|
PR SURGICAL ARTHROSCOPY SHOULDER PRTL SYNOVECTOMY
|
Professional
|
Both
|
$2,356.17
|
|
|
Service Code
|
HCPCS 29820
|
| Min. Negotiated Rate |
$446.60 |
| Max. Negotiated Rate |
$1,435.50 |
| Rate for Payer: Cash Price |
$638.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$638.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$574.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$574.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$606.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$638.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$606.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$638.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$638.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$478.50
|
| Rate for Payer: Healthfirst Commercial |
$638.00
|
| Rate for Payer: Healthfirst Essential Plan |
$1,435.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$606.10
|
| Rate for Payer: Healthfirst QHP |
$638.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$446.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$638.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$542.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$446.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$638.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$478.50
|
| Rate for Payer: SOMOS Essential |
$478.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$638.00
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER REMOVAL LOOSE/FB
|
Professional
|
Both
|
$2,596.34
|
|
|
Service Code
|
HCPCS 29819
|
| Min. Negotiated Rate |
$490.06 |
| Max. Negotiated Rate |
$1,575.18 |
| Rate for Payer: Cash Price |
$703.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$700.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$630.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$630.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$665.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$700.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$665.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$700.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$700.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$525.06
|
| Rate for Payer: Healthfirst Commercial |
$700.08
|
| Rate for Payer: Healthfirst Essential Plan |
$1,575.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$665.08
|
| Rate for Payer: Healthfirst QHP |
$700.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$490.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$700.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$595.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$490.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$700.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$525.06
|
| Rate for Payer: SOMOS Essential |
$525.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$700.08
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER REPAIR SLAP LESION
|
Professional
|
Both
|
$4,563.44
|
|
|
Service Code
|
HCPCS 29807
|
| Min. Negotiated Rate |
$856.76 |
| Max. Negotiated Rate |
$2,753.86 |
| Rate for Payer: Cash Price |
$1,232.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,223.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,101.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,101.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,162.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,223.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,162.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,223.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,223.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$917.96
|
| Rate for Payer: Healthfirst Commercial |
$1,223.94
|
| Rate for Payer: Healthfirst Essential Plan |
$2,753.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,162.74
|
| Rate for Payer: Healthfirst QHP |
$1,223.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$856.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,223.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,040.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$856.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,223.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$917.96
|
| Rate for Payer: SOMOS Essential |
$917.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,223.94
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER W/LSS&RESCJ ADS
|
Professional
|
Both
|
$2,596.34
|
|
|
Service Code
|
HCPCS 29825
|
| Min. Negotiated Rate |
$490.17 |
| Max. Negotiated Rate |
$1,575.54 |
| Rate for Payer: Cash Price |
$701.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$700.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$630.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$630.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$665.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$700.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$665.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$700.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$700.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$525.18
|
| Rate for Payer: Healthfirst Commercial |
$700.24
|
| Rate for Payer: Healthfirst Essential Plan |
$1,575.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$665.23
|
| Rate for Payer: Healthfirst QHP |
$700.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$490.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$700.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$595.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$490.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$700.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$525.18
|
| Rate for Payer: SOMOS Essential |
$525.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$700.24
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER W/ROTATOR CUFF RPR
|
Professional
|
Both
|
$4,709.64
|
|
|
Service Code
|
HCPCS 29827
|
| Min. Negotiated Rate |
$883.37 |
| Max. Negotiated Rate |
$2,839.41 |
| Rate for Payer: Cash Price |
$1,270.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,261.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,135.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,135.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,198.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,261.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,198.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,261.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,261.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$946.47
|
| Rate for Payer: Healthfirst Commercial |
$1,261.96
|
| Rate for Payer: Healthfirst Essential Plan |
$2,839.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,198.86
|
| Rate for Payer: Healthfirst QHP |
$1,261.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$883.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,261.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,072.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$883.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,261.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$946.47
|
| Rate for Payer: SOMOS Essential |
$946.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,261.96
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER XTNSV DBRDMT 3+
|
Professional
|
Both
|
$2,622.59
|
|
|
Service Code
|
HCPCS 29823
|
| Min. Negotiated Rate |
$494.26 |
| Max. Negotiated Rate |
$1,588.68 |
| Rate for Payer: Cash Price |
$710.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$706.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$635.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$635.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$670.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$706.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$670.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$706.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$706.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$529.56
|
| Rate for Payer: Healthfirst Commercial |
$706.08
|
| Rate for Payer: Healthfirst Essential Plan |
$1,588.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$670.78
|
| Rate for Payer: Healthfirst QHP |
$706.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$494.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$706.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$600.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$494.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$706.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$529.56
|
| Rate for Payer: SOMOS Essential |
$529.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$706.08
|
|
|
PR SURGICAL ARTHROSCOPY SHO W/CORACOACRM LIGM RLS
|
Professional
|
Both
|
$754.39
|
|
|
Service Code
|
HCPCS 29826
|
| Min. Negotiated Rate |
$140.26 |
| Max. Negotiated Rate |
$450.83 |
| Rate for Payer: Cash Price |
$200.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$200.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$180.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$180.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$190.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$200.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$190.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$150.28
|
| Rate for Payer: Healthfirst Commercial |
$200.37
|
| Rate for Payer: Healthfirst Essential Plan |
$450.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$190.35
|
| Rate for Payer: Healthfirst QHP |
$200.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$140.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$200.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$170.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$140.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$200.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$150.28
|
| Rate for Payer: SOMOS Essential |
$150.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$200.37
|
|
|
PR SURG NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE BI
|
Professional
|
Both
|
$1,038.24
|
|
|
Service Code
|
HCPCS 69706
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$627.32 |
| Rate for Payer: Cash Price |
$280.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$278.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$250.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$250.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$264.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$278.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$264.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$278.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$209.11
|
| Rate for Payer: Healthfirst Commercial |
$278.81
|
| Rate for Payer: Healthfirst Essential Plan |
$627.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$264.87
|
| Rate for Payer: Healthfirst QHP |
$278.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$195.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$278.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$236.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$195.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$278.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$209.11
|
| Rate for Payer: SOMOS Essential |
$209.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$278.81
|
|
|
PR SURG NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE UNI
|
Professional
|
Both
|
$746.41
|
|
|
Service Code
|
HCPCS 69705
|
| Min. Negotiated Rate |
$139.75 |
| Max. Negotiated Rate |
$449.19 |
| Rate for Payer: Cash Price |
$200.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$199.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$179.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$179.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$189.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$199.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$189.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$199.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$149.73
|
| Rate for Payer: Healthfirst Commercial |
$199.64
|
| Rate for Payer: Healthfirst Essential Plan |
$449.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$189.66
|
| Rate for Payer: Healthfirst QHP |
$199.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$139.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$199.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$169.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$139.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$199.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$149.73
|
| Rate for Payer: SOMOS Essential |
$149.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$199.64
|
|
|
PR SURG PATH,LEVEL II
|
Professional
|
Both
|
$27.65
|
|
|
Service Code
|
HCPCS 88302 26
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$16.72 |
| Rate for Payer: Cash Price |
$7.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.57
|
| Rate for Payer: Healthfirst Commercial |
$7.43
|
| Rate for Payer: Healthfirst Essential Plan |
$16.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.06
|
| Rate for Payer: Healthfirst QHP |
$7.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$7.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$6.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.57
|
| Rate for Payer: SOMOS Essential |
$5.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.43
|
|
|
PR SURG PATH,LEVEL II
|
Professional
|
Both
|
$113.44
|
|
|
Service Code
|
HCPCS 88302 TC
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$70.38 |
| Rate for Payer: Cash Price |
$31.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.46
|
| Rate for Payer: Healthfirst Commercial |
$31.28
|
| Rate for Payer: Healthfirst Essential Plan |
$70.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.72
|
| Rate for Payer: Healthfirst QHP |
$31.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.46
|
| Rate for Payer: SOMOS Essential |
$23.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.28
|
|
|
PR SURG PATH,LEVEL II
|
Professional
|
Both
|
$141.05
|
|
|
Service Code
|
HCPCS 88302
|
| Min. Negotiated Rate |
$27.10 |
| Max. Negotiated Rate |
$87.10 |
| Rate for Payer: Cash Price |
$39.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.03
|
| Rate for Payer: Healthfirst Commercial |
$38.71
|
| Rate for Payer: Healthfirst Essential Plan |
$87.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.77
|
| Rate for Payer: Healthfirst QHP |
$38.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.03
|
| Rate for Payer: SOMOS Essential |
$29.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.71
|
|
|
PR SURG PATH,LEVEL III
|
Professional
|
Both
|
$136.43
|
|
|
Service Code
|
HCPCS 88304 TC
|
| Min. Negotiated Rate |
$25.97 |
| Max. Negotiated Rate |
$83.47 |
| Rate for Payer: Cash Price |
$37.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.82
|
| Rate for Payer: Healthfirst Commercial |
$37.10
|
| Rate for Payer: Healthfirst Essential Plan |
$83.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.24
|
| Rate for Payer: Healthfirst QHP |
$37.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.82
|
| Rate for Payer: SOMOS Essential |
$27.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.10
|
|
|
PR SURG PATH,LEVEL III
|
Professional
|
Both
|
$181.09
|
|
|
Service Code
|
HCPCS 88304
|
| Min. Negotiated Rate |
$34.43 |
| Max. Negotiated Rate |
$110.66 |
| Rate for Payer: Cash Price |
$50.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.88
|
| Rate for Payer: Healthfirst Commercial |
$49.18
|
| Rate for Payer: Healthfirst Essential Plan |
$110.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.72
|
| Rate for Payer: Healthfirst QHP |
$49.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.88
|
| Rate for Payer: SOMOS Essential |
$36.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.18
|
|
|
PR SURG PATH,LEVEL III
|
Professional
|
Both
|
$44.66
|
|
|
Service Code
|
HCPCS 88304 26
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$27.18 |
| Rate for Payer: Cash Price |
$12.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.06
|
| Rate for Payer: Healthfirst Commercial |
$12.08
|
| Rate for Payer: Healthfirst Essential Plan |
$27.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.48
|
| Rate for Payer: Healthfirst QHP |
$12.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.06
|
| Rate for Payer: SOMOS Essential |
$9.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.08
|
|
|
PR SURG PATH,LEVEL IV
|
Professional
|
Both
|
$150.82
|
|
|
Service Code
|
HCPCS 88305 TC
|
| Min. Negotiated Rate |
$29.23 |
| Max. Negotiated Rate |
$93.96 |
| Rate for Payer: Cash Price |
$42.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.32
|
| Rate for Payer: Healthfirst Commercial |
$41.76
|
| Rate for Payer: Healthfirst Essential Plan |
$93.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.67
|
| Rate for Payer: Healthfirst QHP |
$41.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.32
|
| Rate for Payer: SOMOS Essential |
$31.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.76
|
|
|
PR SURG PATH,LEVEL IV
|
Professional
|
Both
|
$142.66
|
|
|
Service Code
|
HCPCS 88305 26
|
| Min. Negotiated Rate |
$27.22 |
| Max. Negotiated Rate |
$87.48 |
| Rate for Payer: Cash Price |
$39.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.16
|
| Rate for Payer: Healthfirst Commercial |
$38.88
|
| Rate for Payer: Healthfirst Essential Plan |
$87.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.94
|
| Rate for Payer: Healthfirst QHP |
$38.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.16
|
| Rate for Payer: SOMOS Essential |
$29.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.88
|
|
|
PR SURG PATH,LEVEL IV
|
Professional
|
Both
|
$293.48
|
|
|
Service Code
|
HCPCS 88305
|
| Min. Negotiated Rate |
$56.45 |
| Max. Negotiated Rate |
$181.44 |
| Rate for Payer: Cash Price |
$81.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$80.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.48
|
| Rate for Payer: Healthfirst Commercial |
$80.64
|
| Rate for Payer: Healthfirst Essential Plan |
$181.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.61
|
| Rate for Payer: Healthfirst QHP |
$80.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.48
|
| Rate for Payer: SOMOS Essential |
$60.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.64
|
|
|
PR SURG PATH,LEVEL V
|
Professional
|
Both
|
$903.63
|
|
|
Service Code
|
HCPCS 88307 TC
|
| Min. Negotiated Rate |
$169.92 |
| Max. Negotiated Rate |
$546.16 |
| Rate for Payer: Cash Price |
$247.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$242.74
|
| 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 |
$230.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$242.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$230.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$242.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$242.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$182.06
|
| Rate for Payer: Healthfirst Commercial |
$242.74
|
| Rate for Payer: Healthfirst Essential Plan |
$546.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$230.60
|
| Rate for Payer: Healthfirst QHP |
$242.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$169.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$242.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$206.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$169.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$242.74
|
| 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 |
$242.74
|
|
|
PR SURG PATH,LEVEL V
|
Professional
|
Both
|
$319.34
|
|
|
Service Code
|
HCPCS 88307 26
|
| Min. Negotiated Rate |
$60.02 |
| Max. Negotiated Rate |
$192.91 |
| Rate for Payer: Cash Price |
$86.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$77.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$81.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$81.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.31
|
| Rate for Payer: Healthfirst Commercial |
$85.74
|
| Rate for Payer: Healthfirst Essential Plan |
$192.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$81.45
|
| Rate for Payer: Healthfirst QHP |
$85.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$60.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$85.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$72.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$60.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.31
|
| Rate for Payer: SOMOS Essential |
$64.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.74
|
|
|
PR SURG PATH,LEVEL V
|
Professional
|
Both
|
$1,222.97
|
|
|
Service Code
|
HCPCS 88307
|
| Min. Negotiated Rate |
$229.94 |
| Max. Negotiated Rate |
$739.08 |
| Rate for Payer: Cash Price |
$334.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$328.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$295.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$295.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$312.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$328.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$312.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$328.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$328.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$246.36
|
| Rate for Payer: Healthfirst Commercial |
$328.48
|
| Rate for Payer: Healthfirst Essential Plan |
$739.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$312.06
|
| Rate for Payer: Healthfirst QHP |
$328.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$229.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$328.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$279.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$229.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$328.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$246.36
|
| Rate for Payer: SOMOS Essential |
$246.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$328.48
|
|
|
PR SURG PATH,LEVEL VI
|
Professional
|
Both
|
$557.13
|
|
|
Service Code
|
HCPCS 88309 26
|
| Min. Negotiated Rate |
$105.66 |
| Max. Negotiated Rate |
$339.62 |
| Rate for Payer: Cash Price |
$153.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$150.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$135.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$143.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$143.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.20
|
| Rate for Payer: Healthfirst Commercial |
$150.94
|
| Rate for Payer: Healthfirst Essential Plan |
$339.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$143.39
|
| Rate for Payer: Healthfirst QHP |
$150.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$150.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$128.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$113.20
|
| Rate for Payer: SOMOS Essential |
$113.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150.94
|
|
|
PR SURG PATH,LEVEL VI
|
Professional
|
Both
|
$1,274.49
|
|
|
Service Code
|
HCPCS 88309 TC
|
| Min. Negotiated Rate |
$235.94 |
| Max. Negotiated Rate |
$758.38 |
| Rate for Payer: Cash Price |
$346.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$337.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$303.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$303.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$320.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$337.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$320.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$337.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$337.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$252.79
|
| Rate for Payer: Healthfirst Commercial |
$337.06
|
| Rate for Payer: Healthfirst Essential Plan |
$758.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$320.21
|
| Rate for Payer: Healthfirst QHP |
$337.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$235.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$337.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$286.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$235.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$337.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$252.79
|
| Rate for Payer: SOMOS Essential |
$252.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$337.06
|
|
|
PR SURG PATH,LEVEL VI
|
Professional
|
Both
|
$1,831.66
|
|
|
Service Code
|
HCPCS 88309
|
| Min. Negotiated Rate |
$341.61 |
| Max. Negotiated Rate |
$1,098.02 |
| Rate for Payer: Cash Price |
$499.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$488.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$439.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$439.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$463.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$488.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$463.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$488.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$488.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$366.01
|
| Rate for Payer: Healthfirst Commercial |
$488.01
|
| Rate for Payer: Healthfirst Essential Plan |
$1,098.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$463.61
|
| Rate for Payer: Healthfirst QHP |
$488.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$341.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$488.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$414.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$341.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$488.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$366.01
|
| Rate for Payer: SOMOS Essential |
$366.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$488.01
|
|
|
PR SURG TX ANAL FISTULA 2ND STAGE
|
Professional
|
Both
|
$1,839.22
|
|
|
Service Code
|
HCPCS 46285
|
| Min. Negotiated Rate |
$352.32 |
| Max. Negotiated Rate |
$1,132.47 |
| Rate for Payer: Cash Price |
$502.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$503.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$452.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$452.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$478.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$503.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$478.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$503.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$503.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$377.49
|
| Rate for Payer: Healthfirst Commercial |
$503.32
|
| Rate for Payer: Healthfirst Essential Plan |
$1,132.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$478.15
|
| Rate for Payer: Healthfirst QHP |
$503.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$352.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$503.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$427.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$352.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$503.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$377.49
|
| Rate for Payer: SOMOS Essential |
$377.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$503.32
|
|
