate for Payer: Healthfirst Commercial |
$73.79
|
| Rate for Payer: Healthfirst Essential Plan |
$166.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.10
|
| Rate for Payer: Healthfirst QHP |
$73.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$73.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$55.34
|
| Rate for Payer: SOMOS Essential |
$55.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.79
|
|
|
PR NASAL FUNCTION STUDIES
|
Professional
|
Both
|
$111.44
|
|
|
Service Code
|
HCPCS 92512
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$67.41 |
| Rate for Payer: Cash Price |
$30.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.47
|
| Rate for Payer: Healthfirst Commercial |
$29.96
|
| Rate for Payer: Healthfirst Essential Plan |
$67.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.46
|
| Rate for Payer: Healthfirst QHP |
$29.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.47
|
| Rate for Payer: SOMOS Essential |
$22.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.96
|
|
|
PR NASAL/SINUS ENDOSCOPY DX MAXILLARY SINUSOSCOPY
|
Professional
|
Both
|
$576.49
|
|
|
Service Code
|
HCPCS 31233
|
| Min. Negotiated Rate |
$108.48 |
| Max. Negotiated Rate |
$348.68 |
| Rate for Payer: Cash Price |
$157.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$154.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$139.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$139.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$147.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$154.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$147.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$116.23
|
| Rate for Payer: Healthfirst Commercial |
$154.97
|
| Rate for Payer: Healthfirst Essential Plan |
$348.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$147.22
|
| Rate for Payer: Healthfirst QHP |
$154.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$108.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$154.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$131.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$108.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$154.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$116.23
|
| Rate for Payer: SOMOS Essential |
$116.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$154.97
|
|
|
PR NASAL/SINUS ENDOSCOPY DX SPHENOID SINUSOSCOPY
|
Professional
|
Both
|
$675.26
|
|
|
Service Code
|
HCPCS 31235
|
| Min. Negotiated Rate |
$129.44 |
| Max. Negotiated Rate |
$416.07 |
| Rate for Payer: Cash Price |
$184.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$166.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$166.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$184.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$138.69
|
| Rate for Payer: Healthfirst Commercial |
$184.92
|
| Rate for Payer: Healthfirst Essential Plan |
$416.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$175.67
|
| Rate for Payer: Healthfirst QHP |
$184.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$129.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$184.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$157.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$129.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.69
|
| Rate for Payer: SOMOS Essential |
$138.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.92
|
|
|
PR NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY
|
Professional
|
Both
|
$770.11
|
|
|
Service Code
|
HCPCS 31256
|
| Min. Negotiated Rate |
$145.76 |
| Max. Negotiated Rate |
$468.52 |
| Rate for Payer: Cash Price |
$207.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$208.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$187.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$187.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$197.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$208.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$197.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$208.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$208.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$156.17
|
| Rate for Payer: Healthfirst Commercial |
$208.23
|
| Rate for Payer: Healthfirst Essential Plan |
$468.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$197.82
|
| Rate for Payer: Healthfirst QHP |
$208.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$145.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$208.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$177.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$145.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$208.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$156.17
|
| Rate for Payer: SOMOS Essential |
$156.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$208.23
|
|
|
PR NASAL/SINUS ENDOSCOPY W/SPHENOIDOTOMY
|
Professional
|
Both
|
$862.68
|
|
|
Service Code
|
HCPCS 31287
|
| Min. Negotiated Rate |
$161.19 |
| Max. Negotiated Rate |
$518.11 |
| Rate for Payer: Cash Price |
$231.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$230.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$207.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$207.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$218.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$230.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$218.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$230.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$230.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$172.70
|
| Rate for Payer: Healthfirst Commercial |
$230.27
|
| Rate for Payer: Healthfirst Essential Plan |
$518.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$218.76
|
| Rate for Payer: Healthfirst QHP |
$230.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$161.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$230.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$195.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$161.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$230.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$172.70
|
| Rate for Payer: SOMOS Essential |
$172.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$230.27
|
|
|
PR NASAL/SINUS NDSC RPR CEREBRSP FLUID LEAK ETHMOID
|
Professional
|
Both
|
$4,940.29
|
|
|
Service Code
|
HCPCS 31290
|
| Min. Negotiated Rate |
$927.45 |
| Max. Negotiated Rate |
$2,981.09 |
| Rate for Payer: Cash Price |
$1,329.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,324.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,192.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,192.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,258.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,324.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,258.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,324.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,324.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$993.70
|
| Rate for Payer: Healthfirst Commercial |
$1,324.93
|
| Rate for Payer: Healthfirst Essential Plan |
$2,981.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,258.68
|
| Rate for Payer: Healthfirst QHP |
$1,324.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$927.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,324.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,126.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$927.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,324.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$993.70
|
| Rate for Payer: SOMOS Essential |
$993.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,324.93
|
|
|
PR NASAL/SINUS NDSC RPR CEREBSP FLUID LEAK SPHENOID
|
Professional
|
Both
|
$5,307.65
|
|
|
Service Code
|
HCPCS 31291
|
| Min. Negotiated Rate |
$1,002.01 |
| Max. Negotiated Rate |
$3,220.74 |
| Rate for Payer: Cash Price |
$1,441.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,431.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,288.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,288.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,359.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,431.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,359.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,431.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,431.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,073.58
|
| Rate for Payer: Healthfirst Commercial |
$1,431.44
|
| Rate for Payer: Healthfirst Essential Plan |
$3,220.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,359.87
|
| Rate for Payer: Healthfirst QHP |
$1,431.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,002.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,431.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,216.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,002.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,431.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,073.58
|
| Rate for Payer: SOMOS Essential |
$1,073.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,431.44
|
|
|
PR NASAL/SINUS NDSC SURG MEDIAL&INF ORB WALL DCMPRN
|
Professional
|
Both
|
$4,629.03
|
|
|
Service Code
|
HCPCS 31293
|
| Min. Negotiated Rate |
$861.10 |
| Max. Negotiated Rate |
$2,767.82 |
| Rate for Payer: Cash Price |
$1,248.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,230.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,107.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,107.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,168.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,230.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,168.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,230.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,230.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$922.61
|
| Rate for Payer: Healthfirst Commercial |
$1,230.14
|
| Rate for Payer: Healthfirst Essential Plan |
$2,767.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,168.63
|
| Rate for Payer: Healthfirst QHP |
$1,230.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$861.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,230.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,045.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$861.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,230.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$922.61
|
| Rate for Payer: SOMOS Essential |
$922.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,230.14
|
|
|
PR NASAL/SINUS NDSC SURG MEDIAL/INF ORB WALL DCMPRN
|
Professional
|
Both
|
$4,287.99
|
|
|
Service Code
|
HCPCS 31292
|
| Min. Negotiated Rate |
$797.35 |
| Max. Negotiated Rate |
$2,562.91 |
| Rate for Payer: Cash Price |
$1,148.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,139.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,025.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,025.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,082.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,139.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,082.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,139.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,139.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$854.30
|
| Rate for Payer: Healthfirst Commercial |
$1,139.07
|
| Rate for Payer: Healthfirst Essential Plan |
$2,562.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,082.12
|
| Rate for Payer: Healthfirst QHP |
$1,139.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$797.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,139.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$968.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$797.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,139.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$854.30
|
| Rate for Payer: SOMOS Essential |
$854.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,139.07
|
|
|
PR NASAL/SINUS NDSC SURG W/BX POLYPC/DBRDMT SPX
|
Professional
|
Both
|
$684.18
|
|
|
Service Code
|
HCPCS 31237
|
| Min. Negotiated Rate |
$129.57 |
| Max. Negotiated Rate |
$416.48 |
| Rate for Payer: Cash Price |
$185.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$185.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$166.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$166.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$185.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$185.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$138.82
|
| Rate for Payer: Healthfirst Commercial |
$185.10
|
| Rate for Payer: Healthfirst Essential Plan |
$416.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$175.84
|
| Rate for Payer: Healthfirst QHP |
$185.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$129.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$185.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$157.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$129.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$185.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.82
|
| Rate for Payer: SOMOS Essential |
$138.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$185.10
|
|
