|
PR SINUSOT FRNT NONOBLIT W/OSTPL FLAP CORONAL INC
|
Professional
|
Both
|
$4,872.21
|
|
|
Service Code
|
HCPCS 31087
|
| Min. Negotiated Rate |
$904.72 |
| Max. Negotiated Rate |
$2,908.01 |
| Rate for Payer: Cash Price |
$1,314.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,292.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,163.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,163.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,227.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,292.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,227.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,292.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,292.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$969.34
|
| Rate for Payer: Healthfirst Commercial |
$1,292.45
|
| Rate for Payer: Healthfirst Essential Plan |
$2,908.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,227.83
|
| Rate for Payer: Healthfirst QHP |
$1,292.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$904.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,292.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,098.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$904.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,292.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$969.34
|
| Rate for Payer: SOMOS Essential |
$969.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,292.45
|
|
|
PR SINUSOT FRNT OBLIT W/O OSTPL FLAP CORONAL INC
|
Professional
|
Both
|
$5,081.48
|
|
|
Service Code
|
HCPCS 31081
|
| Min. Negotiated Rate |
$941.32 |
| Max. Negotiated Rate |
$3,025.66 |
| Rate for Payer: Cash Price |
$1,370.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,344.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,210.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,210.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,277.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,344.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,277.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,344.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,344.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,008.55
|
| Rate for Payer: Healthfirst Commercial |
$1,344.74
|
| Rate for Payer: Healthfirst Essential Plan |
$3,025.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,277.50
|
| Rate for Payer: Healthfirst QHP |
$1,344.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$941.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,344.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,143.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$941.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,344.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,008.55
|
| Rate for Payer: SOMOS Essential |
$1,008.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,344.74
|
|
|
PR SINUSOT FRNT OBLIT W/OSTPL FLAP BROW INC
|
Professional
|
Both
|
$5,253.05
|
|
|
Service Code
|
HCPCS 31084
|
| Min. Negotiated Rate |
$973.32 |
| Max. Negotiated Rate |
$3,128.53 |
| Rate for Payer: Cash Price |
$1,418.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,390.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,251.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,251.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,320.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,390.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,320.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,390.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,390.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,042.85
|
| Rate for Payer: Healthfirst Commercial |
$1,390.46
|
| Rate for Payer: Healthfirst Essential Plan |
$3,128.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,320.94
|
| Rate for Payer: Healthfirst QHP |
$1,390.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$973.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,390.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,181.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$973.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,390.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,042.85
|
| Rate for Payer: SOMOS Essential |
$1,042.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,390.46
|
|
|
PR SINUSOT FRNT OBLIT W/OSTPL FLAP CORONAL INC
|
Professional
|
Both
|
$5,423.78
|
|
|
Service Code
|
HCPCS 31085
|
| Min. Negotiated Rate |
$1,003.25 |
| Max. Negotiated Rate |
$3,224.74 |
| Rate for Payer: Cash Price |
$1,460.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,433.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,289.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,289.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,361.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,433.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,361.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,433.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,433.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,074.91
|
| Rate for Payer: Healthfirst Commercial |
$1,433.22
|
| Rate for Payer: Healthfirst Essential Plan |
$3,224.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,361.56
|
| Rate for Payer: Healthfirst QHP |
$1,433.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,003.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,433.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,218.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,003.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,433.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,074.91
|
| Rate for Payer: SOMOS Essential |
$1,074.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,433.22
|
|
|
PR SINUSOT MAX ANTRT RAD W/RMVL ANTROCH POLYPS
|
Professional
|
Both
|
$2,582.16
|
|
|
Service Code
|
HCPCS 31032
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$1,548.00 |
| Rate for Payer: Cash Price |
$697.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$688.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$619.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$619.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$653.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$688.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$653.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$688.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$688.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$516.00
|
| Rate for Payer: Healthfirst Commercial |
$688.00
|
| Rate for Payer: Healthfirst Essential Plan |
$1,548.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$653.60
|
| Rate for Payer: Healthfirst QHP |
$688.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$481.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$688.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$584.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$481.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$688.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$516.00
|
| Rate for Payer: SOMOS Essential |
$516.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$688.00
|
|
|
PR SINUSOTOMY FRNT OBLITERATIVE W/O FLAP BROW INC
|
Professional
|
Both
|
$4,744.67
|
|
|
Service Code
|
HCPCS 31080
|
| Min. Negotiated Rate |
$878.36 |
| Max. Negotiated Rate |
$2,823.30 |
| Rate for Payer: Cash Price |
$1,279.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,254.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,129.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,129.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,192.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,254.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,192.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,254.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,254.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$941.10
|
| Rate for Payer: Healthfirst Commercial |
$1,254.80
|
| Rate for Payer: Healthfirst Essential Plan |
$2,823.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,192.06
|
| Rate for Payer: Healthfirst QHP |
$1,254.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$878.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,254.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,066.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$878.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,254.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$941.10
|
| Rate for Payer: SOMOS Essential |
$941.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,254.80
|
|
|
PR SINUSOTOMY FRONTAL EXTERNAL SIMPLE
|
Professional
|
Both
|
$2,083.20
|
|
|
Service Code
|
HCPCS 31070
|
| Min. Negotiated Rate |
$385.24 |
| Max. Negotiated Rate |
$1,238.27 |
| Rate for Payer: Cash Price |
$561.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$550.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$495.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$495.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$522.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$550.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$522.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$550.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$550.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$412.75
|
| Rate for Payer: Healthfirst Commercial |
$550.34
|
| Rate for Payer: Healthfirst Essential Plan |
$1,238.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$522.82
|
| Rate for Payer: Healthfirst QHP |
$550.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$385.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$550.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$467.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$385.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$550.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$412.75
|
| Rate for Payer: SOMOS Essential |
$412.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$550.34
|
|
|
PR SINUSOTOMY FRONTAL TRANSORBITAL UNILATERAL
|
Professional
|
Both
|
$3,604.76
|
|
|
Service Code
|
HCPCS 31075
|
| Min. Negotiated Rate |
$668.35 |
| Max. Negotiated Rate |
$2,148.26 |
| Rate for Payer: Cash Price |
$972.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$954.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$859.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$859.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$907.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$954.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$907.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$954.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$716.09
|
| Rate for Payer: Healthfirst Commercial |
$954.78
|
| Rate for Payer: Healthfirst Essential Plan |
$2,148.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$907.04
|
| Rate for Payer: Healthfirst QHP |
$954.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$668.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$954.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$811.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$668.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$954.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$716.09
|
| Rate for Payer: SOMOS Essential |
$716.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$954.78
|
|
|
PR SINUSOTOMY MAXILLARY ANTROTOMY INTRANASAL
|
Professional
|
Both
|
$1,529.50
|
|
|
Service Code
|
HCPCS 31020
|
| Min. Negotiated Rate |
$278.12 |
| Max. Negotiated Rate |
$893.97 |
| Rate for Payer: Cash Price |
$399.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$397.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$357.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$357.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$377.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$397.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$377.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$397.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$397.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$297.99
|
| Rate for Payer: Healthfirst Commercial |
$397.32
|
| Rate for Payer: Healthfirst Essential Plan |
$893.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$377.45
|
| Rate for Payer: Healthfirst QHP |
$397.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$278.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$397.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$337.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$278.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$397.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$297.99
|
| Rate for Payer: SOMOS Essential |
$297.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$397.32
|
|
|
PR SINUSOTOMY MAXILLARY RAD W/O RMVL ANTROCH POLYPS
|
Professional
|
Both
|
$2,188.13
|
|
|
Service Code
|
HCPCS 31030
|
| Min. Negotiated Rate |
$415.84 |
| Max. Negotiated Rate |
$1,336.63 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$594.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$594.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$445.55
|
| Rate for Payer: Healthfirst Commercial |
$594.06
|
| Rate for Payer: Healthfirst Essential Plan |
$1,336.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$564.36
|
| Rate for Payer: Healthfirst QHP |
$594.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$415.84
|
| Rate for Payer: Cash Price |
$599.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$594.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$534.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$534.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$564.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$594.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$564.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$594.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$504.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$415.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$594.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$445.55
|
| Rate for Payer: SOMOS Essential |
$445.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$594.06
|
|
|
PR SINUSOTOMY SPHENOID W/WO BIOPSY
|
Professional
|
Both
|
$2,253.48
|
|
|
Service Code
|
HCPCS 31050
|
| Min. Negotiated Rate |
$419.08 |
| Max. Negotiated Rate |
$1,347.05 |
| Rate for Payer: Cash Price |
$608.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$598.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$538.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$538.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$568.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$598.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$568.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$598.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$598.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$449.02
|
| Rate for Payer: Healthfirst Commercial |
$598.69
|
| Rate for Payer: Healthfirst Essential Plan |
$1,347.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$568.76
|
| Rate for Payer: Healthfirst QHP |
$598.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$419.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$598.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$508.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$419.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$598.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$449.02
|
| Rate for Payer: SOMOS Essential |
$449.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$598.69
|
|
|
PR SINUSOT SPHENOID W/MUCOSAL STRIPPING/RMVL POLYP
|
Professional
|
Both
|
$3,028.45
|
|
|
Service Code
|
HCPCS 31051
|
| Min. Negotiated Rate |
$559.20 |
| Max. Negotiated Rate |
$1,797.41 |
| Rate for Payer: Cash Price |
$817.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$798.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$718.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$718.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$758.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$798.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$758.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$798.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$798.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$599.14
|
| Rate for Payer: Healthfirst Commercial |
$798.85
|
| Rate for Payer: Healthfirst Essential Plan |
$1,797.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$758.91
|
| Rate for Payer: Healthfirst QHP |
$798.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$559.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$798.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$679.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$559.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$798.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$599.14
|
| Rate for Payer: SOMOS Essential |
$599.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$798.85
|
|
|
PR SINUSOT UNI 3/> PARANSL SINUSES
|
Professional
|
Both
|
$4,829.83
|
|
|
Service Code
|
HCPCS 31090
|
| Min. Negotiated Rate |
$891.68 |
| Max. Negotiated Rate |
$2,866.12 |
| Rate for Payer: Cash Price |
$1,303.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,273.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,146.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,146.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,210.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,273.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,210.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,273.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,273.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$955.37
|
| Rate for Payer: Healthfirst Commercial |
$1,273.83
|
| Rate for Payer: Healthfirst Essential Plan |
$2,866.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,210.14
|
| Rate for Payer: Healthfirst QHP |
$1,273.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$891.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,273.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,082.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$891.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,273.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$955.37
|
| Rate for Payer: SOMOS Essential |
$955.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,273.83
|
|
|
PR SKIN TEST UNLISTED ANTIGEN EACH
|
Professional
|
Both
|
$28.60
|
|
|
Service Code
|
HCPCS 86486
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Cash Price |
$7.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.70
|
| Rate for Payer: Healthfirst Commercial |
$7.60
|
| Rate for Payer: Healthfirst Essential Plan |
$17.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.22
|
| Rate for Payer: Healthfirst QHP |
$7.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$7.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$6.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.70
|
| Rate for Payer: SOMOS Essential |
$5.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.60
|
|
|
PR SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN
|
Professional
|
Both
|
$1,097.78
|
|
|
Service Code
|
HCPCS 36251
|
| Min. Negotiated Rate |
$201.59 |
| Max. Negotiated Rate |
$647.98 |
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$287.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$259.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$259.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$273.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$287.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$273.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$287.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$287.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$215.99
|
| Rate for Payer: Healthfirst Commercial |
$287.99
|
| Rate for Payer: Healthfirst Essential Plan |
$647.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$273.59
|
| Rate for Payer: Healthfirst QHP |
$287.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$201.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$287.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$244.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$201.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$287.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$215.99
|
| Rate for Payer: SOMOS Essential |
$215.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$287.99
|
|
|
PR SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BIL
|
Professional
|
Both
|
$1,558.62
|
|
|
Service Code
|
HCPCS 36252
|
| Min. Negotiated Rate |
$287.00 |
| Max. Negotiated Rate |
$922.50 |
| Rate for Payer: Cash Price |
$414.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$410.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$369.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$369.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$389.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$410.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$389.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$410.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$410.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$307.50
|
| Rate for Payer: Healthfirst Commercial |
$410.00
|
| Rate for Payer: Healthfirst Essential Plan |
$922.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$389.50
|
| Rate for Payer: Healthfirst QHP |
$410.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$287.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$410.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$348.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$287.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$410.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$307.50
|
| Rate for Payer: SOMOS Essential |
$307.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$410.00
|
|
|
PR SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART
|
Professional
|
Both
|
$1,479.10
|
|
|
Service Code
|
HCPCS 36223
|
| Min. Negotiated Rate |
$276.08 |
| Max. Negotiated Rate |
$887.40 |
| Rate for Payer: Cash Price |
$395.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$394.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$354.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$354.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$374.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$394.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$374.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$394.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$394.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$295.80
|
| Rate for Payer: Healthfirst Commercial |
$394.40
|
| Rate for Payer: Healthfirst Essential Plan |
$887.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$374.68
|
| Rate for Payer: Healthfirst QHP |
$394.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$276.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$394.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$335.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$276.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$394.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$295.80
|
| Rate for Payer: SOMOS Essential |
$295.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$394.40
|
|
|
PR SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART
|
Professional
|
Both
|
$1,266.27
|
|
|
Service Code
|
HCPCS 36222
|
| Min. Negotiated Rate |
$234.38 |
| Max. Negotiated Rate |
$753.37 |
| Rate for Payer: Cash Price |
$337.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$334.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$301.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$301.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$318.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$334.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$318.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$334.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$334.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$251.12
|
| Rate for Payer: Healthfirst Commercial |
$334.83
|
| Rate for Payer: Healthfirst Essential Plan |
$753.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$318.09
|
| Rate for Payer: Healthfirst QHP |
$334.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$234.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$334.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$284.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$234.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$334.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$251.12
|
| Rate for Payer: SOMOS Essential |
$251.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$334.83
|
|
|
PR SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY
|
Professional
|
Both
|
$640.54
|
|
|
Service Code
|
HCPCS 36014
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$385.72 |
| Rate for Payer: Cash Price |
$171.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$171.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$154.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$154.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$171.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$171.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$128.57
|
| Rate for Payer: Healthfirst Commercial |
$171.43
|
| Rate for Payer: Healthfirst Essential Plan |
$385.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$162.86
|
| Rate for Payer: Healthfirst QHP |
$171.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$120.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$171.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$145.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$120.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$171.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$128.57
|
| Rate for Payer: SOMOS Essential |
$128.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$171.43
|
|
|
PR SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT
|
Professional
|
Both
|
$1,131.24
|
|
|
Service Code
|
HCPCS 36228
|
| Min. Negotiated Rate |
$212.62 |
| Max. Negotiated Rate |
$683.44 |
| Rate for Payer: Cash Price |
$302.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$303.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$273.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$273.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$288.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$303.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$288.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$303.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$303.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$227.81
|
| Rate for Payer: Healthfirst Commercial |
$303.75
|
| Rate for Payer: Healthfirst Essential Plan |
$683.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$288.56
|
| Rate for Payer: Healthfirst QHP |
$303.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$212.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$303.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$258.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$212.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$303.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$227.81
|
| Rate for Payer: SOMOS Essential |
$227.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$303.75
|
|
|
PR SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART
|
Professional
|
Both
|
$1,680.14
|
|
|
Service Code
|
HCPCS 36224
|
| Min. Negotiated Rate |
$311.93 |
| Max. Negotiated Rate |
$1,002.64 |
| Rate for Payer: Cash Price |
$446.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$445.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$401.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$401.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$423.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$445.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$423.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$445.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$445.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$334.21
|
| Rate for Payer: Healthfirst Commercial |
$445.62
|
| Rate for Payer: Healthfirst Essential Plan |
$1,002.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$423.34
|
| Rate for Payer: Healthfirst QHP |
$445.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$311.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$445.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$378.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$311.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$445.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$334.21
|
| Rate for Payer: SOMOS Essential |
$334.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$445.62
|
|
|
PR SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH
|
Professional
|
Both
|
$1,169.28
|
|
|
Service Code
|
HCPCS 36216
|
| Min. Negotiated Rate |
$219.19 |
| Max. Negotiated Rate |
$704.54 |
| Rate for Payer: Cash Price |
$315.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$313.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$281.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$281.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$297.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$313.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$297.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$313.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$313.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$234.85
|
| Rate for Payer: Healthfirst Commercial |
$313.13
|
| Rate for Payer: Healthfirst Essential Plan |
$704.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$297.47
|
| Rate for Payer: Healthfirst QHP |
$313.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$219.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$313.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$266.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$219.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$313.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$234.85
|
| Rate for Payer: SOMOS Essential |
$234.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$313.13
|
|
|
PR SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH
|
Professional
|
Both
|
$1,088.08
|
|
|
Service Code
|
HCPCS 36246
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$288.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$259.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$259.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$273.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$288.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$273.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$288.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$288.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$216.00
|
| Rate for Payer: Healthfirst Commercial |
$288.00
|
| Rate for Payer: Healthfirst Essential Plan |
$648.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$273.60
|
| Rate for Payer: Healthfirst QHP |
$288.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$201.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$288.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$244.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$201.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$288.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$216.00
|
| Rate for Payer: SOMOS Essential |
$216.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$288.00
|
|
|
PR SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH
|
Professional
|
Both
|
$1,271.34
|
|
|
Service Code
|
HCPCS 36247
|
| Min. Negotiated Rate |
$234.14 |
| Max. Negotiated Rate |
$752.58 |
| Rate for Payer: Cash Price |
$338.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$334.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$301.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$301.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$317.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$334.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$317.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$334.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$334.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$250.86
|
| Rate for Payer: Healthfirst Commercial |
$334.48
|
| Rate for Payer: Healthfirst Essential Plan |
$752.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$317.76
|
| Rate for Payer: Healthfirst QHP |
$334.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$234.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$334.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$284.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$234.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$334.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$250.86
|
| Rate for Payer: SOMOS Essential |
$250.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$334.48
|
|
|
PR SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH
|
Professional
|
Both
|
$1,450.16
|
|
|
Service Code
|
HCPCS 36217
|
| Min. Negotiated Rate |
$275.81 |
| Max. Negotiated Rate |
$886.54 |
| Rate for Payer: Cash Price |
$390.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$394.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$354.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$354.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$374.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$394.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$374.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$394.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$394.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$295.51
|
| Rate for Payer: Healthfirst Commercial |
$394.02
|
| Rate for Payer: Healthfirst Essential Plan |
$886.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$374.32
|
| Rate for Payer: Healthfirst QHP |
$394.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$275.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$394.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$334.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$275.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$394.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$295.51
|
| Rate for Payer: SOMOS Essential |
$295.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$394.02
|
|
