|
PR PROLONGED CLINICAL STAFF SVC OFFICE/O/P 1ST HR
|
Professional
|
Both
|
$81.80
|
|
|
Service Code
|
HCPCS 99415
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$54.67 |
| Rate for Payer: Cash Price |
$24.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.23
|
| Rate for Payer: Healthfirst Commercial |
$24.30
|
| Rate for Payer: Healthfirst Essential Plan |
$54.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.09
|
| Rate for Payer: Healthfirst QHP |
$24.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.23
|
| Rate for Payer: SOMOS Essential |
$18.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.30
|
|
|
PR PROLONGED CLINICAL STAFF SVC OFFICE/O/P EA ADDL
|
Professional
|
Both
|
$38.68
|
|
|
Service Code
|
HCPCS 99416
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$25.85 |
| Rate for Payer: Cash Price |
$11.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.62
|
| Rate for Payer: Healthfirst Commercial |
$11.49
|
| Rate for Payer: Healthfirst Essential Plan |
$25.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.92
|
| Rate for Payer: Healthfirst QHP |
$11.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$11.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.62
|
| Rate for Payer: SOMOS Essential |
$8.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.49
|
|
|
PR PROLONGED OUTPATIENT E/M SERVICE EACH 15 MINUTES
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 99417
|
| Min. Negotiated Rate |
$16.48 |
| Max. Negotiated Rate |
$16.48 |
| Rate for Payer: Amida Care Medicaid |
$16.48
|
|
|
PR PROLONG HOME EVAL ADD 15M
|
Professional
|
Both
|
$120.40
|
|
|
Service Code
|
HCPCS G0318
|
| Min. Negotiated Rate |
$22.96 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Cash Price |
$33.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.60
|
| Rate for Payer: Healthfirst Commercial |
$32.80
|
| Rate for Payer: Healthfirst Essential Plan |
$73.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.16
|
| Rate for Payer: Healthfirst QHP |
$32.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.60
|
| Rate for Payer: SOMOS Essential |
$24.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.80
|
|
|
PR PROLONG INPT EVAL ADD15 M
|
Professional
|
Both
|
$123.27
|
|
|
Service Code
|
HCPCS G0316
|
| Min. Negotiated Rate |
$23.51 |
| Max. Negotiated Rate |
$75.56 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.18
|
| Rate for Payer: Healthfirst Commercial |
$33.58
|
| Rate for Payer: Healthfirst Essential Plan |
$75.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.90
|
| Rate for Payer: Healthfirst QHP |
$33.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.18
|
| Rate for Payer: SOMOS Essential |
$25.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.58
|
|
|
PR PROLONG NURSIN FAC EVAL 15M
|
Professional
|
Both
|
$123.27
|
|
|
Service Code
|
HCPCS G0317
|
| Min. Negotiated Rate |
$23.23 |
| Max. Negotiated Rate |
$74.68 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.89
|
| Rate for Payer: Healthfirst Commercial |
$33.19
|
| Rate for Payer: Healthfirst Essential Plan |
$74.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.53
|
| Rate for Payer: Healthfirst QHP |
$33.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.89
|
| Rate for Payer: SOMOS Essential |
$24.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.19
|
|
|
PR PROLONG OUTPT/OFFICE VIS
|
Professional
|
Both
|
$126.18
|
|
|
Service Code
|
HCPCS G2212
|
| Min. Negotiated Rate |
$23.78 |
| Max. Negotiated Rate |
$76.43 |
| Rate for Payer: Cash Price |
$35.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.48
|
| Rate for Payer: Healthfirst Commercial |
$33.97
|
| Rate for Payer: Healthfirst Essential Plan |
$76.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.27
|
| Rate for Payer: Healthfirst QHP |
$33.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.48
|
| Rate for Payer: SOMOS Essential |
$25.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.97
|
|
|
PR PROLONG PREV SVCS, ADDL 30M
|
Professional
|
Both
|
$241.75
|
|
|
Service Code
|
HCPCS G0514
|
| Min. Negotiated Rate |
$45.10 |
| Max. Negotiated Rate |
$144.97 |
| Rate for Payer: Cash Price |
$66.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$64.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$57.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$61.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.32
|
| Rate for Payer: Healthfirst Commercial |
$64.43
|
| Rate for Payer: Healthfirst Essential Plan |
$144.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.21
|
| Rate for Payer: Healthfirst QHP |
$64.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$64.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$54.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.32
|
| Rate for Payer: SOMOS Essential |
$48.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.43
|
|
|
PR PROLONG PREV SVCS, FIRST 30M
|
Professional
|
Both
|
$240.31
|
|
|
Service Code
|
HCPCS G0513
|
| Min. Negotiated Rate |
$45.10 |
| Max. Negotiated Rate |
$144.97 |
| Rate for Payer: Cash Price |
$65.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$64.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$57.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$61.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.32
|
| Rate for Payer: Healthfirst Commercial |
$64.43
|
| Rate for Payer: Healthfirst Essential Plan |
$144.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.21
|
| Rate for Payer: Healthfirst QHP |
$64.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$64.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$54.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.32
|
| Rate for Payer: SOMOS Essential |
$48.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.43
|
|
|
PR PROPH RETINAL DTCHMNT W/O DRG CRTX DIATHERMY
|
Professional
|
Both
|
$893.55
|
|
|
Service Code
|
HCPCS 67141
|
| Min. Negotiated Rate |
$169.93 |
| Max. Negotiated Rate |
$546.19 |
| Rate for Payer: Cash Price |
$246.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$242.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$218.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$218.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$230.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$242.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$230.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$242.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$242.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$182.06
|
| Rate for Payer: Healthfirst Commercial |
$242.75
|
| Rate for Payer: Healthfirst Essential Plan |
$546.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$230.61
|
| Rate for Payer: Healthfirst QHP |
$242.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$169.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$242.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$206.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$169.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$242.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$182.06
|
| Rate for Payer: SOMOS Essential |
$182.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$242.75
|
|
|
PR PROPH RETINAL DTCHMNT W/O DRG PHOTOCOAGULATION
|
Professional
|
Both
|
$893.55
|
|
|
Service Code
|
HCPCS 67145
|
| Min. Negotiated Rate |
$169.93 |
| Max. Negotiated Rate |
$546.19 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$242.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$218.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$218.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$230.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$242.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$230.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$242.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$242.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$182.06
|
| Rate for Payer: Healthfirst Commercial |
$242.75
|
| Rate for Payer: Healthfirst Essential Plan |
$546.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$230.61
|
| Rate for Payer: Healthfirst QHP |
$242.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$169.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$242.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$206.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$169.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$242.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$182.06
|
| Rate for Payer: SOMOS Essential |
$182.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$242.75
|
|
|
PR PROPH TX N/P/PLTWR W/WO METHYLACRYLATE RADIUS
|
Professional
|
Both
|
$3,195.33
|
|
|
Service Code
|
HCPCS 25490
|
| Min. Negotiated Rate |
$602.34 |
| Max. Negotiated Rate |
$1,936.10 |
| Rate for Payer: Cash Price |
$864.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$860.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$774.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$774.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$817.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$860.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$817.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$860.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$860.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$645.37
|
| Rate for Payer: Healthfirst Commercial |
$860.49
|
| Rate for Payer: Healthfirst Essential Plan |
$1,936.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$817.47
|
| Rate for Payer: Healthfirst QHP |
$860.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$602.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$860.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$731.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$602.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$860.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$645.37
|
| Rate for Payer: SOMOS Essential |
$645.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$860.49
|
|
|
PR PROPH TX N/P/PLTWR W/WO METHYLMECRYLATE RAD&UL
|
Professional
|
Both
|
$4,018.42
|
|
|
Service Code
|
HCPCS 25492
|
| Min. Negotiated Rate |
$756.45 |
| Max. Negotiated Rate |
$2,431.44 |
| Rate for Payer: Cash Price |
$1,085.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,080.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$972.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$972.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,026.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,080.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,026.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,080.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,080.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$810.48
|
| Rate for Payer: Healthfirst Commercial |
$1,080.64
|
| Rate for Payer: Healthfirst Essential Plan |
$2,431.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,026.61
|
| Rate for Payer: Healthfirst QHP |
$1,080.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$756.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,080.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$918.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$756.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,080.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$810.48
|
| Rate for Payer: SOMOS Essential |
$810.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,080.64
|
|
|
PR PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE FEMUR
|
Professional
|
Both
|
$4,992.65
|
|
|
Service Code
|
HCPCS 27495
|
| Min. Negotiated Rate |
$937.40 |
| Max. Negotiated Rate |
$3,013.09 |
| Rate for Payer: Cash Price |
$1,345.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,339.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,205.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,205.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,272.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,339.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,272.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,339.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,339.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,004.36
|
| Rate for Payer: Healthfirst Commercial |
$1,339.15
|
| Rate for Payer: Healthfirst Essential Plan |
$3,013.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,272.19
|
| Rate for Payer: Healthfirst QHP |
$1,339.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$937.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,339.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,138.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$937.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,339.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,004.36
|
| Rate for Payer: SOMOS Essential |
$1,004.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,339.15
|
|
|
PR PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE TIBIA
|
Professional
|
Both
|
$3,338.27
|
|
|
Service Code
|
HCPCS 27745
|
| Min. Negotiated Rate |
$608.50 |
| Max. Negotiated Rate |
$1,955.90 |
| Rate for Payer: Cash Price |
$889.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$869.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$782.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$782.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$825.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$869.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$825.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$869.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$869.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$651.97
|
| Rate for Payer: Healthfirst Commercial |
$869.29
|
| Rate for Payer: Healthfirst Essential Plan |
$1,955.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$825.83
|
| Rate for Payer: Healthfirst QHP |
$869.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$608.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$869.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$738.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$608.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$869.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$651.97
|
| Rate for Payer: SOMOS Essential |
$651.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$869.29
|
|
|
PR PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE ULNA
|
Professional
|
Both
|
$3,282.76
|
|
|
Service Code
|
HCPCS 25491
|
| Min. Negotiated Rate |
$619.67 |
| Max. Negotiated Rate |
$1,991.81 |
| Rate for Payer: Cash Price |
$888.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$885.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$796.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$796.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$840.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$885.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$840.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$885.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$885.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$663.94
|
| Rate for Payer: Healthfirst Commercial |
$885.25
|
| Rate for Payer: Healthfirst Essential Plan |
$1,991.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$840.99
|
| Rate for Payer: Healthfirst QHP |
$885.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$619.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$885.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$752.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$619.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$885.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$663.94
|
| Rate for Payer: SOMOS Essential |
$663.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$885.25
|
|
|
PR PROPH TX N/P/PLTWR W/WO MMA FEM NCK & PROX FEMUR
|
Professional
|
Both
|
$4,403.67
|
|
|
Service Code
|
HCPCS 27187
|
| Min. Negotiated Rate |
$828.49 |
| Max. Negotiated Rate |
$2,662.99 |
| Rate for Payer: Cash Price |
$1,188.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,183.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,065.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,065.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,124.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,183.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,124.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,183.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,183.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$887.66
|
| Rate for Payer: Healthfirst Commercial |
$1,183.55
|
| Rate for Payer: Healthfirst Essential Plan |
$2,662.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,124.37
|
| Rate for Payer: Healthfirst QHP |
$1,183.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$828.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,183.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,006.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$828.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,183.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$887.66
|
| Rate for Payer: SOMOS Essential |
$887.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,183.55
|
|
|
PR PROPH TX W/WO METHYLMETHACRYLATE CLAVICLE
|
Professional
|
Both
|
$3,816.30
|
|
|
Service Code
|
HCPCS 23490
|
| Min. Negotiated Rate |
$717.47 |
| Max. Negotiated Rate |
$2,306.14 |
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,024.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$922.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$922.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$973.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,024.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$973.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,024.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,024.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$768.71
|
| Rate for Payer: Healthfirst Commercial |
$1,024.95
|
| Rate for Payer: Healthfirst Essential Plan |
$2,306.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$973.70
|
| Rate for Payer: Healthfirst QHP |
$1,024.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$717.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,024.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$871.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$717.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,024.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$768.71
|
| Rate for Payer: SOMOS Essential |
$768.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,024.95
|
|
|
PR PROPH TX W/WO METHYLMETHACRYLATE HUMERAL SHAFT
|
Professional
|
Both
|
$3,842.58
|
|
|
Service Code
|
HCPCS 24498
|
| Min. Negotiated Rate |
$719.27 |
| Max. Negotiated Rate |
$2,311.94 |
| Rate for Payer: Cash Price |
$1,037.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,027.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$924.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$924.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$976.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,027.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$976.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,027.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,027.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$770.65
|
| Rate for Payer: Healthfirst Commercial |
$1,027.53
|
| Rate for Payer: Healthfirst Essential Plan |
$2,311.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$976.15
|
| Rate for Payer: Healthfirst QHP |
$1,027.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$719.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,027.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$873.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$719.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,027.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$770.65
|
| Rate for Payer: SOMOS Essential |
$770.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,027.53
|
|
|
PR PROPH TX W/WO METHYLMETHACRYLATE PROX HUMERUS
|
Professional
|
Both
|
$4,494.56
|
|
|
Service Code
|
HCPCS 23491
|
| Min. Negotiated Rate |
$845.56 |
| Max. Negotiated Rate |
$2,717.86 |
| Rate for Payer: Cash Price |
$1,212.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,207.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,087.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,087.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,147.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,207.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,147.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,207.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,207.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$905.96
|
| Rate for Payer: Healthfirst Commercial |
$1,207.94
|
| Rate for Payer: Healthfirst Essential Plan |
$2,717.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,147.54
|
| Rate for Payer: Healthfirst QHP |
$1,207.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$845.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,207.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,026.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$845.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,207.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$905.96
|
| Rate for Payer: SOMOS Essential |
$905.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,207.94
|
|
|
PR PROSTATE CA SCREENING; DRE
|
Professional
|
Both
|
$35.35
|
|
|
Service Code
|
HCPCS G0102
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$21.46 |
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.16
|
| Rate for Payer: Healthfirst Commercial |
$9.54
|
| Rate for Payer: Healthfirst Essential Plan |
$21.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.06
|
| Rate for Payer: Healthfirst QHP |
$9.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.16
|
| Rate for Payer: SOMOS Essential |
$7.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.54
|
|
|
PR PROSTATECTOMY PERINEAL RADICAL
|
Professional
|
Both
|
$5,444.60
|
|
|
Service Code
|
HCPCS 55810
|
| Min. Negotiated Rate |
$1,034.49 |
| Max. Negotiated Rate |
$3,325.16 |
| Rate for Payer: Cash Price |
$1,486.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,477.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,330.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,330.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,403.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,477.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,403.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,477.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,477.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,108.39
|
| Rate for Payer: Healthfirst Commercial |
$1,477.85
|
| Rate for Payer: Healthfirst Essential Plan |
$3,325.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,403.96
|
| Rate for Payer: Healthfirst QHP |
$1,477.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,034.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,477.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,256.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,034.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,477.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,108.39
|
| Rate for Payer: SOMOS Essential |
$1,108.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,477.85
|
|
|
PR PROSTATECTOMY PERINEAL RADICAL W/LYMPH NODE BX
|
Professional
|
Both
|
$6,699.91
|
|
|
Service Code
|
HCPCS 55812
|
| Min. Negotiated Rate |
$1,271.23 |
| Max. Negotiated Rate |
$4,086.11 |
| Rate for Payer: Cash Price |
$1,827.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,816.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,634.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,634.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,725.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,816.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,725.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,816.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,816.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,362.04
|
| Rate for Payer: Healthfirst Commercial |
$1,816.05
|
| Rate for Payer: Healthfirst Essential Plan |
$4,086.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,725.25
|
| Rate for Payer: Healthfirst QHP |
$1,816.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,271.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,816.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,543.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,271.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,816.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,362.04
|
| Rate for Payer: SOMOS Essential |
$1,362.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,816.05
|
|
|
PR PROSTATECTOMY PERINEAL RAD W/BI PELVIC LYMPH EXC
|
Professional
|
Both
|
$7,332.61
|
|
|
Service Code
|
HCPCS 55815
|
| Min. Negotiated Rate |
$1,391.19 |
| Max. Negotiated Rate |
$4,471.69 |
| Rate for Payer: Cash Price |
$1,999.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,987.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,788.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,788.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,888.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,987.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,888.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,987.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,987.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,490.57
|
| Rate for Payer: Healthfirst Commercial |
$1,987.42
|
| Rate for Payer: Healthfirst Essential Plan |
$4,471.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,888.05
|
| Rate for Payer: Healthfirst QHP |
$1,987.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,391.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,987.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,689.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,391.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,987.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,490.57
|
| Rate for Payer: SOMOS Essential |
$1,490.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,987.42
|
|
|
PR PROSTATECTOMY PERINEAL SUBTOTAL
|
Professional
|
Both
|
$4,577.51
|
|
|
Service Code
|
HCPCS 55801
|
| Min. Negotiated Rate |
$869.98 |
| Max. Negotiated Rate |
$2,796.37 |
| Rate for Payer: Cash Price |
$1,250.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,242.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,118.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,118.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,180.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,242.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,180.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,242.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,242.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$932.12
|
| Rate for Payer: Healthfirst Commercial |
$1,242.83
|
| Rate for Payer: Healthfirst Essential Plan |
$2,796.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,180.69
|
| Rate for Payer: Healthfirst QHP |
$1,242.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$869.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,242.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,056.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$869.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,242.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$932.12
|
| Rate for Payer: SOMOS Essential |
$932.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,242.83
|
|
