|
PR PLASTIC RPR PENIS EPISPADIAS W/EXSTROPHY BLADDER
|
Professional
|
Both
|
$5,181.82
|
|
|
Service Code
|
HCPCS 54390
|
| Min. Negotiated Rate |
$984.78 |
| Max. Negotiated Rate |
$3,165.37 |
| Rate for Payer: Cash Price |
$1,414.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,406.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,266.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,266.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,336.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,406.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,336.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,406.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,406.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,055.12
|
| Rate for Payer: Healthfirst Commercial |
$1,406.83
|
| Rate for Payer: Healthfirst Essential Plan |
$3,165.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,336.49
|
| Rate for Payer: Healthfirst QHP |
$1,406.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$984.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,406.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,195.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$984.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,406.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,055.12
|
| Rate for Payer: SOMOS Essential |
$1,055.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,406.83
|
|
|
PR PLASTIC URETHRAL SPHINCTER VAGINAL APPROACH
|
Professional
|
Both
|
$1,505.53
|
|
|
Service Code
|
HCPCS 57220
|
| Min. Negotiated Rate |
$282.81 |
| Max. Negotiated Rate |
$909.02 |
| Rate for Payer: Cash Price |
$408.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$404.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$363.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$363.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$383.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$404.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$383.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$404.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$404.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$303.01
|
| Rate for Payer: Healthfirst Commercial |
$404.01
|
| Rate for Payer: Healthfirst Essential Plan |
$909.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$383.81
|
| Rate for Payer: Healthfirst QHP |
$404.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$282.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$404.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$343.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$282.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$404.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$303.01
|
| Rate for Payer: SOMOS Essential |
$303.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$404.01
|
|
|
PR PLCMT VAD PMP IMPLTBL ICORP 1 VENTR W/O BYPASS
|
Professional
|
Both
|
$8,567.97
|
|
|
Service Code
|
HCPCS 33982
|
| Min. Negotiated Rate |
$1,569.88 |
| Max. Negotiated Rate |
$5,046.05 |
| Rate for Payer: Cash Price |
$2,265.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,242.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,018.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,018.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,130.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,242.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,130.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,242.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,242.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,682.02
|
| Rate for Payer: Healthfirst Commercial |
$2,242.69
|
| Rate for Payer: Healthfirst Essential Plan |
$5,046.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,130.56
|
| Rate for Payer: Healthfirst QHP |
$2,242.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,569.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,242.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,906.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,569.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,242.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,682.02
|
| Rate for Payer: SOMOS Essential |
$1,682.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,242.69
|
|
|
PR PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST
|
Professional
|
Both
|
$46.80
|
|
|
Service Code
|
HCPCS 94726 26
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$28.53 |
| Rate for Payer: Amida Care Medicaid |
$24.96
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.51
|
| Rate for Payer: Healthfirst Commercial |
$12.68
|
| Rate for Payer: Healthfirst Essential Plan |
$28.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.05
|
| Rate for Payer: Healthfirst QHP |
$12.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.51
|
| Rate for Payer: SOMOS Essential |
$9.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.68
|
|
|
PR PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST
|
Professional
|
Both
|
$185.15
|
|
|
Service Code
|
HCPCS 94726 TC
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$118.94 |
| Rate for Payer: Amida Care Medicaid |
$24.96
|
| Rate for Payer: Cash Price |
$52.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.65
|
| Rate for Payer: Healthfirst Commercial |
$52.86
|
| Rate for Payer: Healthfirst Essential Plan |
$118.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.22
|
| Rate for Payer: Healthfirst QHP |
$52.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.65
|
| Rate for Payer: SOMOS Essential |
$39.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.86
|
|
|
PR PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST
|
Professional
|
Both
|
$231.95
|
|
|
Service Code
|
HCPCS 94726
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$147.47 |
| Rate for Payer: Amida Care Medicaid |
$24.96
|
| Rate for Payer: Cash Price |
$65.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$65.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.16
|
| Rate for Payer: Healthfirst Commercial |
$65.54
|
| Rate for Payer: Healthfirst Essential Plan |
$147.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.26
|
| Rate for Payer: Healthfirst QHP |
$65.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$49.16
|
| Rate for Payer: SOMOS Essential |
$49.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.54
|
|
|
PR PLEURAL SCARIFICATION REPEAT PNEUMOTHORAX
|
Professional
|
Both
|
$3,577.39
|
|
|
Service Code
|
HCPCS 32215
|
| Min. Negotiated Rate |
$663.68 |
| Max. Negotiated Rate |
$2,133.27 |
| Rate for Payer: Cash Price |
$955.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$948.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$853.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$853.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$900.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$948.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$900.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$948.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$948.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$711.09
|
| Rate for Payer: Healthfirst Commercial |
$948.12
|
| Rate for Payer: Healthfirst Essential Plan |
$2,133.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$900.71
|
| Rate for Payer: Healthfirst QHP |
$948.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$663.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$948.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$805.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$663.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$948.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$711.09
|
| Rate for Payer: SOMOS Essential |
$711.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$948.12
|
|
|
PR PLEURECTOMY PARIETAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$4,087.20
|
|
|
Service Code
|
HCPCS 32310
|
| Min. Negotiated Rate |
$758.81 |
| Max. Negotiated Rate |
$2,439.02 |
| Rate for Payer: Cash Price |
$1,092.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,084.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$975.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$975.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,029.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,084.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,029.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,084.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,084.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$813.01
|
| Rate for Payer: Healthfirst Commercial |
$1,084.01
|
| Rate for Payer: Healthfirst Essential Plan |
$2,439.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,029.81
|
| Rate for Payer: Healthfirst QHP |
$1,084.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$758.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,084.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$921.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$758.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,084.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$813.01
|
| Rate for Payer: SOMOS Essential |
$813.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,084.01
|
|
|
PR PLMT ACCESS THRU BILIARY TREE INTO SMALL BWL NEW
|
Professional
|
Both
|
$1,375.92
|
|
|
Service Code
|
HCPCS 47541
|
| Min. Negotiated Rate |
$258.10 |
| Max. Negotiated Rate |
$829.60 |
| Rate for Payer: Cash Price |
$369.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$368.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$331.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$331.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$350.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$368.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$350.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$368.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$368.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$276.53
|
| Rate for Payer: Healthfirst Commercial |
$368.71
|
| Rate for Payer: Healthfirst Essential Plan |
$829.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$350.27
|
| Rate for Payer: Healthfirst QHP |
$368.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$258.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$368.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$313.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$258.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$368.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$276.53
|
| Rate for Payer: SOMOS Essential |
$276.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$368.71
|
|
|
PR PLMT BILE DUCT STENT PRQ EXISTING ACCESS
|
Professional
|
Both
|
$953.54
|
|
|
Service Code
|
HCPCS 47538
|
| Min. Negotiated Rate |
$180.19 |
| Max. Negotiated Rate |
$579.20 |
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$257.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$231.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$231.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$244.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$257.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$244.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$257.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$257.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$193.06
|
| Rate for Payer: Healthfirst Commercial |
$257.42
|
| Rate for Payer: Healthfirst Essential Plan |
$579.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$244.55
|
| Rate for Payer: Healthfirst QHP |
$257.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$180.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$257.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$218.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$180.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$257.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$193.06
|
| Rate for Payer: SOMOS Essential |
$193.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$257.42
|
|
|
PR PLMT BILE DUCT STENT PRQ NEW ACCESS W/O SEP CATH
|
Professional
|
Both
|
$1,738.38
|
|
|
Service Code
|
HCPCS 47539
|
| Min. Negotiated Rate |
$324.17 |
| Max. Negotiated Rate |
$1,041.97 |
| Rate for Payer: Cash Price |
$468.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$463.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$416.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$416.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$439.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$463.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$439.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$463.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$463.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$347.32
|
| Rate for Payer: Healthfirst Commercial |
$463.10
|
| Rate for Payer: Healthfirst Essential Plan |
$1,041.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$439.94
|
| Rate for Payer: Healthfirst QHP |
$463.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$324.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$463.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$393.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$324.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$463.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$347.32
|
| Rate for Payer: SOMOS Essential |
$347.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$463.10
|
|
|
PR PLMT BILE DUCT STENT PRQ NEW ACCESS W/SEP CATH
|
Professional
|
Both
|
$1,786.79
|
|
|
Service Code
|
HCPCS 47540
|
| Min. Negotiated Rate |
$334.56 |
| Max. Negotiated Rate |
$1,075.39 |
| Rate for Payer: Cash Price |
$482.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$477.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$430.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$430.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$454.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$477.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$454.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$477.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$477.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$358.46
|
| Rate for Payer: Healthfirst Commercial |
$477.95
|
| Rate for Payer: Healthfirst Essential Plan |
$1,075.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$454.05
|
| Rate for Payer: Healthfirst QHP |
$477.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$334.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$477.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$406.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$334.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$477.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$358.46
|
| Rate for Payer: SOMOS Essential |
$358.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$477.95
|
|
|
PR PLMT DSTL XTN PROSTH DLYD AFTER EVASC RPR DTA
|
Professional
|
Both
|
$4,261.67
|
|
|
Service Code
|
HCPCS 33886
|
| Min. Negotiated Rate |
$779.11 |
| Max. Negotiated Rate |
$2,504.27 |
| Rate for Payer: Cash Price |
$1,127.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,113.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,001.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,001.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,057.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,113.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,057.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,113.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,113.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$834.76
|
| Rate for Payer: Healthfirst Commercial |
$1,113.01
|
| Rate for Payer: Healthfirst Essential Plan |
$2,504.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,057.36
|
| Rate for Payer: Healthfirst QHP |
$1,113.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$779.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,113.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$946.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$779.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,113.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$834.76
|
| Rate for Payer: SOMOS Essential |
$834.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,113.01
|
|
|
PR PLMT EXPANDABLE CATH BRST CONCURRENT PRTL MAST
|
Professional
|
Both
|
$425.22
|
|
|
Service Code
|
HCPCS 19297
|
| Min. Negotiated Rate |
$77.58 |
| Max. Negotiated Rate |
$249.37 |
| Rate for Payer: Cash Price |
$111.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$110.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$99.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$99.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$105.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$110.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$105.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.12
|
| Rate for Payer: Healthfirst Commercial |
$110.83
|
| Rate for Payer: Healthfirst Essential Plan |
$249.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$105.29
|
| Rate for Payer: Healthfirst QHP |
$110.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$77.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$110.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$94.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$77.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$110.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.12
|
| Rate for Payer: SOMOS Essential |
$83.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$110.83
|
|
|
PR PLMT EXPANDABLE CATH BRST FOLLOWING PRTL MAST
|
Professional
|
Both
|
$945.56
|
|
|
Service Code
|
HCPCS 19296
|
| Min. Negotiated Rate |
$174.95 |
| Max. Negotiated Rate |
$562.34 |
| Rate for Payer: Cash Price |
$251.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$249.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$224.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$224.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$237.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$249.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$237.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$249.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$249.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$187.45
|
| Rate for Payer: Healthfirst Commercial |
$249.93
|
| Rate for Payer: Healthfirst Essential Plan |
$562.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$237.43
|
| Rate for Payer: Healthfirst QHP |
$249.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$174.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$249.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$212.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$174.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$249.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$187.45
|
| Rate for Payer: SOMOS Essential |
$187.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$249.93
|
|
|
PR PLMT FEM-FEM PROSTC GRF EVASC AORTIC ARYSM RPR
|
Professional
|
Both
|
$1,045.56
|
|
|
Service Code
|
HCPCS 34813
|
| Min. Negotiated Rate |
$190.16 |
| Max. Negotiated Rate |
$611.21 |
| Rate for Payer: Cash Price |
$275.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$271.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$244.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$244.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$258.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$271.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$258.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$271.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$271.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$203.74
|
| Rate for Payer: Healthfirst Commercial |
$271.65
|
| Rate for Payer: Healthfirst Essential Plan |
$611.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$258.07
|
| Rate for Payer: Healthfirst QHP |
$271.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$190.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$271.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$230.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$190.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$271.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$203.74
|
| Rate for Payer: SOMOS Essential |
$203.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$271.65
|
|
|
PR PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT
|
Professional
|
Both
|
$423.92
|
|
|
Service Code
|
HCPCS 55876
|
| Min. Negotiated Rate |
$80.86 |
| Max. Negotiated Rate |
$259.92 |
| Rate for Payer: Cash Price |
$116.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$115.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$103.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$103.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$109.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$115.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$109.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$115.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$115.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$86.64
|
| Rate for Payer: Healthfirst Commercial |
$115.52
|
| Rate for Payer: Healthfirst Essential Plan |
$259.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$109.74
|
| Rate for Payer: Healthfirst QHP |
$115.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$80.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$115.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$98.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$80.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$115.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$86.64
|
| Rate for Payer: SOMOS Essential |
$86.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$115.52
|
|
|
PR PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RS&I
|
Professional
|
Both
|
$837.55
|
|
|
Service Code
|
HCPCS 50432
|
| Min. Negotiated Rate |
$157.51 |
| Max. Negotiated Rate |
$506.30 |
| Rate for Payer: Cash Price |
$225.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$225.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$202.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$202.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$213.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$225.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$213.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$168.76
|
| Rate for Payer: Healthfirst Commercial |
$225.02
|
| Rate for Payer: Healthfirst Essential Plan |
$506.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$213.77
|
| Rate for Payer: Healthfirst QHP |
$225.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$157.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$225.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$191.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$157.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$225.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$168.76
|
| Rate for Payer: SOMOS Essential |
$168.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$225.02
|
|
|
PR PLMT NEPHROURETERAL CATH PRQ NEW ACCESS RS&I
|
Professional
|
Both
|
$1,039.43
|
|
|
Service Code
|
HCPCS 50433
|
| Min. Negotiated Rate |
$195.74 |
| Max. Negotiated Rate |
$629.17 |
| Rate for Payer: Cash Price |
$280.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$279.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$251.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$251.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$265.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$279.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$265.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$279.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$279.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$209.72
|
| Rate for Payer: Healthfirst Commercial |
$279.63
|
| Rate for Payer: Healthfirst Essential Plan |
$629.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$265.65
|
| Rate for Payer: Healthfirst QHP |
$279.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$195.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$279.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$237.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$195.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$279.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$209.72
|
| Rate for Payer: SOMOS Essential |
$209.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$279.63
|
|
|
PR PLMT NTRSTL DEV RADJ THX GID PRQ INTRATHRC 1/MLT
|
Professional
|
Both
|
$720.09
|
|
|
Service Code
|
HCPCS 32553
|
| Min. Negotiated Rate |
$136.56 |
| Max. Negotiated Rate |
$438.93 |
| Rate for Payer: Cash Price |
$194.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$195.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$175.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$175.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$185.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$195.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$185.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$146.31
|
| Rate for Payer: Healthfirst Commercial |
$195.08
|
| Rate for Payer: Healthfirst Essential Plan |
$438.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$185.33
|
| Rate for Payer: Healthfirst QHP |
$195.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$136.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$195.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$165.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$136.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$195.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$146.31
|
| Rate for Payer: SOMOS Essential |
$146.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$195.08
|
|
|
PR PLMT PROX XTN PROSTH EVASC RPR DTA 1ST XTN
|
Professional
|
Both
|
$4,908.37
|
|
|
Service Code
|
HCPCS 33883
|
| Min. Negotiated Rate |
$900.44 |
| Max. Negotiated Rate |
$2,894.26 |
| Rate for Payer: Cash Price |
$1,304.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,286.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,157.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,157.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,222.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,286.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,222.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,286.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,286.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$964.75
|
| Rate for Payer: Healthfirst Commercial |
$1,286.34
|
| Rate for Payer: Healthfirst Essential Plan |
$2,894.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,222.02
|
| Rate for Payer: Healthfirst QHP |
$1,286.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$900.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,286.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,093.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$900.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,286.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$964.75
|
| Rate for Payer: SOMOS Essential |
$964.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,286.34
|
|
|
PR PLMT PROX XTN PROSTH EVASC RPR DTA EA PROX XTN
|
Professional
|
Both
|
$1,756.97
|
|
|
Service Code
|
HCPCS 33884
|
| Min. Negotiated Rate |
$321.01 |
| Max. Negotiated Rate |
$1,031.81 |
| Rate for Payer: Cash Price |
$463.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$458.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$412.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$412.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$435.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$458.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$435.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$458.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$458.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$343.94
|
| Rate for Payer: Healthfirst Commercial |
$458.58
|
| Rate for Payer: Healthfirst Essential Plan |
$1,031.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$435.65
|
| Rate for Payer: Healthfirst QHP |
$458.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$321.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$458.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$389.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$321.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$458.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$343.94
|
| Rate for Payer: SOMOS Essential |
$343.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$458.58
|
|
|
PR PLMT RADTHX BRACHYTX BRST FOLLOWING PRTL MAST
|
Professional
|
Both
|
$1,304.87
|
|
|
Service Code
|
HCPCS 19298
|
| Min. Negotiated Rate |
$252.35 |
| Max. Negotiated Rate |
$811.12 |
| Rate for Payer: Cash Price |
$356.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$360.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$324.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$324.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$342.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$360.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$342.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$360.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$360.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$270.38
|
| Rate for Payer: Healthfirst Commercial |
$360.50
|
| Rate for Payer: Healthfirst Essential Plan |
$811.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$342.48
|
| Rate for Payer: Healthfirst QHP |
$360.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$252.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$360.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$306.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$252.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$360.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$270.38
|
| Rate for Payer: SOMOS Essential |
$270.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$360.50
|
|
|
PR PLMT SFT TISS LOCLZJ DEV PERQ 1ST LESION
|
Professional
|
Both
|
$351.30
|
|
|
Service Code
|
HCPCS 10035
|
| 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 PLMT SFT TISS LOCLZJ DEV PERQ EACH ADDL LESION
|
Professional
|
Both
|
$178.40
|
|
|
Service Code
|
HCPCS 10036
|
| Min. Negotiated Rate |
$33.25 |
| Max. Negotiated Rate |
$106.88 |
| Rate for Payer: Cash Price |
$47.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.62
|
| Rate for Payer: Healthfirst Commercial |
$47.50
|
| Rate for Payer: Healthfirst Essential Plan |
$106.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.12
|
| Rate for Payer: Healthfirst QHP |
$47.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.62
|
| Rate for Payer: SOMOS Essential |
$35.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.50
|
|
