|
PR BIOPSY EXTRAOCULAR MUSCLE
|
Professional
|
Both
|
$783.34
|
|
|
Service Code
|
HCPCS 67346
|
| Min. Negotiated Rate |
$150.73 |
| Max. Negotiated Rate |
$484.49 |
| Rate for Payer: Cash Price |
$216.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$215.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$193.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$193.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$204.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$215.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$204.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$215.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$215.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$161.50
|
| Rate for Payer: Healthfirst Commercial |
$215.33
|
| Rate for Payer: Healthfirst Essential Plan |
$484.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$204.56
|
| Rate for Payer: Healthfirst QHP |
$215.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$150.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$215.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$183.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$150.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$215.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$161.50
|
| Rate for Payer: SOMOS Essential |
$161.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$215.33
|
|
|
PR BIOPSY FLOOR MOUTH
|
Professional
|
Both
|
$397.04
|
|
|
Service Code
|
HCPCS 41108
|
| Min. Negotiated Rate |
$75.02 |
| Max. Negotiated Rate |
$241.13 |
| Rate for Payer: Cash Price |
$107.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$107.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$101.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$101.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.38
|
| Rate for Payer: Healthfirst Commercial |
$107.17
|
| Rate for Payer: Healthfirst Essential Plan |
$241.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$101.81
|
| Rate for Payer: Healthfirst QHP |
$107.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$107.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$91.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$80.38
|
| Rate for Payer: SOMOS Essential |
$80.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.17
|
|
|
PR BIOPSY INTRANASAL
|
Professional
|
Both
|
$288.58
|
|
|
Service Code
|
HCPCS 30100
|
| Min. Negotiated Rate |
$55.73 |
| Max. Negotiated Rate |
$179.15 |
| Rate for Payer: Cash Price |
$79.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$79.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.72
|
| Rate for Payer: Healthfirst Commercial |
$79.62
|
| Rate for Payer: Healthfirst Essential Plan |
$179.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$75.64
|
| Rate for Payer: Healthfirst QHP |
$79.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$79.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$67.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$59.72
|
| Rate for Payer: SOMOS Essential |
$59.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.62
|
|
|
PR BIOPSY LACRIMAL GLAND
|
Professional
|
Both
|
$1,169.28
|
|
|
Service Code
|
HCPCS 68510
|
| Min. Negotiated Rate |
$222.96 |
| Max. Negotiated Rate |
$716.65 |
| Rate for Payer: Cash Price |
$321.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$318.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$286.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$286.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$302.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$318.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$302.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$318.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$318.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$238.88
|
| Rate for Payer: Healthfirst Commercial |
$318.51
|
| Rate for Payer: Healthfirst Essential Plan |
$716.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$302.58
|
| Rate for Payer: Healthfirst QHP |
$318.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$222.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$318.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$270.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$222.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$318.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$238.88
|
| Rate for Payer: SOMOS Essential |
$238.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$318.51
|
|
|
PR BIOPSY LACRIMAL SAC
|
Professional
|
Both
|
$1,053.01
|
|
|
Service Code
|
HCPCS 68525
|
| Min. Negotiated Rate |
$199.65 |
| Max. Negotiated Rate |
$641.72 |
| Rate for Payer: Cash Price |
$288.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$285.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$256.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$256.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$270.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$285.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$270.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$285.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$285.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$213.91
|
| Rate for Payer: Healthfirst Commercial |
$285.21
|
| Rate for Payer: Healthfirst Essential Plan |
$641.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$270.95
|
| Rate for Payer: Healthfirst QHP |
$285.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$199.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$285.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$242.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$199.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$285.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$213.91
|
| Rate for Payer: SOMOS Essential |
$213.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$285.21
|
|
|
PR BIOPSY LIVER NEEDLE PERCUTANEOUS
|
Professional
|
Both
|
$363.86
|
|
|
Service Code
|
HCPCS 47000
|
| Min. Negotiated Rate |
$67.91 |
| Max. Negotiated Rate |
$218.27 |
| Rate for Payer: Cash Price |
$98.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$97.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$87.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$92.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$97.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$92.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.76
|
| Rate for Payer: Healthfirst Commercial |
$97.01
|
| Rate for Payer: Healthfirst Essential Plan |
$218.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$92.16
|
| Rate for Payer: Healthfirst QHP |
$97.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$67.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$97.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$82.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$67.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$97.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.76
|
| Rate for Payer: SOMOS Essential |
$72.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$97.01
|
|
|
PR BIOPSY LIVER WEDGE
|
Professional
|
Both
|
$3,817.73
|
|
|
Service Code
|
HCPCS 47100
|
| Min. Negotiated Rate |
$709.27 |
| Max. Negotiated Rate |
$2,279.81 |
| Rate for Payer: Cash Price |
$1,022.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,013.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$911.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$911.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$962.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,013.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$962.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,013.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,013.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$759.94
|
| Rate for Payer: Healthfirst Commercial |
$1,013.25
|
| Rate for Payer: Healthfirst Essential Plan |
$2,279.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$962.59
|
| Rate for Payer: Healthfirst QHP |
$1,013.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$709.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,013.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$861.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$709.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,013.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$759.94
|
| Rate for Payer: SOMOS Essential |
$759.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,013.25
|
|
|
PR BIOPSY MUSCLE DEEP
|
Professional
|
Both
|
$703.61
|
|
|
Service Code
|
HCPCS 20205
|
| Min. Negotiated Rate |
$130.28 |
| Max. Negotiated Rate |
$418.75 |
| Rate for Payer: Cash Price |
$188.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$186.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$167.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$176.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$186.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$176.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$186.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$186.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.58
|
| Rate for Payer: Healthfirst Commercial |
$186.11
|
| Rate for Payer: Healthfirst Essential Plan |
$418.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$176.80
|
| Rate for Payer: Healthfirst QHP |
$186.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$130.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$186.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$158.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$130.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$186.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$139.58
|
| Rate for Payer: SOMOS Essential |
$139.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$186.11
|
|
|
PR BIOPSY MUSCLE PERCUTANEOUS NEEDLE
|
Professional
|
Both
|
$237.62
|
|
|
Service Code
|
HCPCS 20206
|
| Min. Negotiated Rate |
$45.05 |
| Max. Negotiated Rate |
$144.79 |
| Rate for Payer: Cash Price |
$64.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$64.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$57.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$61.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.26
|
| Rate for Payer: Healthfirst Commercial |
$64.35
|
| Rate for Payer: Healthfirst Essential Plan |
$144.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.13
|
| Rate for Payer: Healthfirst QHP |
$64.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$64.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$54.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.26
|
| Rate for Payer: SOMOS Essential |
$48.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.35
|
|
|
PR BIOPSY MUSCLE SUPERFICIAL
|
Professional
|
Both
|
$427.84
|
|
|
Service Code
|
HCPCS 20200
|
| Min. Negotiated Rate |
$80.45 |
| Max. Negotiated Rate |
$258.59 |
| Rate for Payer: Cash Price |
$114.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$114.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$103.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$103.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$109.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$114.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$109.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$114.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$86.20
|
| Rate for Payer: Healthfirst Commercial |
$114.93
|
| Rate for Payer: Healthfirst Essential Plan |
$258.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$109.18
|
| Rate for Payer: Healthfirst QHP |
$114.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$80.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$114.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$97.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$80.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$114.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$86.20
|
| Rate for Payer: SOMOS Essential |
$86.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$114.93
|
|
|
PR BIOPSY NAIL UNIT SEPARATE PROCEDURE
|
Professional
|
Both
|
$247.17
|
|
|
Service Code
|
HCPCS 11755
|
| Min. Negotiated Rate |
$46.97 |
| Max. Negotiated Rate |
$150.97 |
| Rate for Payer: Cash Price |
$67.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$67.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$63.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$67.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$63.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.33
|
| Rate for Payer: Healthfirst Commercial |
$67.10
|
| Rate for Payer: Healthfirst Essential Plan |
$150.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$63.74
|
| Rate for Payer: Healthfirst QHP |
$67.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$67.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$57.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$67.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$50.33
|
| Rate for Payer: SOMOS Essential |
$50.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$67.10
|
|
|
PR BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE
|
Professional
|
Both
|
$532.67
|
|
|
Service Code
|
HCPCS 42804
|
| Min. Negotiated Rate |
$100.30 |
| Max. Negotiated Rate |
$322.40 |
| Rate for Payer: Cash Price |
$145.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$143.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$128.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$128.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$136.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$143.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$136.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$143.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$143.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$107.47
|
| Rate for Payer: Healthfirst Commercial |
$143.29
|
| Rate for Payer: Healthfirst Essential Plan |
$322.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$136.13
|
| Rate for Payer: Healthfirst QHP |
$143.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$100.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$143.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$121.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$100.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$143.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$107.47
|
| Rate for Payer: SOMOS Essential |
$107.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$143.29
|
|
|
PR BIOPSY NERVE
|
Professional
|
Both
|
$879.10
|
|
|
Service Code
|
HCPCS 64795
|
| Min. Negotiated Rate |
$167.29 |
| Max. Negotiated Rate |
$537.71 |
| Rate for Payer: Cash Price |
$237.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$238.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$215.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$215.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$227.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$238.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$227.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$238.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$238.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$179.24
|
| Rate for Payer: Healthfirst Commercial |
$238.98
|
| Rate for Payer: Healthfirst Essential Plan |
$537.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$227.03
|
| Rate for Payer: Healthfirst QHP |
$238.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$167.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$238.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$203.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$167.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$238.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$179.24
|
| Rate for Payer: SOMOS Essential |
$179.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$238.98
|
|
|
PR BIOPSY OF LIP
|
Professional
|
Both
|
$287.70
|
|
|
Service Code
|
HCPCS 40490
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Cash Price |
$78.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$78.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$70.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$70.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$74.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$78.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$74.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$78.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.80
|
| Rate for Payer: Healthfirst Commercial |
$78.40
|
| Rate for Payer: Healthfirst Essential Plan |
$176.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$74.48
|
| Rate for Payer: Healthfirst QHP |
$78.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$54.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$78.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$66.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$54.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$78.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$58.80
|
| Rate for Payer: SOMOS Essential |
$58.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$78.40
|
|
|
PR BIOPSY OROPHARYNX
|
Professional
|
Both
|
$502.46
|
|
|
Service Code
|
HCPCS 42800
|
| Min. Negotiated Rate |
$96.25 |
| Max. Negotiated Rate |
$309.38 |
| Rate for Payer: Cash Price |
$138.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$137.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$123.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$130.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$137.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$130.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.12
|
| Rate for Payer: Healthfirst Commercial |
$137.50
|
| Rate for Payer: Healthfirst Essential Plan |
$309.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.62
|
| Rate for Payer: Healthfirst QHP |
$137.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$96.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$137.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$116.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$96.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$137.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$103.12
|
| Rate for Payer: SOMOS Essential |
$103.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.50
|
|
|
PR BIOPSY OVARY UNI/BI SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,916.99
|
|
|
Service Code
|
HCPCS 58900
|
| Min. Negotiated Rate |
$355.84 |
| Max. Negotiated Rate |
$1,143.77 |
| Rate for Payer: Cash Price |
$517.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$508.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$457.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$457.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$482.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$508.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$482.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$508.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$508.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$381.25
|
| Rate for Payer: Healthfirst Commercial |
$508.34
|
| Rate for Payer: Healthfirst Essential Plan |
$1,143.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$482.92
|
| Rate for Payer: Healthfirst QHP |
$508.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$355.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$508.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$432.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$355.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$508.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$381.25
|
| Rate for Payer: SOMOS Essential |
$381.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$508.34
|
|
|
PR BIOPSY PALATE UVULA
|
Professional
|
Both
|
$472.57
|
|
|
Service Code
|
HCPCS 42100
|
| Min. Negotiated Rate |
$89.44 |
| Max. Negotiated Rate |
$287.48 |
| Rate for Payer: Cash Price |
$129.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$114.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$114.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$121.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$121.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.83
|
| Rate for Payer: Healthfirst Commercial |
$127.77
|
| Rate for Payer: Healthfirst Essential Plan |
$287.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$121.38
|
| Rate for Payer: Healthfirst QHP |
$127.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$89.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$127.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$108.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$89.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$95.83
|
| Rate for Payer: SOMOS Essential |
$95.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.77
|
|
|
PR BIOPSY PANCREA PERCUTANEOUS NEEDLE
|
Professional
|
Both
|
$967.54
|
|
|
Service Code
|
HCPCS 48102
|
| Min. Negotiated Rate |
$182.90 |
| Max. Negotiated Rate |
$587.90 |
| Rate for Payer: Cash Price |
$261.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$261.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$235.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$235.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$248.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$261.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$248.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$261.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$261.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$195.97
|
| Rate for Payer: Healthfirst Commercial |
$261.29
|
| Rate for Payer: Healthfirst Essential Plan |
$587.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$248.23
|
| Rate for Payer: Healthfirst QHP |
$261.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$182.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$261.29
|
| 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) |
$182.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$261.29
|
| 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 |
$261.29
|
|
|
PR BIOPSY PANCREAS OPEN
|
Professional
|
Both
|
$3,994.34
|
|
|
Service Code
|
HCPCS 48100
|
| Min. Negotiated Rate |
$741.42 |
| Max. Negotiated Rate |
$2,383.13 |
| Rate for Payer: Cash Price |
$1,073.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,059.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$953.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$953.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,006.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,059.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,006.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,059.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,059.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$794.38
|
| Rate for Payer: Healthfirst Commercial |
$1,059.17
|
| Rate for Payer: Healthfirst Essential Plan |
$2,383.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,006.21
|
| Rate for Payer: Healthfirst QHP |
$1,059.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$741.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,059.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$900.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$741.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,059.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$794.38
|
| Rate for Payer: SOMOS Essential |
$794.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,059.17
|
|
|
PR BIOPSY PENIS DEEP STRUCTURES
|
Professional
|
Both
|
$893.24
|
|
|
Service Code
|
HCPCS 54105
|
| Min. Negotiated Rate |
$170.97 |
| Max. Negotiated Rate |
$549.56 |
| Rate for Payer: Cash Price |
$245.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$244.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$219.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$219.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$232.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$244.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$232.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$244.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$244.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$183.19
|
| Rate for Payer: Healthfirst Commercial |
$244.25
|
| Rate for Payer: Healthfirst Essential Plan |
$549.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$232.04
|
| Rate for Payer: Healthfirst QHP |
$244.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$170.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$244.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$207.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$170.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$244.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$183.19
|
| Rate for Payer: SOMOS Essential |
$183.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$244.25
|
|
|
PR BIOPSY PENIS SEPARATE PROCEDURE
|
Professional
|
Both
|
$505.44
|
|
|
Service Code
|
HCPCS 54100
|
| Min. Negotiated Rate |
$97.29 |
| Max. Negotiated Rate |
$312.73 |
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$138.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$125.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$132.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$138.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$132.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$138.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$138.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$104.24
|
| Rate for Payer: Healthfirst Commercial |
$138.99
|
| Rate for Payer: Healthfirst Essential Plan |
$312.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$132.04
|
| Rate for Payer: Healthfirst QHP |
$138.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$97.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$138.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$118.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$97.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$138.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$104.24
|
| Rate for Payer: SOMOS Essential |
$104.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$138.99
|
|
|
PR BIOPSY PLEURA PERCUTANEOUS NEEDLE
|
Professional
|
Both
|
$347.31
|
|
|
Service Code
|
HCPCS 32400
|
| Min. Negotiated Rate |
$64.47 |
| Max. Negotiated Rate |
$207.22 |
| Rate for Payer: Cash Price |
$93.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.08
|
| Rate for Payer: Healthfirst Commercial |
$92.10
|
| Rate for Payer: Healthfirst Essential Plan |
$207.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.50
|
| Rate for Payer: Healthfirst QHP |
$92.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.08
|
| Rate for Payer: SOMOS Essential |
$69.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.10
|
|
|
PR BIOPSY PROSTATE INCISIONAL ANY APPROACH
|
Professional
|
Both
|
$1,111.71
|
|
|
Service Code
|
HCPCS 55705
|
| Min. Negotiated Rate |
$211.75 |
| Max. Negotiated Rate |
$680.62 |
| Rate for Payer: Cash Price |
$303.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$302.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$272.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$272.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$287.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$302.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$287.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$302.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$302.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$226.88
|
| Rate for Payer: Healthfirst Commercial |
$302.50
|
| Rate for Payer: Healthfirst Essential Plan |
$680.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$287.38
|
| Rate for Payer: Healthfirst QHP |
$302.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$211.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$302.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$257.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$211.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$302.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$226.88
|
| Rate for Payer: SOMOS Essential |
$226.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$302.50
|
|
|
PR BIOPSY SALIVARY GLAND INCISIONAL
|
Professional
|
Both
|
$976.89
|
|
|
Service Code
|
HCPCS 42405
|
| Min. Negotiated Rate |
$184.89 |
| Max. Negotiated Rate |
$594.29 |
| Rate for Payer: Cash Price |
$265.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$264.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$237.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$237.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$250.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$264.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$250.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$264.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$198.10
|
| Rate for Payer: Healthfirst Commercial |
$264.13
|
| Rate for Payer: Healthfirst Essential Plan |
$594.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$250.92
|
| Rate for Payer: Healthfirst QHP |
$264.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$184.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$264.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$224.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$184.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$264.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$198.10
|
| Rate for Payer: SOMOS Essential |
$198.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$264.13
|
|
|
PR BIOPSY SALIVARY GLAND NEEDLE
|
Professional
|
Both
|
$221.66
|
|
|
Service Code
|
HCPCS 42400
|
| Min. Negotiated Rate |
$41.94 |
| Max. Negotiated Rate |
$134.82 |
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$59.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.94
|
| Rate for Payer: Healthfirst Commercial |
$59.92
|
| Rate for Payer: Healthfirst Essential Plan |
$134.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.92
|
| Rate for Payer: Healthfirst QHP |
$59.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.94
|
| Rate for Payer: SOMOS Essential |
$44.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.92
|
|
