|
PR PHYS/QHP TELEPHONE EVALUATION 11-20 MIN
|
Professional
|
Both
|
$269.26
|
|
|
Service Code
|
HCPCS 99442
|
| Rate for Payer: Cash Price |
$72.97
|
|
|
PR PHYS/QHP TELEPHONE EVALUATION 21-30 MIN
|
Professional
|
Both
|
$391.20
|
|
|
Service Code
|
HCPCS 99443
|
| Rate for Payer: Cash Price |
$108.33
|
|
|
PR PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
|
Professional
|
Both
|
$140.32
|
|
|
Service Code
|
HCPCS 99441
|
| Rate for Payer: Cash Price |
$38.93
|
|
|
PR PILD/PLACEBO CONTROL CLIN TR
|
Professional
|
Both
|
$1,536.08
|
|
|
Service Code
|
HCPCS G0276
|
| Min. Negotiated Rate |
$287.25 |
| Max. Negotiated Rate |
$923.29 |
| Rate for Payer: Cash Price |
$416.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$410.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$369.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$369.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$389.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$410.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$389.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$410.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$410.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$307.76
|
| Rate for Payer: Healthfirst Commercial |
$410.35
|
| Rate for Payer: Healthfirst Essential Plan |
$923.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$389.83
|
| Rate for Payer: Healthfirst QHP |
$410.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$287.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$410.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$348.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$287.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$410.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$307.76
|
| Rate for Payer: SOMOS Essential |
$307.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$410.35
|
|
|
PR PINCH GRAFT 1/MLT SM ULCER TIP/OTH AR UP TO 2 CM
|
Professional
|
Both
|
$2,010.82
|
|
|
Service Code
|
HCPCS 15050
|
| Min. Negotiated Rate |
$377.79 |
| Max. Negotiated Rate |
$1,214.33 |
| Rate for Payer: Cash Price |
$540.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$539.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$485.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$485.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$512.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$539.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$512.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$539.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$539.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$404.77
|
| Rate for Payer: Healthfirst Commercial |
$539.70
|
| Rate for Payer: Healthfirst Essential Plan |
$1,214.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$512.72
|
| Rate for Payer: Healthfirst QHP |
$539.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$377.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$539.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$458.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$377.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$539.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$404.77
|
| Rate for Payer: SOMOS Essential |
$404.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$539.70
|
|
|
PR PLACE AMNIOTIC MEMBRANE OCULAR SURFACE SUTURED
|
Professional
|
Both
|
$597.98
|
|
|
Service Code
|
HCPCS 65779
|
| Min. Negotiated Rate |
$81.84 |
| Max. Negotiated Rate |
$263.05 |
| Rate for Payer: Cash Price |
$132.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$116.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$105.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$105.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$111.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$116.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$111.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$116.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$116.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$87.68
|
| Rate for Payer: Healthfirst Commercial |
$116.91
|
| Rate for Payer: Healthfirst Essential Plan |
$263.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$111.06
|
| Rate for Payer: Healthfirst QHP |
$116.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$81.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$116.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$99.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$81.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$116.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$87.68
|
| Rate for Payer: SOMOS Essential |
$87.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$116.91
|
|
|
PR PLACE AMNIOTIC MEMBRA OCULAR SURFACE W/O SUTURES
|
Professional
|
Both
|
$209.51
|
|
|
Service Code
|
HCPCS 65778
|
| Min. Negotiated Rate |
$33.40 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Cash Price |
$48.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.78
|
| Rate for Payer: Healthfirst Commercial |
$47.71
|
| Rate for Payer: Healthfirst Essential Plan |
$107.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.32
|
| Rate for Payer: Healthfirst QHP |
$47.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.78
|
| Rate for Payer: SOMOS Essential |
$35.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.71
|
|
|
PR PLACE DRAIN PERIPANCREATIC ACUTE PANCREATITIS
|
Professional
|
Both
|
$8,517.78
|
|
|
Service Code
|
HCPCS 48000
|
| Min. Negotiated Rate |
$1,571.81 |
| Max. Negotiated Rate |
$5,052.24 |
| Rate for Payer: Cash Price |
$2,264.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,245.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,020.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,020.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,133.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,245.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,133.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,245.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,245.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,684.08
|
| Rate for Payer: Healthfirst Commercial |
$2,245.44
|
| Rate for Payer: Healthfirst Essential Plan |
$5,052.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,133.17
|
| Rate for Payer: Healthfirst QHP |
$2,245.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,571.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,245.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,908.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,571.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,245.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,684.08
|
| Rate for Payer: SOMOS Essential |
$1,684.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,245.44
|
|
|
PR PLACE DRAIN PERIPANCREATIC W/CHOLECYSTOSTOMY
|
Professional
|
Both
|
$10,430.60
|
|
|
Service Code
|
HCPCS 48001
|
| Min. Negotiated Rate |
$1,923.36 |
| Max. Negotiated Rate |
$6,182.21 |
| Rate for Payer: Cash Price |
$2,772.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,747.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,472.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,472.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,610.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,747.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,610.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,747.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,747.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,060.74
|
| Rate for Payer: Healthfirst Commercial |
$2,747.65
|
| Rate for Payer: Healthfirst Essential Plan |
$6,182.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,610.27
|
| Rate for Payer: Healthfirst QHP |
$2,747.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,923.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,747.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,335.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,923.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,747.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,060.74
|
| Rate for Payer: SOMOS Essential |
$2,060.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,747.65
|
|
|
PR PLACEMENT ADJUSTABLE SUTURE STRABISMUS
|
Professional
|
Both
|
$763.32
|
|
|
Service Code
|
HCPCS 67335
|
| Min. Negotiated Rate |
$144.41 |
| Max. Negotiated Rate |
$464.18 |
| Rate for Payer: Cash Price |
$207.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$206.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$185.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$185.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$195.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$206.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$195.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$206.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$206.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$154.72
|
| Rate for Payer: Healthfirst Commercial |
$206.30
|
| Rate for Payer: Healthfirst Essential Plan |
$464.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$195.99
|
| Rate for Payer: Healthfirst QHP |
$206.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$144.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$206.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$175.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$144.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$206.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$154.72
|
| Rate for Payer: SOMOS Essential |
$154.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$206.30
|
|
|
PR PLACEMENT CHOLEDOCHAL STENT
|
Professional
|
Both
|
$5,048.33
|
|
|
Service Code
|
HCPCS 47801
|
| Min. Negotiated Rate |
$923.48 |
| Max. Negotiated Rate |
$2,968.34 |
| Rate for Payer: Cash Price |
$1,345.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,319.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,187.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,187.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,253.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,319.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,253.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,319.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,319.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$989.45
|
| Rate for Payer: Healthfirst Commercial |
$1,319.26
|
| Rate for Payer: Healthfirst Essential Plan |
$2,968.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,253.30
|
| Rate for Payer: Healthfirst QHP |
$1,319.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$923.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,319.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,121.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$923.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,319.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$989.45
|
| Rate for Payer: SOMOS Essential |
$989.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,319.26
|
|
|
PR PLACEMENT ENTEROSTOMY/CECOSTOMY TUBE OPEN
|
Professional
|
Both
|
$3,789.35
|
|
|
Service Code
|
HCPCS 44300
|
| Min. Negotiated Rate |
$702.75 |
| Max. Negotiated Rate |
$2,258.84 |
| Rate for Payer: Cash Price |
$1,012.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,003.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$903.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$903.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$953.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,003.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$953.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,003.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,003.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$752.95
|
| Rate for Payer: Healthfirst Commercial |
$1,003.93
|
| Rate for Payer: Healthfirst Essential Plan |
$2,258.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$953.73
|
| Rate for Payer: Healthfirst QHP |
$1,003.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$702.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,003.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$853.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$702.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,003.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$752.95
|
| Rate for Payer: SOMOS Essential |
$752.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,003.93
|
|
|
PR PLACEMENT INTRSTL DEV OPN W/IMG GUID 1/MLT
|
Professional
|
Both
|
$369.60
|
|
|
Service Code
|
HCPCS 49412
|
| Min. Negotiated Rate |
$68.54 |
| Max. Negotiated Rate |
$220.30 |
| Rate for Payer: Cash Price |
$98.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$97.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$88.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$88.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$97.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.43
|
| Rate for Payer: Healthfirst Commercial |
$97.91
|
| Rate for Payer: Healthfirst Essential Plan |
$220.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$93.01
|
| Rate for Payer: Healthfirst QHP |
$97.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$97.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$83.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$97.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$73.43
|
| Rate for Payer: SOMOS Essential |
$73.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$97.91
|
|
|
PR PLACEMENT NEEDLE HEAD/NECK RADIOELEMENT APPLICAT
|
Professional
|
Both
|
$2,010.44
|
|
|
Service Code
|
HCPCS 41019
|
| Min. Negotiated Rate |
$387.09 |
| Max. Negotiated Rate |
$1,244.20 |
| Rate for Payer: Cash Price |
$549.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$552.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$497.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$497.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$525.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$552.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$525.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$552.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$552.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$414.74
|
| Rate for Payer: Healthfirst Commercial |
$552.98
|
| Rate for Payer: Healthfirst Essential Plan |
$1,244.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$525.33
|
| Rate for Payer: Healthfirst QHP |
$552.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$387.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$552.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$470.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$387.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$552.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$414.74
|
| Rate for Payer: SOMOS Essential |
$414.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$552.98
|
|
|
PR PLACEMENT NEEDLE INTRAOSSEOUS INFUSION
|
Professional
|
Both
|
$259.39
|
|
|
Service Code
|
HCPCS 36680
|
| Min. Negotiated Rate |
$48.08 |
| Max. Negotiated Rate |
$154.53 |
| Rate for Payer: Cash Price |
$69.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$68.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.51
|
| Rate for Payer: Healthfirst Commercial |
$68.68
|
| Rate for Payer: Healthfirst Essential Plan |
$154.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.25
|
| Rate for Payer: Healthfirst QHP |
$68.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$68.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$68.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.51
|
| Rate for Payer: SOMOS Essential |
$51.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.68
|
|
|
PR PLACEMENT NEEDLE PELVIC ORGAN RADIOELEMENT APPL
|
Professional
|
Both
|
$1,898.33
|
|
|
Service Code
|
HCPCS 55920
|
| Min. Negotiated Rate |
$364.74 |
| Max. Negotiated Rate |
$1,172.38 |
| Rate for Payer: Cash Price |
$518.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$521.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$468.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$468.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$495.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$521.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$495.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$521.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$521.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$390.80
|
| Rate for Payer: Healthfirst Commercial |
$521.06
|
| Rate for Payer: Healthfirst Essential Plan |
$1,172.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$495.01
|
| Rate for Payer: Healthfirst QHP |
$521.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$364.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$521.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$442.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$364.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$521.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$390.80
|
| Rate for Payer: SOMOS Essential |
$390.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$521.06
|
|
|
PR PLACEMENT NEEDLES MUSCLE SUBSEQUENT RADIOELEMENT
|
Professional
|
Both
|
$1,379.04
|
|
|
Service Code
|
HCPCS 20555
|
| Min. Negotiated Rate |
$266.69 |
| Max. Negotiated Rate |
$857.23 |
| Rate for Payer: Cash Price |
$377.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$380.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$342.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$342.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$361.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$380.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$361.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$380.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$380.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$285.74
|
| Rate for Payer: Healthfirst Commercial |
$380.99
|
| Rate for Payer: Healthfirst Essential Plan |
$857.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$361.94
|
| Rate for Payer: Healthfirst QHP |
$380.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$266.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$380.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$323.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$266.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$380.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$285.74
|
| Rate for Payer: SOMOS Essential |
$285.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$380.99
|
|
|
PR PLACEMENT SETON
|
Professional
|
Both
|
$509.85
|
|
|
Service Code
|
HCPCS 46020
|
| Min. Negotiated Rate |
$95.86 |
| Max. Negotiated Rate |
$308.14 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$136.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$123.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$130.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$136.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$130.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.71
|
| Rate for Payer: Healthfirst Commercial |
$136.95
|
| Rate for Payer: Healthfirst Essential Plan |
$308.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.10
|
| Rate for Payer: Healthfirst QHP |
$136.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$95.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$136.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$116.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$95.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$136.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.71
|
| Rate for Payer: SOMOS Essential |
$102.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$136.95
|
|
|
PR PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR
|
Professional
|
Both
|
$1,429.54
|
|
|
Service Code
|
HCPCS 34709
|
| Min. Negotiated Rate |
$260.65 |
| Max. Negotiated Rate |
$837.81 |
| Rate for Payer: Cash Price |
$376.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$372.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$335.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$335.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$353.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$372.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$353.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$372.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$372.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$279.27
|
| Rate for Payer: Healthfirst Commercial |
$372.36
|
| Rate for Payer: Healthfirst Essential Plan |
$837.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$353.74
|
| Rate for Payer: Healthfirst QHP |
$372.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$260.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$372.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$316.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$260.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$372.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$279.27
|
| Rate for Payer: SOMOS Essential |
$279.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$372.36
|
|
|
PR PLASTIC PENIS EPISPADIAS DSTL SPHNCTR W/INCONT
|
Professional
|
Both
|
$3,893.93
|
|
|
Service Code
|
HCPCS 54385
|
| Min. Negotiated Rate |
$740.85 |
| Max. Negotiated Rate |
$2,381.29 |
| Rate for Payer: Cash Price |
$1,065.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,058.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$952.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$952.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,005.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,058.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,005.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,058.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,058.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$793.76
|
| Rate for Payer: Healthfirst Commercial |
$1,058.35
|
| Rate for Payer: Healthfirst Essential Plan |
$2,381.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,005.43
|
| Rate for Payer: Healthfirst QHP |
$1,058.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$740.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,058.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$899.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$740.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,058.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$793.76
|
| Rate for Payer: SOMOS Essential |
$793.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,058.35
|
|
|
PR PLASTIC REPAIR CANALICULI
|
Professional
|
Both
|
$2,475.24
|
|
|
Service Code
|
HCPCS 68700
|
| Min. Negotiated Rate |
$473.26 |
| Max. Negotiated Rate |
$1,521.20 |
| Rate for Payer: Cash Price |
$682.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$676.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$608.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$608.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$642.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$676.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$642.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$676.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$676.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$507.07
|
| Rate for Payer: Healthfirst Commercial |
$676.09
|
| Rate for Payer: Healthfirst Essential Plan |
$1,521.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$642.29
|
| Rate for Payer: Healthfirst QHP |
$676.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$473.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$676.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$574.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$473.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$676.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$507.07
|
| Rate for Payer: SOMOS Essential |
$507.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$676.09
|
|
|
PR PLASTIC REPAIR INTROITUS
|
Professional
|
Both
|
$1,107.09
|
|
|
Service Code
|
HCPCS 56800
|
| Min. Negotiated Rate |
$206.42 |
| Max. Negotiated Rate |
$663.50 |
| Rate for Payer: Cash Price |
$298.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$294.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$265.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$265.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$280.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$294.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$280.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$294.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$294.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$221.17
|
| Rate for Payer: Healthfirst Commercial |
$294.89
|
| Rate for Payer: Healthfirst Essential Plan |
$663.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$280.15
|
| Rate for Payer: Healthfirst QHP |
$294.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$206.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$294.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$250.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$206.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$294.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$221.17
|
| Rate for Payer: SOMOS Essential |
$221.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$294.89
|
|
|
PR PLASTIC REPAIR URETHROCELE
|
Professional
|
Both
|
$1,839.53
|
|
|
Service Code
|
HCPCS 57230
|
| Min. Negotiated Rate |
$340.11 |
| Max. Negotiated Rate |
$1,093.21 |
| Rate for Payer: Cash Price |
$496.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$485.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$437.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$437.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$461.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$485.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$461.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$485.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$485.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$364.40
|
| Rate for Payer: Healthfirst Commercial |
$485.87
|
| Rate for Payer: Healthfirst Essential Plan |
$1,093.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$461.58
|
| Rate for Payer: Healthfirst QHP |
$485.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$340.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$485.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$412.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$340.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$485.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$364.40
|
| Rate for Payer: SOMOS Essential |
$364.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$485.87
|
|
|
PR PLASTIC RPR PENIS CORRECT ANGULATION
|
Professional
|
Both
|
$3,024.11
|
|
|
Service Code
|
HCPCS 54360
|
| Min. Negotiated Rate |
$575.50 |
| Max. Negotiated Rate |
$1,849.82 |
| Rate for Payer: Cash Price |
$826.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$822.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$739.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$739.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$781.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$822.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$781.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$822.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$822.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$616.61
|
| Rate for Payer: Healthfirst Commercial |
$822.14
|
| Rate for Payer: Healthfirst Essential Plan |
$1,849.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$781.03
|
| Rate for Payer: Healthfirst QHP |
$822.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$575.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$822.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$698.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$575.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$822.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$616.61
|
| Rate for Payer: SOMOS Essential |
$616.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$822.14
|
|
|
PR PLASTIC RPR PENIS EPISPADIAS DSTL SPHNCTR
|
Professional
|
Both
|
$3,344.15
|
|
|
Service Code
|
HCPCS 54380
|
| Min. Negotiated Rate |
$637.81 |
| Max. Negotiated Rate |
$2,050.11 |
| Rate for Payer: Cash Price |
$915.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$911.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$820.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$820.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$865.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$911.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$865.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$911.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$911.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$683.37
|
| Rate for Payer: Healthfirst Commercial |
$911.16
|
| Rate for Payer: Healthfirst Essential Plan |
$2,050.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.60
|
| Rate for Payer: Healthfirst QHP |
$911.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$637.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$911.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$774.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$637.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$911.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$683.37
|
| Rate for Payer: SOMOS Essential |
$683.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$911.16
|
|
