|
PR RAD ABDL HYSTERECTOMY W/BI PELVIC LMPHADENECTOMY
|
Professional
|
Both
|
$7,913.15
|
|
|
Service Code
|
HCPCS 58210
|
| Min. Negotiated Rate |
$1,479.90 |
| Max. Negotiated Rate |
$4,756.81 |
| Rate for Payer: Cash Price |
$2,140.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,114.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,902.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,902.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,008.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,114.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,008.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,114.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,114.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,585.61
|
| Rate for Payer: Healthfirst Commercial |
$2,114.14
|
| Rate for Payer: Healthfirst Essential Plan |
$4,756.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,008.43
|
| Rate for Payer: Healthfirst QHP |
$2,114.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,479.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,114.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,797.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,479.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,114.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,585.61
|
| Rate for Payer: SOMOS Essential |
$1,585.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,114.14
|
|
|
PR RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS FLXRS
|
Professional
|
Both
|
$3,338.13
|
|
|
Service Code
|
HCPCS 25115
|
| Min. Negotiated Rate |
$633.76 |
| Max. Negotiated Rate |
$2,037.08 |
| Rate for Payer: Cash Price |
$905.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$905.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$814.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$814.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$860.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$905.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$860.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$905.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$905.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$679.03
|
| Rate for Payer: Healthfirst Commercial |
$905.37
|
| Rate for Payer: Healthfirst Essential Plan |
$2,037.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$860.10
|
| Rate for Payer: Healthfirst QHP |
$905.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$633.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$905.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$769.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$633.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$905.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$679.03
|
| Rate for Payer: SOMOS Essential |
$679.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$905.37
|
|
|
PR RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS XTNSRS
|
Professional
|
Both
|
$2,667.07
|
|
|
Service Code
|
HCPCS 25116
|
| Min. Negotiated Rate |
$507.96 |
| Max. Negotiated Rate |
$1,632.73 |
| Rate for Payer: Cash Price |
$727.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$725.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$653.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$653.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$689.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$725.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$689.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$725.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$725.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$544.25
|
| Rate for Payer: Healthfirst Commercial |
$725.66
|
| Rate for Payer: Healthfirst Essential Plan |
$1,632.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$689.38
|
| Rate for Payer: Healthfirst QHP |
$725.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$507.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$725.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$616.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$507.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$725.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$544.25
|
| Rate for Payer: SOMOS Essential |
$544.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$725.66
|
|
|
PR RAD EXC XTRNL AUDITORY CANAL LES NCK DSJ
|
Professional
|
Both
|
$7,034.37
|
|
|
Service Code
|
HCPCS 69155
|
| Min. Negotiated Rate |
$1,309.81 |
| Max. Negotiated Rate |
$4,210.09 |
| Rate for Payer: Cash Price |
$1,901.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,871.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,684.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,684.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,777.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,871.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,777.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,871.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,871.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,403.36
|
| Rate for Payer: Healthfirst Commercial |
$1,871.15
|
| Rate for Payer: Healthfirst Essential Plan |
$4,210.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,777.59
|
| Rate for Payer: Healthfirst QHP |
$1,871.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,309.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,871.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,590.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,309.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,871.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,403.36
|
| Rate for Payer: SOMOS Essential |
$1,403.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,871.15
|
|
|
PR RAD EXC XTRNL AUDITORY CANAL LES W/O NCK DSJ
|
Professional
|
Both
|
$4,380.64
|
|
|
Service Code
|
HCPCS 69150
|
| Min. Negotiated Rate |
$810.40 |
| Max. Negotiated Rate |
$2,604.85 |
| Rate for Payer: Cash Price |
$1,179.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,157.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,041.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,041.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,099.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,157.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,099.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,157.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,157.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$868.28
|
| Rate for Payer: Healthfirst Commercial |
$1,157.71
|
| Rate for Payer: Healthfirst Essential Plan |
$2,604.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,099.82
|
| Rate for Payer: Healthfirst QHP |
$1,157.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$810.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,157.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$984.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$810.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,157.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$868.28
|
| Rate for Payer: SOMOS Essential |
$868.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,157.71
|
|
|
PR RADIATION TREATMENT DELIVERY
|
Professional
|
Both
|
$1,010.28
|
|
|
Service Code
|
HCPCS G6014
|
| Min. Negotiated Rate |
$181.82 |
| Max. Negotiated Rate |
$584.44 |
| Rate for Payer: Cash Price |
$270.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$259.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$233.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$233.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$246.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$259.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$246.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$259.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$259.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$194.81
|
| Rate for Payer: Healthfirst Commercial |
$259.75
|
| Rate for Payer: Healthfirst Essential Plan |
$584.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$246.76
|
| Rate for Payer: Healthfirst QHP |
$259.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$181.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$259.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$220.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$181.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$259.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$194.81
|
| Rate for Payer: SOMOS Essential |
$194.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$259.75
|
|
|
PR RADIATION TREATMENT DELIVERY
|
Professional
|
Both
|
$1,024.66
|
|
|
Service Code
|
HCPCS G6011
|
| Min. Negotiated Rate |
$181.82 |
| Max. Negotiated Rate |
$584.44 |
| Rate for Payer: Cash Price |
$270.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$259.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$233.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$233.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$246.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$259.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$246.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$259.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$259.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$194.81
|
| Rate for Payer: Healthfirst Commercial |
$259.75
|
| Rate for Payer: Healthfirst Essential Plan |
$584.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$246.76
|
| Rate for Payer: Healthfirst QHP |
$259.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$181.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$259.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$220.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$181.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$259.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$194.81
|
| Rate for Payer: SOMOS Essential |
$194.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$259.75
|
|
|
PR RADIATION TREATMENT DELIVERY
|
Professional
|
Both
|
$761.60
|
|
|
Service Code
|
HCPCS G6010
|
| Min. Negotiated Rate |
$136.99 |
| Max. Negotiated Rate |
$440.32 |
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$195.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$176.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$176.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$185.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$195.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$185.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$146.78
|
| Rate for Payer: Healthfirst Commercial |
$195.70
|
| Rate for Payer: Healthfirst Essential Plan |
$440.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$185.91
|
| Rate for Payer: Healthfirst QHP |
$195.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$136.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$195.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$166.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$136.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$195.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$146.78
|
| Rate for Payer: SOMOS Essential |
$146.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$195.70
|
|
|
PR RADIATION TREATMENT DELIVERY
|
Professional
|
Both
|
$765.91
|
|
|
Service Code
|
HCPCS G6009
|
| Min. Negotiated Rate |
$139.17 |
| Max. Negotiated Rate |
$447.32 |
| Rate for Payer: Cash Price |
$205.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$198.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$178.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$178.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$188.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$198.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$188.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$198.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$149.11
|
| Rate for Payer: Healthfirst Commercial |
$198.81
|
| Rate for Payer: Healthfirst Essential Plan |
$447.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$188.87
|
| Rate for Payer: Healthfirst QHP |
$198.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$139.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$198.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$168.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$139.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$198.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$149.11
|
| Rate for Payer: SOMOS Essential |
$149.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$198.81
|
|
|
PR RADIATION TREATMENT DELIVERY
|
Professional
|
Both
|
$768.78
|
|
|
Service Code
|
HCPCS G6008
|
| Min. Negotiated Rate |
$138.08 |
| Max. Negotiated Rate |
$443.83 |
| Rate for Payer: Cash Price |
$205.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$197.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$177.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$177.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$187.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$197.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$187.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$197.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$197.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$147.94
|
| Rate for Payer: Healthfirst Commercial |
$197.26
|
| Rate for Payer: Healthfirst Essential Plan |
$443.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$187.40
|
| Rate for Payer: Healthfirst QHP |
$197.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$138.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$197.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$167.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$138.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$197.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$147.94
|
| Rate for Payer: SOMOS Essential |
$147.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$197.26
|
|
|
PR RADIATION TREATMENT DELIVERY
|
Professional
|
Both
|
$1,024.80
|
|
|
Service Code
|
HCPCS G6007
|
| Min. Negotiated Rate |
$177.59 |
| Max. Negotiated Rate |
$570.83 |
| Rate for Payer: Cash Price |
$271.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$253.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$228.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$228.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$241.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$253.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$241.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$253.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$253.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$190.28
|
| Rate for Payer: Healthfirst Commercial |
$253.70
|
| Rate for Payer: Healthfirst Essential Plan |
$570.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$241.01
|
| Rate for Payer: Healthfirst QHP |
$253.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$177.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$253.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$215.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$177.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$253.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$190.28
|
| Rate for Payer: SOMOS Essential |
$190.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$253.70
|
|
|
PR RADIATION TREATMENT DELIVERY
|
Professional
|
Both
|
$554.75
|
|
|
Service Code
|
HCPCS G6006
|
| Min. Negotiated Rate |
$99.61 |
| Max. Negotiated Rate |
$320.18 |
| Rate for Payer: Cash Price |
$148.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$142.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$128.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$128.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$135.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$142.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$135.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$106.72
|
| Rate for Payer: Healthfirst Commercial |
$142.30
|
| Rate for Payer: Healthfirst Essential Plan |
$320.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$135.19
|
| Rate for Payer: Healthfirst QHP |
$142.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$99.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$142.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$120.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$99.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$142.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$106.72
|
| Rate for Payer: SOMOS Essential |
$106.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$142.30
|
|
|
PR RADIATION TREATMENT DELIVERY
|
Professional
|
Both
|
$557.62
|
|
|
Service Code
|
HCPCS G6005
|
| Min. Negotiated Rate |
$100.15 |
| Max. Negotiated Rate |
$321.91 |
| Rate for Payer: Cash Price |
$149.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$143.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$128.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$128.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$135.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$143.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$135.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$143.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$143.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$107.30
|
| Rate for Payer: Healthfirst Commercial |
$143.07
|
| Rate for Payer: Healthfirst Essential Plan |
$321.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$135.92
|
| Rate for Payer: Healthfirst QHP |
$143.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$100.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$143.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$121.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$100.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$143.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$107.30
|
| Rate for Payer: SOMOS Essential |
$107.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$143.07
|
|
|
PR RADIATION TREATMENT DELIVERY
|
Professional
|
Both
|
$556.19
|
|
|
Service Code
|
HCPCS G6004
|
| Min. Negotiated Rate |
$100.15 |
| Max. Negotiated Rate |
$321.91 |
| Rate for Payer: Cash Price |
$149.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$143.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$128.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$128.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$135.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$143.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$135.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$143.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$143.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$107.30
|
| Rate for Payer: Healthfirst Commercial |
$143.07
|
| Rate for Payer: Healthfirst Essential Plan |
$321.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$135.92
|
| Rate for Payer: Healthfirst QHP |
$143.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$100.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$143.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$121.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$100.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$143.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$107.30
|
| Rate for Payer: SOMOS Essential |
$107.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$143.07
|
|
|
PR RADIATION TREATMENT DELIVERY
|
Professional
|
Both
|
$658.25
|
|
|
Service Code
|
HCPCS G6003
|
| Min. Negotiated Rate |
$123.52 |
| Max. Negotiated Rate |
$397.01 |
| Rate for Payer: Cash Price |
$181.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$176.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$158.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$158.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$167.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$176.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$167.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$176.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$176.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$132.34
|
| Rate for Payer: Healthfirst Commercial |
$176.45
|
| Rate for Payer: Healthfirst Essential Plan |
$397.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$167.63
|
| Rate for Payer: Healthfirst QHP |
$176.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$123.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$176.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$149.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$123.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$176.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$132.34
|
| Rate for Payer: SOMOS Essential |
$132.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$176.45
|
|
|
PR RADIATION TREATMENT DELIVERY
|
Professional
|
Both
|
$1,016.02
|
|
|
Service Code
|
HCPCS G6013
|
| Min. Negotiated Rate |
$182.91 |
| Max. Negotiated Rate |
$587.92 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$261.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$235.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$235.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$248.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$261.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$248.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$261.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$261.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$195.97
|
| Rate for Payer: Healthfirst Commercial |
$261.30
|
| Rate for Payer: Healthfirst Essential Plan |
$587.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$248.24
|
| Rate for Payer: Healthfirst QHP |
$261.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$182.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$261.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$222.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$182.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$261.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$195.97
|
| Rate for Payer: SOMOS Essential |
$195.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$261.30
|
|
|
PR RADIATION TREATMENT DELIVERY
|
Professional
|
Both
|
$1,013.15
|
|
|
Service Code
|
HCPCS G6012
|
| Min. Negotiated Rate |
$182.10 |
| Max. Negotiated Rate |
$585.32 |
| Rate for Payer: Cash Price |
$271.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$260.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$234.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$234.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$247.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$260.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$247.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$260.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$260.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$195.10
|
| Rate for Payer: Healthfirst Commercial |
$260.14
|
| Rate for Payer: Healthfirst Essential Plan |
$585.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$247.13
|
| Rate for Payer: Healthfirst QHP |
$260.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$182.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$260.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$221.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$182.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$260.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$195.10
|
| Rate for Payer: SOMOS Essential |
$195.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$260.14
|
|
|
PR RADIATION TX DELIVERY IMRT
|
Professional
|
Both
|
$1,553.37
|
|
|
Service Code
|
HCPCS G6015
|
| Min. Negotiated Rate |
$284.20 |
| Max. Negotiated Rate |
$913.50 |
| Rate for Payer: Cash Price |
$421.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$406.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$365.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$365.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$385.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$406.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$385.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$406.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$406.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$304.50
|
| Rate for Payer: Healthfirst Commercial |
$406.00
|
| Rate for Payer: Healthfirst Essential Plan |
$913.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$385.70
|
| Rate for Payer: Healthfirst QHP |
$406.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$284.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$406.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$345.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$284.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$406.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$304.50
|
| Rate for Payer: SOMOS Essential |
$304.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$406.00
|
|
|
PR RADICAL RESCJ TONSIL CLOSURE W/LOCAL FLAP
|
Professional
|
Both
|
$5,932.57
|
|
|
Service Code
|
HCPCS 42844
|
| Min. Negotiated Rate |
$1,107.29 |
| Max. Negotiated Rate |
$3,559.14 |
| Rate for Payer: Cash Price |
$1,602.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,581.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,423.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,423.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,502.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,581.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,502.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,581.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,581.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,186.38
|
| Rate for Payer: Healthfirst Commercial |
$1,581.84
|
| Rate for Payer: Healthfirst Essential Plan |
$3,559.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,502.75
|
| Rate for Payer: Healthfirst QHP |
$1,581.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,107.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,581.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,344.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,107.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,581.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,186.38
|
| Rate for Payer: SOMOS Essential |
$1,186.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,581.84
|
|
|
PR RADICAL RESCJ TONSIL CLOSURE W/OTHER FLAP
|
Professional
|
Both
|
$9,483.60
|
|
|
Service Code
|
HCPCS 42845
|
| Min. Negotiated Rate |
$1,763.99 |
| Max. Negotiated Rate |
$5,669.98 |
| Rate for Payer: Cash Price |
$2,552.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,519.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,267.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,267.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,393.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,519.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,393.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,519.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,519.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,889.99
|
| Rate for Payer: Healthfirst Commercial |
$2,519.99
|
| Rate for Payer: Healthfirst Essential Plan |
$5,669.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,393.99
|
| Rate for Payer: Healthfirst QHP |
$2,519.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,763.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,519.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,141.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,763.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,519.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,889.99
|
| Rate for Payer: SOMOS Essential |
$1,889.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,519.99
|
|
|
PR RADICAL RESCTION TUMOR INNOMINATE BONE TOTAL
|
Professional
|
Both
|
$12,355.63
|
|
|
Service Code
|
HCPCS 27077
|
| Min. Negotiated Rate |
$2,307.21 |
| Max. Negotiated Rate |
$7,416.05 |
| Rate for Payer: Cash Price |
$3,316.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,296.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,966.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,966.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,131.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,296.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,131.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,296.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,296.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,472.01
|
| Rate for Payer: Healthfirst Commercial |
$3,296.02
|
| Rate for Payer: Healthfirst Essential Plan |
$7,416.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,131.22
|
| Rate for Payer: Healthfirst QHP |
$3,296.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,307.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,296.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,801.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,307.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,296.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,472.01
|
| Rate for Payer: SOMOS Essential |
$2,472.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,296.02
|
|
|
PR RADICAL RESECTION BONE TUMOR PROXIMAL HUMERUS
|
Professional
|
Both
|
$8,527.02
|
|
|
Service Code
|
HCPCS 23220
|
| Min. Negotiated Rate |
$1,596.88 |
| Max. Negotiated Rate |
$5,132.81 |
| Rate for Payer: Cash Price |
$2,288.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,281.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,053.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,053.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,167.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,281.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,167.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,281.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,281.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,710.94
|
| Rate for Payer: Healthfirst Commercial |
$2,281.25
|
| Rate for Payer: Healthfirst Essential Plan |
$5,132.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,167.19
|
| Rate for Payer: Healthfirst QHP |
$2,281.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,596.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,281.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,939.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,596.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,281.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,710.94
|
| Rate for Payer: SOMOS Essential |
$1,710.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,281.25
|
|
|
PR RADICAL RESECTION OF TUMOR TALUS OR CALCANEUS
|
Professional
|
Both
|
$4,062.59
|
|
|
Service Code
|
HCPCS 27647
|
| Min. Negotiated Rate |
$777.99 |
| Max. Negotiated Rate |
$2,500.67 |
| Rate for Payer: Cash Price |
$1,117.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,111.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,000.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,000.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,055.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,111.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,055.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,111.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,111.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$833.56
|
| Rate for Payer: Healthfirst Commercial |
$1,111.41
|
| Rate for Payer: Healthfirst Essential Plan |
$2,500.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,055.84
|
| Rate for Payer: Healthfirst QHP |
$1,111.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$777.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,111.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$944.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$777.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,111.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$833.56
|
| Rate for Payer: SOMOS Essential |
$833.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,111.41
|
|
|
PR RADICAL RESECTION OF TUMOR TIBIA
|
Professional
|
Both
|
$7,788.03
|
|
|
Service Code
|
HCPCS 27645
|
| Min. Negotiated Rate |
$1,459.22 |
| Max. Negotiated Rate |
$4,690.35 |
| Rate for Payer: Cash Price |
$2,094.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,084.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,876.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,876.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,980.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,084.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,980.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,084.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,084.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,563.45
|
| Rate for Payer: Healthfirst Commercial |
$2,084.60
|
| Rate for Payer: Healthfirst Essential Plan |
$4,690.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,980.37
|
| Rate for Payer: Healthfirst QHP |
$2,084.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,459.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,084.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,771.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,459.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,084.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,563.45
|
| Rate for Payer: SOMOS Essential |
$1,563.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,084.60
|
|
|
PR RADICAL RESECTION STERNUM
|
Professional
|
Both
|
$5,743.85
|
|
|
Service Code
|
HCPCS 21630
|
| Min. Negotiated Rate |
$1,078.58 |
| Max. Negotiated Rate |
$3,466.87 |
| Rate for Payer: Cash Price |
$1,547.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,540.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,386.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,386.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,463.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,540.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,463.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,540.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,540.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,155.62
|
| Rate for Payer: Healthfirst Commercial |
$1,540.83
|
| Rate for Payer: Healthfirst Essential Plan |
$3,466.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,463.79
|
| Rate for Payer: Healthfirst QHP |
$1,540.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,078.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,540.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,309.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,078.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,540.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,155.62
|
| Rate for Payer: SOMOS Essential |
$1,155.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,540.83
|
|
