|
PR PDT DSTR PRMLG LES SKN ILLUM/ACTIVJ BY PHYS/QHP
|
Professional
|
Both
|
$985.60
|
|
|
Service Code
|
HCPCS 96573
|
| Min. Negotiated Rate |
$104.12 |
| Max. Negotiated Rate |
$570.98 |
| Rate for Payer: Amida Care Medicaid |
$104.12
|
| Rate for Payer: Cash Price |
$265.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$253.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$228.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$228.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$241.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$253.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$241.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$253.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$253.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$190.33
|
| Rate for Payer: Healthfirst Commercial |
$253.77
|
| Rate for Payer: Healthfirst Essential Plan |
$570.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$241.08
|
| Rate for Payer: Healthfirst QHP |
$253.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$177.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$253.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$215.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$177.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$253.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$190.33
|
| Rate for Payer: SOMOS Essential |
$190.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$253.77
|
|
|
PR PDT DSTR PRMLG LES SKN ILLUM/ACTIVJ PER DAY
|
Professional
|
Both
|
$606.48
|
|
|
Service Code
|
HCPCS 96567
|
| Min. Negotiated Rate |
$107.48 |
| Max. Negotiated Rate |
$345.49 |
| Rate for Payer: Cash Price |
$161.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$153.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$138.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$138.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$145.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$153.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$145.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$153.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$153.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$115.16
|
| Rate for Payer: Healthfirst Commercial |
$153.55
|
| Rate for Payer: Healthfirst Essential Plan |
$345.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$145.87
|
| Rate for Payer: Healthfirst QHP |
$153.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$107.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$153.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$130.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$107.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$153.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$115.16
|
| Rate for Payer: SOMOS Essential |
$115.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$153.55
|
|
|
PR PDT NDSC ABL ABNOR TISS VIA ACTIVJ RX 30 MIN
|
Professional
|
Both
|
$237.20
|
|
|
Service Code
|
HCPCS 96570
|
| Min. Negotiated Rate |
$28.88 |
| Max. Negotiated Rate |
$138.08 |
| Rate for Payer: Amida Care Medicaid |
$28.88
|
| Rate for Payer: Cash Price |
$55.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.03
|
| Rate for Payer: Healthfirst Commercial |
$61.37
|
| Rate for Payer: Healthfirst Essential Plan |
$138.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$58.30
|
| Rate for Payer: Healthfirst QHP |
$61.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$42.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$61.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$52.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$42.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$46.03
|
| Rate for Payer: SOMOS Essential |
$46.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.37
|
|
|
PR PDT NDSC ABL ABNOR TISS VIA ACTIVJ RX A 15 MIN
|
Professional
|
Both
|
$101.40
|
|
|
Service Code
|
HCPCS 96571
|
| Min. Negotiated Rate |
$13.87 |
| Max. Negotiated Rate |
$61.29 |
| Rate for Payer: Amida Care Medicaid |
$13.87
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.43
|
| Rate for Payer: Healthfirst Commercial |
$27.24
|
| Rate for Payer: Healthfirst Essential Plan |
$61.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.88
|
| Rate for Payer: Healthfirst QHP |
$27.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.43
|
| Rate for Payer: SOMOS Essential |
$20.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.24
|
|
|
PR PEDIATRIC APNEA MONITOR PHYS/QHP REVIEW
|
Professional
|
Both
|
$127.44
|
|
|
Service Code
|
HCPCS 94777
|
| Min. Negotiated Rate |
$42.42 |
| Max. Negotiated Rate |
$42.42 |
| Rate for Payer: Amida Care Medicaid |
$42.42
|
|
|
PR PEL EXNTJ GYNECOLOGIC MAL
|
Professional
|
Both
|
$12,743.12
|
|
|
Service Code
|
HCPCS 58240
|
| Min. Negotiated Rate |
$2,387.65 |
| Max. Negotiated Rate |
$7,674.59 |
| Rate for Payer: Cash Price |
$3,429.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,410.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,069.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,069.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,240.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,410.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,240.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,410.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,410.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,558.20
|
| Rate for Payer: Healthfirst Commercial |
$3,410.93
|
| Rate for Payer: Healthfirst Essential Plan |
$7,674.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,240.38
|
| Rate for Payer: Healthfirst QHP |
$3,410.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,387.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,410.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,899.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,387.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,410.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,558.20
|
| Rate for Payer: SOMOS Essential |
$2,558.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,410.93
|
|
|
PR PEL LMPHADEC W/XTRNL ILIAC HYPOGSTR&OBTURATOR
|
Professional
|
Both
|
$3,442.74
|
|
|
Service Code
|
HCPCS 38770
|
| Min. Negotiated Rate |
$649.08 |
| Max. Negotiated Rate |
$2,086.34 |
| Rate for Payer: Cash Price |
$937.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$927.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$834.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$834.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$880.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$927.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$880.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$927.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$927.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$695.45
|
| Rate for Payer: Healthfirst Commercial |
$927.26
|
| Rate for Payer: Healthfirst Essential Plan |
$2,086.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$880.90
|
| Rate for Payer: Healthfirst QHP |
$927.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$649.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$927.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$788.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$649.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$927.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$695.45
|
| Rate for Payer: SOMOS Essential |
$695.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$927.26
|
|
|
PR PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL
|
Professional
|
Both
|
$454.06
|
|
|
Service Code
|
HCPCS 57410
|
| Min. Negotiated Rate |
$85.83 |
| Max. Negotiated Rate |
$275.89 |
| Rate for Payer: Cash Price |
$124.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$122.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$110.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$116.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$122.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$116.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.97
|
| Rate for Payer: Healthfirst Commercial |
$122.62
|
| Rate for Payer: Healthfirst Essential Plan |
$275.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$116.49
|
| Rate for Payer: Healthfirst QHP |
$122.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$85.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$122.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$104.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$85.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$122.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$91.97
|
| Rate for Payer: SOMOS Essential |
$91.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.62
|
|
|
PR PELVIC EXENTERATION COLORECTAL MALIGNANCY
|
Professional
|
Both
|
$11,685.03
|
|
|
Service Code
|
HCPCS 45126
|
| Min. Negotiated Rate |
$2,185.71 |
| Max. Negotiated Rate |
$7,025.49 |
| Rate for Payer: Cash Price |
$3,177.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,122.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,810.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,810.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,966.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,122.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,966.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,122.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,122.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,341.83
|
| Rate for Payer: Healthfirst Commercial |
$3,122.44
|
| Rate for Payer: Healthfirst Essential Plan |
$7,025.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,966.32
|
| Rate for Payer: Healthfirst QHP |
$3,122.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,185.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,122.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,654.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,185.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,122.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,341.83
|
| Rate for Payer: SOMOS Essential |
$2,341.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,122.44
|
|
|
PR PELVIC EXENTERATION COMPLETE MALIGNANCY
|
Professional
|
Both
|
$9,613.70
|
|
|
Service Code
|
HCPCS 51597
|
| Min. Negotiated Rate |
$1,819.50 |
| Max. Negotiated Rate |
$5,848.40 |
| Rate for Payer: Cash Price |
$2,618.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,599.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,339.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,339.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,469.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,599.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,469.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,599.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,599.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,949.47
|
| Rate for Payer: Healthfirst Commercial |
$2,599.29
|
| Rate for Payer: Healthfirst Essential Plan |
$5,848.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,469.33
|
| Rate for Payer: Healthfirst QHP |
$2,599.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,819.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,599.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,209.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,819.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,599.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,949.47
|
| Rate for Payer: SOMOS Essential |
$1,949.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,599.29
|
|
|
PR PELVIC FIXATION OTHER THAN SACRUM
|
Professional
|
Both
|
$1,645.35
|
|
|
Service Code
|
HCPCS 22848
|
| Min. Negotiated Rate |
$302.55 |
| Max. Negotiated Rate |
$972.50 |
| Rate for Payer: Cash Price |
$436.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$432.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$389.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$389.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$432.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$432.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$432.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$324.17
|
| Rate for Payer: Healthfirst Commercial |
$432.22
|
| Rate for Payer: Healthfirst Essential Plan |
$972.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$410.61
|
| Rate for Payer: Healthfirst QHP |
$432.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$302.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$432.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$367.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$302.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$432.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$324.17
|
| Rate for Payer: SOMOS Essential |
$324.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$432.22
|
|
|
PR PELVIC RING FRACTURE UNI/BIL
|
Professional
|
Both
|
$4,700.78
|
|
|
Service Code
|
HCPCS G0413
|
| Min. Negotiated Rate |
$882.64 |
| Max. Negotiated Rate |
$2,837.05 |
| Rate for Payer: Cash Price |
$1,267.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,260.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,134.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,134.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,197.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,260.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,197.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,260.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,260.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$945.68
|
| Rate for Payer: Healthfirst Commercial |
$1,260.91
|
| Rate for Payer: Healthfirst Essential Plan |
$2,837.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,197.86
|
| Rate for Payer: Healthfirst QHP |
$1,260.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$882.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,260.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,071.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$882.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,260.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$945.68
|
| Rate for Payer: SOMOS Essential |
$945.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,260.91
|
|
|
PR PELVIC RING FX TREAT INT FIX
|
Professional
|
Both
|
$4,432.02
|
|
|
Service Code
|
HCPCS G0414
|
| Min. Negotiated Rate |
$834.09 |
| Max. Negotiated Rate |
$2,680.99 |
| Rate for Payer: Cash Price |
$1,196.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,191.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,072.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,072.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,131.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,191.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,131.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,191.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,191.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$893.66
|
| Rate for Payer: Healthfirst Commercial |
$1,191.55
|
| Rate for Payer: Healthfirst Essential Plan |
$2,680.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,131.97
|
| Rate for Payer: Healthfirst QHP |
$1,191.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$834.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,191.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,012.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$834.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,191.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$893.66
|
| Rate for Payer: SOMOS Essential |
$893.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,191.55
|
|
|
PR PENICILLIN G BENZATHINE INJ
|
Professional
|
Both
|
$602.49
|
|
|
Service Code
|
HCPCS J0561
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$67.52 |
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.51
|
| Rate for Payer: Healthfirst Commercial |
$30.01
|
| Rate for Payer: Healthfirst Essential Plan |
$67.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.51
|
| Rate for Payer: Healthfirst QHP |
$30.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$30.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.51
|
| Rate for Payer: SOMOS Essential |
$22.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.01
|
|
|
PR PENILE PLETHYSMOGRAPHY
|
Professional
|
Both
|
$276.71
|
|
|
Service Code
|
HCPCS 54240 26
|
| Min. Negotiated Rate |
$50.85 |
| Max. Negotiated Rate |
$163.44 |
| Rate for Payer: Cash Price |
$71.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$65.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$69.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.48
|
| Rate for Payer: Healthfirst Commercial |
$72.64
|
| Rate for Payer: Healthfirst Essential Plan |
$163.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.01
|
| Rate for Payer: Healthfirst QHP |
$72.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$50.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$72.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$61.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.48
|
| Rate for Payer: SOMOS Essential |
$54.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.64
|
|
|
PR PENILE PLETHYSMOGRAPHY
|
Professional
|
Both
|
$182.28
|
|
|
Service Code
|
HCPCS 54240 TC
|
| Min. Negotiated Rate |
$36.73 |
| Max. Negotiated Rate |
$118.06 |
| Rate for Payer: Cash Price |
$52.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.35
|
| Rate for Payer: Healthfirst Commercial |
$52.47
|
| Rate for Payer: Healthfirst Essential Plan |
$118.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.85
|
| Rate for Payer: Healthfirst QHP |
$52.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.35
|
| Rate for Payer: SOMOS Essential |
$39.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.47
|
|
|
PR PENILE PLETHYSMOGRAPHY
|
Professional
|
Both
|
$458.99
|
|
|
Service Code
|
HCPCS 54240
|
| Min. Negotiated Rate |
$87.58 |
| Max. Negotiated Rate |
$281.52 |
| Rate for Payer: Cash Price |
$124.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$125.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$112.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$112.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$118.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$125.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$118.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$93.84
|
| Rate for Payer: Healthfirst Commercial |
$125.12
|
| Rate for Payer: Healthfirst Essential Plan |
$281.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$118.86
|
| Rate for Payer: Healthfirst QHP |
$125.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$87.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$125.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$106.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$87.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$125.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$93.84
|
| Rate for Payer: SOMOS Essential |
$93.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$125.12
|
|
|
PR PENILE REVASCULARIZATION ARTERY W/WO VEIN GRAFT
|
Professional
|
Both
|
$5,262.64
|
|
|
Service Code
|
HCPCS 37788
|
| Min. Negotiated Rate |
$998.65 |
| Max. Negotiated Rate |
$3,209.96 |
| Rate for Payer: Cash Price |
$1,436.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,426.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,283.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,283.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,355.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,426.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,355.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,426.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,426.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,069.99
|
| Rate for Payer: Healthfirst Commercial |
$1,426.65
|
| Rate for Payer: Healthfirst Essential Plan |
$3,209.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,355.32
|
| Rate for Payer: Healthfirst QHP |
$1,426.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$998.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,426.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,212.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$998.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,426.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,069.99
|
| Rate for Payer: SOMOS Essential |
$1,069.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,426.65
|
|
|
PR PENILE VENOUS OCCLUSIVE PROCEDURE
|
Professional
|
Both
|
$2,033.82
|
|
|
Service Code
|
HCPCS 37790
|
| Min. Negotiated Rate |
$388.32 |
| Max. Negotiated Rate |
$1,248.19 |
| Rate for Payer: Cash Price |
$558.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$554.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$499.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$499.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$527.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$554.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$527.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$554.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$554.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$416.06
|
| Rate for Payer: Healthfirst Commercial |
$554.75
|
| Rate for Payer: Healthfirst Essential Plan |
$1,248.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$527.01
|
| Rate for Payer: Healthfirst QHP |
$554.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$388.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$554.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$471.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$388.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$554.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$416.06
|
| Rate for Payer: SOMOS Essential |
$416.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$554.75
|
|
|
PR PENIS CORRJ CHORDEE/1ST STAGE HYPOSPADIAS RPR
|
Professional
|
Both
|
$3,129.32
|
|
|
Service Code
|
HCPCS 54304
|
| Min. Negotiated Rate |
$595.97 |
| Max. Negotiated Rate |
$1,915.63 |
| Rate for Payer: Cash Price |
$856.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$851.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$766.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$766.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$808.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$851.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$808.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$851.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$851.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$638.54
|
| Rate for Payer: Healthfirst Commercial |
$851.39
|
| Rate for Payer: Healthfirst Essential Plan |
$1,915.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$808.82
|
| Rate for Payer: Healthfirst QHP |
$851.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$595.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$851.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$723.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$595.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$851.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$638.54
|
| Rate for Payer: SOMOS Essential |
$638.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$851.39
|
|
|
PR PENIS STRAIGHTENING CHORDEE
|
Professional
|
Both
|
$2,706.66
|
|
|
Service Code
|
HCPCS 54300
|
| Min. Negotiated Rate |
$516.30 |
| Max. Negotiated Rate |
$1,659.53 |
| Rate for Payer: Cash Price |
$741.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$737.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$663.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$663.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$700.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$737.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$700.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$737.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$737.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$553.18
|
| Rate for Payer: Healthfirst Commercial |
$737.57
|
| Rate for Payer: Healthfirst Essential Plan |
$1,659.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$700.69
|
| Rate for Payer: Healthfirst QHP |
$737.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$516.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$737.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$626.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$516.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$737.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$553.18
|
| Rate for Payer: SOMOS Essential |
$553.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$737.57
|
|
|
PR PENTAMIDINE AERSL INHALATION PNEUMOCYSTIS/PROPH
|
Professional
|
Both
|
$274.02
|
|
|
Service Code
|
HCPCS 94642
|
| Min. Negotiated Rate |
$31.28 |
| Max. Negotiated Rate |
$31.28 |
| Rate for Payer: Amida Care Medicaid |
$31.28
|
|
|
PR PERCUTANEOUS ASPIRATION SPINAL CORD CYST/SYRINX
|
Professional
|
Both
|
$1,065.47
|
|
|
Service Code
|
HCPCS 62268
|
| Min. Negotiated Rate |
$289.46 |
| Max. Negotiated Rate |
$930.40 |
| Rate for Payer: Cash Price |
$416.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$413.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$372.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$372.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$392.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$413.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$392.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$413.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$413.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$310.13
|
| Rate for Payer: Healthfirst Commercial |
$413.51
|
| Rate for Payer: Healthfirst Essential Plan |
$930.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$392.83
|
| Rate for Payer: Healthfirst QHP |
$413.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$289.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$413.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$351.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$289.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$413.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$310.13
|
| Rate for Payer: SOMOS Essential |
$310.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$413.51
|
|
|
PR PERCUTANEOUS ISLET CELLTRANS
|
Professional
|
Both
|
$1,289.65
|
|
|
Service Code
|
HCPCS G0341
|
| Min. Negotiated Rate |
$243.14 |
| Max. Negotiated Rate |
$781.51 |
| Rate for Payer: Cash Price |
$348.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$347.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$312.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$312.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$329.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$347.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$329.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$347.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$347.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$260.50
|
| Rate for Payer: Healthfirst Commercial |
$347.34
|
| Rate for Payer: Healthfirst Essential Plan |
$781.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$329.97
|
| Rate for Payer: Healthfirst QHP |
$347.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$243.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$347.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$295.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$243.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$347.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$260.50
|
| Rate for Payer: SOMOS Essential |
$260.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$347.34
|
|
|
PR PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS
|
Professional
|
Both
|
$18.38
|
|
|
Service Code
|
HCPCS 95004
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$10.04 |
| Rate for Payer: Amida Care Medicaid |
$3.08
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.35
|
| Rate for Payer: Healthfirst Commercial |
$4.46
|
| Rate for Payer: Healthfirst Essential Plan |
$10.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.24
|
| Rate for Payer: Healthfirst QHP |
$4.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.35
|
| Rate for Payer: SOMOS Essential |
$3.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.46
|
|
