|
PR PERI-PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB
|
Professional
|
Both
|
$137.87
|
|
|
Service Code
|
HCPCS 93287 TC
|
| Min. Negotiated Rate |
$24.61 |
| Max. Negotiated Rate |
$79.11 |
| Rate for Payer: Amida Care Medicaid |
$28.30
|
| Rate for Payer: Cash Price |
$36.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.37
|
| Rate for Payer: Healthfirst Commercial |
$35.16
|
| Rate for Payer: Healthfirst Essential Plan |
$79.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.40
|
| Rate for Payer: Healthfirst QHP |
$35.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.37
|
| Rate for Payer: SOMOS Essential |
$26.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.16
|
|
|
PR PERI-PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB
|
Professional
|
Both
|
$224.28
|
|
|
Service Code
|
HCPCS 93287
|
| Min. Negotiated Rate |
$28.30 |
| Max. Negotiated Rate |
$131.11 |
| Rate for Payer: Amida Care Medicaid |
$28.30
|
| Rate for Payer: Cash Price |
$59.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$58.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$52.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$58.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.70
|
| Rate for Payer: Healthfirst Commercial |
$58.27
|
| Rate for Payer: Healthfirst Essential Plan |
$131.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$55.36
|
| Rate for Payer: Healthfirst QHP |
$58.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$58.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$49.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$58.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$43.70
|
| Rate for Payer: SOMOS Essential |
$43.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.27
|
|
|
PR PERIRECTAL INJ SCLEROSING SOLUTION PROLAPSE
|
Professional
|
Both
|
$171.43
|
|
|
Service Code
|
HCPCS 45520
|
| Min. Negotiated Rate |
$32.43 |
| Max. Negotiated Rate |
$104.24 |
| Rate for Payer: Cash Price |
$47.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.75
|
| Rate for Payer: Healthfirst Commercial |
$46.33
|
| Rate for Payer: Healthfirst Essential Plan |
$104.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.01
|
| Rate for Payer: Healthfirst QHP |
$46.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.75
|
| Rate for Payer: SOMOS Essential |
$34.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.33
|
|
|
PR PERITONEAL LAVAGE W/WO IMAGING GUIDANCE
|
Professional
|
Both
|
$477.26
|
|
|
Service Code
|
HCPCS 49084
|
| Min. Negotiated Rate |
$89.10 |
| Max. Negotiated Rate |
$286.40 |
| Rate for Payer: Cash Price |
$126.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$114.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$114.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$120.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$120.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.47
|
| Rate for Payer: Healthfirst Commercial |
$127.29
|
| Rate for Payer: Healthfirst Essential Plan |
$286.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$120.93
|
| Rate for Payer: Healthfirst QHP |
$127.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$89.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$127.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$108.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$89.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$95.47
|
| Rate for Payer: SOMOS Essential |
$95.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.29
|
|
|
PR PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT
|
Professional
|
Both
|
$546.42
|
|
|
Service Code
|
HCPCS 34713
|
| Min. Negotiated Rate |
$99.83 |
| Max. Negotiated Rate |
$320.89 |
| Rate for Payer: Cash Price |
$143.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$142.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$128.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$128.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$135.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$142.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$135.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$106.97
|
| Rate for Payer: Healthfirst Commercial |
$142.62
|
| Rate for Payer: Healthfirst Essential Plan |
$320.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$135.49
|
| Rate for Payer: Healthfirst QHP |
$142.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$99.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$142.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$121.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$99.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$142.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$106.97
|
| Rate for Payer: SOMOS Essential |
$106.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$142.62
|
|
|
PR PERQ ART TRLUML M-THROMBEC &/NFS INTRACRANIAL
|
Professional
|
Both
|
$3,837.12
|
|
|
Service Code
|
HCPCS 61645
|
| Min. Negotiated Rate |
$712.55 |
| Max. Negotiated Rate |
$2,290.34 |
| Rate for Payer: Cash Price |
$1,020.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,017.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$916.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$916.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$967.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,017.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$967.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,017.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,017.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$763.45
|
| Rate for Payer: Healthfirst Commercial |
$1,017.93
|
| Rate for Payer: Healthfirst Essential Plan |
$2,290.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$967.03
|
| Rate for Payer: Healthfirst QHP |
$1,017.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$712.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,017.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$865.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$712.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,017.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$763.45
|
| Rate for Payer: SOMOS Essential |
$763.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,017.93
|
|
|
PR PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES
|
Professional
|
Both
|
$1,959.86
|
|
|
Service Code
|
HCPCS 36837
|
| Min. Negotiated Rate |
$360.05 |
| Max. Negotiated Rate |
$1,157.31 |
| Rate for Payer: Cash Price |
$519.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$514.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$462.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$462.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$488.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$514.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$488.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$514.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$514.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$385.77
|
| Rate for Payer: Healthfirst Commercial |
$514.36
|
| Rate for Payer: Healthfirst Essential Plan |
$1,157.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$488.64
|
| Rate for Payer: Healthfirst QHP |
$514.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$360.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$514.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$437.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$360.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$514.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$385.77
|
| Rate for Payer: SOMOS Essential |
$385.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$514.36
|
|
|
PR PERQ AV FISTULA CREATION UXTR SINGLE ACCESS
|
Professional
|
Both
|
$1,482.01
|
|
|
Service Code
|
HCPCS 36836
|
| Min. Negotiated Rate |
$278.46 |
| Max. Negotiated Rate |
$895.05 |
| Rate for Payer: Cash Price |
$400.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$397.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$358.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$358.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$377.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$397.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$377.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$397.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$397.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$298.35
|
| Rate for Payer: Healthfirst Commercial |
$397.80
|
| Rate for Payer: Healthfirst Essential Plan |
$895.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$377.91
|
| Rate for Payer: Healthfirst QHP |
$397.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$278.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$397.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$338.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$278.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$397.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$298.35
|
| Rate for Payer: SOMOS Essential |
$298.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$397.80
|
|
|
PR PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID
|
Professional
|
Both
|
$513.28
|
|
|
Service Code
|
HCPCS 19287
|
| Min. Negotiated Rate |
$96.28 |
| Max. Negotiated Rate |
$309.46 |
| Rate for Payer: Cash Price |
$139.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$137.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$123.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$130.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$137.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$130.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.16
|
| Rate for Payer: Healthfirst Commercial |
$137.54
|
| Rate for Payer: Healthfirst Essential Plan |
$309.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.66
|
| Rate for Payer: Healthfirst QHP |
$137.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$96.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$137.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$116.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$96.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$137.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$103.16
|
| Rate for Payer: SOMOS Essential |
$103.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.54
|
|
|
PR PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG
|
Professional
|
Both
|
$351.30
|
|
|
Service Code
|
HCPCS 19285
|
| Min. Negotiated Rate |
$64.76 |
| Max. Negotiated Rate |
$208.17 |
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.39
|
| Rate for Payer: Healthfirst Commercial |
$92.52
|
| Rate for Payer: Healthfirst Essential Plan |
$208.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.89
|
| Rate for Payer: Healthfirst QHP |
$92.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.39
|
| Rate for Payer: SOMOS Essential |
$69.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.52
|
|
|
PR PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE
|
Professional
|
Both
|
$410.17
|
|
|
Service Code
|
HCPCS 19283
|
| Min. Negotiated Rate |
$76.72 |
| Max. Negotiated Rate |
$246.60 |
| Rate for Payer: Cash Price |
$110.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$109.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$98.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$98.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$104.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$109.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$104.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.20
|
| Rate for Payer: Healthfirst Commercial |
$109.60
|
| Rate for Payer: Healthfirst Essential Plan |
$246.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$104.12
|
| Rate for Payer: Healthfirst QHP |
$109.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$76.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$109.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$93.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$76.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$109.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.20
|
| Rate for Payer: SOMOS Essential |
$82.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$109.60
|
|
|
PR PERQ BREAST LOC DEVICE PLACEMT ADD LESIO MR GUID
|
Professional
|
Both
|
$257.99
|
|
|
Service Code
|
HCPCS 19288
|
| Min. Negotiated Rate |
$48.83 |
| Max. Negotiated Rate |
$156.96 |
| Rate for Payer: Cash Price |
$69.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$69.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$66.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$69.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$66.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$69.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$69.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.32
|
| Rate for Payer: Healthfirst Commercial |
$69.76
|
| Rate for Payer: Healthfirst Essential Plan |
$156.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$66.27
|
| Rate for Payer: Healthfirst QHP |
$69.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$69.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$59.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$69.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$52.32
|
| Rate for Payer: SOMOS Essential |
$52.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69.76
|
|
|
PR PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE
|
Professional
|
Both
|
$178.40
|
|
|
Service Code
|
HCPCS 19286
|
| Min. Negotiated Rate |
$32.38 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Cash Price |
$47.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.70
|
| Rate for Payer: Healthfirst Commercial |
$46.26
|
| Rate for Payer: Healthfirst Essential Plan |
$104.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.95
|
| Rate for Payer: Healthfirst QHP |
$46.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.70
|
| Rate for Payer: SOMOS Essential |
$34.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.26
|
|
|
PR PERQ BREAST LOC DEVICE PLACEMT EA LESION STRTCTC
|
Professional
|
Both
|
$207.10
|
|
|
Service Code
|
HCPCS 19284
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$122.85 |
| Rate for Payer: Cash Price |
$55.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.95
|
| Rate for Payer: Healthfirst Commercial |
$54.60
|
| Rate for Payer: Healthfirst Essential Plan |
$122.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.87
|
| Rate for Payer: Healthfirst QHP |
$54.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$54.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$46.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.95
|
| Rate for Payer: SOMOS Essential |
$40.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.60
|
|
|
PR PERQ CLSR TCAT L ATR APNDGE W/ENDOCARDIAL IMPLNT
|
Professional
|
Both
|
$3,445.37
|
|
|
Service Code
|
HCPCS 33340
|
| Min. Negotiated Rate |
$629.16 |
| Max. Negotiated Rate |
$2,022.30 |
| Rate for Payer: Cash Price |
$909.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$898.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$808.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$808.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$853.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$898.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$853.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$898.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$898.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$674.10
|
| Rate for Payer: Healthfirst Commercial |
$898.80
|
| Rate for Payer: Healthfirst Essential Plan |
$2,022.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$853.86
|
| Rate for Payer: Healthfirst QHP |
$898.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$629.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$898.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$763.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$629.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$898.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$674.10
|
| Rate for Payer: SOMOS Essential |
$674.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$898.80
|
|
|
PR PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GDNCE
|
Professional
|
Both
|
$404.67
|
|
|
Service Code
|
HCPCS 19281
|
| Min. Negotiated Rate |
$75.42 |
| Max. Negotiated Rate |
$242.41 |
| Rate for Payer: Cash Price |
$108.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$107.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.81
|
| Rate for Payer: Healthfirst Commercial |
$107.74
|
| Rate for Payer: Healthfirst Essential Plan |
$242.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$102.35
|
| Rate for Payer: Healthfirst QHP |
$107.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$107.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$91.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$80.81
|
| Rate for Payer: SOMOS Essential |
$80.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.74
|
|
|
PR PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE
|
Professional
|
Both
|
$205.80
|
|
|
Service Code
|
HCPCS 19282
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$120.96 |
| Rate for Payer: Cash Price |
$54.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.32
|
| Rate for Payer: Healthfirst Commercial |
$53.76
|
| Rate for Payer: Healthfirst Essential Plan |
$120.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.07
|
| Rate for Payer: Healthfirst QHP |
$53.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.32
|
| Rate for Payer: SOMOS Essential |
$40.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.76
|
|
|
PR PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG
|
Professional
|
Both
|
$612.99
|
|
|
Service Code
|
HCPCS 50436
|
| Min. Negotiated Rate |
$118.17 |
| Max. Negotiated Rate |
$379.82 |
| Rate for Payer: Cash Price |
$166.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$168.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$151.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$151.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$168.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$168.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$168.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$126.61
|
| Rate for Payer: Healthfirst Commercial |
$168.81
|
| Rate for Payer: Healthfirst Essential Plan |
$379.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$160.37
|
| Rate for Payer: Healthfirst QHP |
$168.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$118.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$168.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$143.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$118.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$168.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$126.61
|
| Rate for Payer: SOMOS Essential |
$126.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$168.81
|
|
|
PR PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS
|
Professional
|
Both
|
$1,016.37
|
|
|
Service Code
|
HCPCS 50437
|
| Min. Negotiated Rate |
$196.25 |
| Max. Negotiated Rate |
$630.79 |
| Rate for Payer: Cash Price |
$274.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$280.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$252.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$252.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$266.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$280.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$266.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$280.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$280.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$210.26
|
| Rate for Payer: Healthfirst Commercial |
$280.35
|
| Rate for Payer: Healthfirst Essential Plan |
$630.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$266.33
|
| Rate for Payer: Healthfirst QHP |
$280.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$196.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$280.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$238.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$196.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$280.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$210.26
|
| Rate for Payer: SOMOS Essential |
$210.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$280.35
|
|
|
PR PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING
|
Professional
|
Both
|
$610.86
|
|
|
Service Code
|
HCPCS 32557
|
| Min. Negotiated Rate |
$114.14 |
| Max. Negotiated Rate |
$366.88 |
| Rate for Payer: Cash Price |
$165.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$163.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$146.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$146.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$154.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$163.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$154.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$163.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$163.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$122.30
|
| Rate for Payer: Healthfirst Commercial |
$163.06
|
| Rate for Payer: Healthfirst Essential Plan |
$366.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$154.91
|
| Rate for Payer: Healthfirst QHP |
$163.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$114.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$163.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$138.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$114.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$163.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$122.30
|
| Rate for Payer: SOMOS Essential |
$122.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$163.06
|
|
|
PR PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING
|
Professional
|
Both
|
$523.88
|
|
|
Service Code
|
HCPCS 32556
|
| Min. Negotiated Rate |
$98.73 |
| Max. Negotiated Rate |
$317.36 |
| Rate for Payer: Cash Price |
$141.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$141.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$126.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$134.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$141.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$134.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$141.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$141.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.79
|
| Rate for Payer: Healthfirst Commercial |
$141.05
|
| Rate for Payer: Healthfirst Essential Plan |
$317.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$134.00
|
| Rate for Payer: Healthfirst QHP |
$141.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$141.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$119.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$141.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.79
|
| Rate for Payer: SOMOS Essential |
$105.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$141.05
|
|
|
PR PERQ NL/PL LITHOTRP COMPLEX >2 CM MLT LOCATIONS
|
Professional
|
Both
|
$4,694.76
|
|
|
Service Code
|
HCPCS 50081
|
| Min. Negotiated Rate |
$889.98 |
| Max. Negotiated Rate |
$2,860.65 |
| Rate for Payer: Cash Price |
$1,280.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,271.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,144.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,144.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,207.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,271.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,207.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,271.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,271.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$953.55
|
| Rate for Payer: Healthfirst Commercial |
$1,271.40
|
| Rate for Payer: Healthfirst Essential Plan |
$2,860.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,207.83
|
| Rate for Payer: Healthfirst QHP |
$1,271.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$889.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,271.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,080.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$889.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,271.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$953.55
|
| Rate for Payer: SOMOS Essential |
$953.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,271.40
|
|
|
PR PERQ NL/PL LITHOTRP SIMPLE UP TO 2 CM 1 LOCATION
|
Professional
|
Both
|
$2,917.95
|
|
|
Service Code
|
HCPCS 50080
|
| Min. Negotiated Rate |
$555.07 |
| Max. Negotiated Rate |
$1,784.14 |
| Rate for Payer: Cash Price |
$797.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$792.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$713.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$713.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$753.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$792.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$753.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$792.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$792.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$594.71
|
| Rate for Payer: Healthfirst Commercial |
$792.95
|
| Rate for Payer: Healthfirst Essential Plan |
$1,784.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$753.30
|
| Rate for Payer: Healthfirst QHP |
$792.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$555.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$792.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$674.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$555.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$792.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$594.71
|
| Rate for Payer: SOMOS Essential |
$594.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$792.95
|
|
|
PR PERQ P-ART REVSC ST 1ST ABNOR CONNJ UNILATERAL
|
Professional
|
Both
|
$3,228.44
|
|
|
Service Code
|
HCPCS 33902
|
| Min. Negotiated Rate |
$607.03 |
| Max. Negotiated Rate |
$1,951.15 |
| Rate for Payer: Cash Price |
$844.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$867.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$780.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$780.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$823.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$867.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$823.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$867.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$867.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$650.38
|
| Rate for Payer: Healthfirst Commercial |
$867.18
|
| Rate for Payer: Healthfirst Essential Plan |
$1,951.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$823.82
|
| Rate for Payer: Healthfirst QHP |
$867.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$607.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$867.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$737.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$607.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$867.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$650.38
|
| Rate for Payer: SOMOS Essential |
$650.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$867.18
|
|
|
PR PERQ P-ART REVSC ST 1ST ABNORMAL CONNJ BILATERAL
|
Professional
|
Both
|
$3,803.56
|
|
|
Service Code
|
HCPCS 33903
|
| Min. Negotiated Rate |
$715.18 |
| Max. Negotiated Rate |
$2,298.80 |
| Rate for Payer: Cash Price |
$995.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,021.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$919.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$919.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$970.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,021.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$970.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,021.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,021.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$766.27
|
| Rate for Payer: Healthfirst Commercial |
$1,021.69
|
| Rate for Payer: Healthfirst Essential Plan |
$2,298.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$970.61
|
| Rate for Payer: Healthfirst QHP |
$1,021.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$715.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,021.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$868.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$715.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,021.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$766.27
|
| Rate for Payer: SOMOS Essential |
$766.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,021.69
|
|
