|
PR BIOPSY VERTEBRAL BODY OPEN LUMBAR/CERVICAL
|
Professional
|
Both
|
$1,915.34
|
|
|
Service Code
|
HCPCS 20251
|
| Min. Negotiated Rate |
$366.43 |
| Max. Negotiated Rate |
$1,177.81 |
| Rate for Payer: Cash Price |
$507.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$523.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$471.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$471.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$497.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$523.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$497.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$523.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$523.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$392.60
|
| Rate for Payer: Healthfirst Commercial |
$523.47
|
| Rate for Payer: Healthfirst Essential Plan |
$1,177.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$497.30
|
| Rate for Payer: Healthfirst QHP |
$523.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$366.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$523.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$444.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$366.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$523.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$392.60
|
| Rate for Payer: SOMOS Essential |
$392.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$523.47
|
|
|
PR BIOPSY VERTEBRAL BODY OPEN THORACIC
|
Professional
|
Both
|
$1,754.13
|
|
|
Service Code
|
HCPCS 20250
|
| Min. Negotiated Rate |
$332.17 |
| Max. Negotiated Rate |
$1,067.69 |
| Rate for Payer: Cash Price |
$476.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$474.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$427.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$427.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$450.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$474.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$450.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$474.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$474.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$355.90
|
| Rate for Payer: Healthfirst Commercial |
$474.53
|
| Rate for Payer: Healthfirst Essential Plan |
$1,067.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$450.80
|
| Rate for Payer: Healthfirst QHP |
$474.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$332.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$474.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$403.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$332.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$474.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$355.90
|
| Rate for Payer: SOMOS Essential |
$355.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$474.53
|
|
|
PR BIOPSY VESTIBULE MOUTH
|
Professional
|
Both
|
$377.09
|
|
|
Service Code
|
HCPCS 40808
|
| Min. Negotiated Rate |
$73.06 |
| Max. Negotiated Rate |
$234.83 |
| Rate for Payer: Cash Price |
$104.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$104.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$93.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$93.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$99.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$104.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$99.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$78.28
|
| Rate for Payer: Healthfirst Commercial |
$104.37
|
| Rate for Payer: Healthfirst Essential Plan |
$234.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$99.15
|
| Rate for Payer: Healthfirst QHP |
$104.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$73.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$104.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$88.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$73.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$104.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$78.28
|
| Rate for Payer: SOMOS Essential |
$78.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$104.37
|
|
|
PR BIOPSY VULVA/PERINEUM 1 LESION SPX
|
Professional
|
Both
|
$257.46
|
|
|
Service Code
|
HCPCS 56605
|
| Min. Negotiated Rate |
$47.47 |
| Max. Negotiated Rate |
$152.57 |
| Rate for Payer: Cash Price |
$68.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$67.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$67.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.86
|
| Rate for Payer: Healthfirst Commercial |
$67.81
|
| Rate for Payer: Healthfirst Essential Plan |
$152.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$64.42
|
| Rate for Payer: Healthfirst QHP |
$67.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$67.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$57.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$67.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$50.86
|
| Rate for Payer: SOMOS Essential |
$50.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$67.81
|
|
|
PR BIOPSY VULVA/PERINEUM EACH ADDL LESION
|
Professional
|
Both
|
$129.33
|
|
|
Service Code
|
HCPCS 56606
|
| Min. Negotiated Rate |
$22.97 |
| Max. Negotiated Rate |
$73.84 |
| Rate for Payer: Cash Price |
$33.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.61
|
| Rate for Payer: Healthfirst Commercial |
$32.82
|
| Rate for Payer: Healthfirst Essential Plan |
$73.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.18
|
| Rate for Payer: Healthfirst QHP |
$32.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.61
|
| Rate for Payer: SOMOS Essential |
$24.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.82
|
|
|
PR BIS EXTRACELLULAR FLUID ALYS LYMPHEDEMA ASSMNT
|
Professional
|
Both
|
$554.61
|
|
|
Service Code
|
HCPCS 93702
|
| Min. Negotiated Rate |
$96.78 |
| Max. Negotiated Rate |
$311.08 |
| Rate for Payer: Cash Price |
$144.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$138.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$124.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$124.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$138.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$138.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$138.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.69
|
| Rate for Payer: Healthfirst Commercial |
$138.26
|
| Rate for Payer: Healthfirst Essential Plan |
$311.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$131.35
|
| Rate for Payer: Healthfirst QHP |
$138.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$96.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$138.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$117.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$96.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$138.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$103.69
|
| Rate for Payer: SOMOS Essential |
$103.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$138.26
|
|
|
PR BKBENCH RCNSTJ ALGRFT URETERAL ANAST EA
|
Professional
|
Both
|
$804.41
|
|
|
Service Code
|
HCPCS 50329
|
| Min. Negotiated Rate |
$148.57 |
| Max. Negotiated Rate |
$477.56 |
| Rate for Payer: Cash Price |
$213.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$212.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$191.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$191.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$201.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$212.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$201.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$212.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$159.19
|
| Rate for Payer: Healthfirst Commercial |
$212.25
|
| Rate for Payer: Healthfirst Essential Plan |
$477.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$201.64
|
| Rate for Payer: Healthfirst QHP |
$212.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$148.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$212.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$180.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$148.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$212.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$159.19
|
| Rate for Payer: SOMOS Essential |
$159.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$212.25
|
|
|
PR BKBENCH RCNSTJ CDVR PNCRS ALGRFT VEN ANAST EA
|
Professional
|
Both
|
$1,062.64
|
|
|
Service Code
|
HCPCS 48552
|
| Min. Negotiated Rate |
$195.03 |
| Max. Negotiated Rate |
$626.89 |
| Rate for Payer: Cash Price |
$281.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$278.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$250.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$250.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$264.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$278.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$264.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$278.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$208.97
|
| Rate for Payer: Healthfirst Commercial |
$278.62
|
| Rate for Payer: Healthfirst Essential Plan |
$626.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$264.69
|
| Rate for Payer: Healthfirst QHP |
$278.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$195.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$278.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$236.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$195.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$278.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$208.97
|
| Rate for Payer: SOMOS Essential |
$208.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$278.62
|
|
|
PR BKBENCH RCNSTJ INT ALGRFT ARTL ANAST EA
|
Professional
|
Both
|
$1,725.15
|
|
|
Service Code
|
HCPCS 44721
|
| Min. Negotiated Rate |
$317.72 |
| Max. Negotiated Rate |
$1,021.23 |
| Rate for Payer: Cash Price |
$456.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$453.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$408.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$408.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$431.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$453.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$431.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$453.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$453.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$340.41
|
| Rate for Payer: Healthfirst Commercial |
$453.88
|
| Rate for Payer: Healthfirst Essential Plan |
$1,021.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$431.19
|
| Rate for Payer: Healthfirst QHP |
$453.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$317.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$453.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$385.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$317.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$453.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$340.41
|
| Rate for Payer: SOMOS Essential |
$340.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$453.88
|
|
|
PR BKBENCH RCNSTJ INT ALGRFT VEN ANAST EA
|
Professional
|
Both
|
$1,236.94
|
|
|
Service Code
|
HCPCS 44720
|
| Min. Negotiated Rate |
$226.76 |
| Max. Negotiated Rate |
$728.89 |
| Rate for Payer: Cash Price |
$326.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$323.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$291.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$291.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$307.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$323.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$307.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$323.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$323.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$242.96
|
| Rate for Payer: Healthfirst Commercial |
$323.95
|
| Rate for Payer: Healthfirst Essential Plan |
$728.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$307.75
|
| Rate for Payer: Healthfirst QHP |
$323.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$226.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$323.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$275.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$226.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$323.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$242.96
|
| Rate for Payer: SOMOS Essential |
$242.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$323.95
|
|
|
PR BKBENCH RCNSTJ LVR GRF ARTL ANAST EA
|
Professional
|
Both
|
$1,716.93
|
|
|
Service Code
|
HCPCS 47147
|
| Min. Negotiated Rate |
$317.01 |
| Max. Negotiated Rate |
$1,018.96 |
| Rate for Payer: Cash Price |
$455.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$452.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$407.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$407.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$430.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$452.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$430.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$452.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$452.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$339.65
|
| Rate for Payer: Healthfirst Commercial |
$452.87
|
| Rate for Payer: Healthfirst Essential Plan |
$1,018.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$430.23
|
| Rate for Payer: Healthfirst QHP |
$452.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$317.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$452.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$384.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$317.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$452.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$339.65
|
| Rate for Payer: SOMOS Essential |
$339.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$452.87
|
|
|
PR BKBENCH RCNSTJ LVR GRF VENOUS ANAST EA
|
Professional
|
Both
|
$1,475.57
|
|
|
Service Code
|
HCPCS 47146
|
| Min. Negotiated Rate |
$270.73 |
| Max. Negotiated Rate |
$870.19 |
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$386.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$348.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$348.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$367.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$386.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$367.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$386.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$386.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$290.06
|
| Rate for Payer: Healthfirst Commercial |
$386.75
|
| Rate for Payer: Healthfirst Essential Plan |
$870.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$367.41
|
| Rate for Payer: Healthfirst QHP |
$386.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$270.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$386.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$328.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$270.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$386.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$290.06
|
| Rate for Payer: SOMOS Essential |
$290.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$386.75
|
|
|
PR BKBENCH RCNSTJ RENAL ALGRFT VENOUS ANAST EA
|
Professional
|
Both
|
$970.80
|
|
|
Service Code
|
HCPCS 50327
|
| Min. Negotiated Rate |
$177.78 |
| Max. Negotiated Rate |
$571.43 |
| Rate for Payer: Cash Price |
$257.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$253.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$228.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$228.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$241.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$253.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$241.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$253.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$253.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$190.48
|
| Rate for Payer: Healthfirst Commercial |
$253.97
|
| Rate for Payer: Healthfirst Essential Plan |
$571.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$241.27
|
| Rate for Payer: Healthfirst QHP |
$253.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$177.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$253.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$215.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$177.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$253.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$190.48
|
| Rate for Payer: SOMOS Essential |
$190.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$253.97
|
|
|
PR BKBENCH RCNSTJ RENAL ALLOGRAFT ARTERIAL ANAST EA
|
Professional
|
Both
|
$846.72
|
|
|
Service Code
|
HCPCS 50328
|
| Min. Negotiated Rate |
$156.34 |
| Max. Negotiated Rate |
$502.51 |
| Rate for Payer: Cash Price |
$225.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$223.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$201.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$201.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$212.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$223.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$212.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$223.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$223.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$167.50
|
| Rate for Payer: Healthfirst Commercial |
$223.34
|
| Rate for Payer: Healthfirst Essential Plan |
$502.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$212.17
|
| Rate for Payer: Healthfirst QHP |
$223.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$156.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$223.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$189.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$156.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$223.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$167.50
|
| Rate for Payer: SOMOS Essential |
$167.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$223.34
|
|
|
PR BLADDER INSTILLATION ANTICARCINOGENIC AGENT
|
Professional
|
Both
|
$183.61
|
|
|
Service Code
|
HCPCS 51720
|
| Min. Negotiated Rate |
$34.87 |
| Max. Negotiated Rate |
$112.07 |
| Rate for Payer: Cash Price |
$49.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$47.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.36
|
| Rate for Payer: Healthfirst Commercial |
$49.81
|
| Rate for Payer: Healthfirst Essential Plan |
$112.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.32
|
| Rate for Payer: Healthfirst QHP |
$49.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$42.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$37.36
|
| Rate for Payer: SOMOS Essential |
$37.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.81
|
|
|
PR BLADDER PRESSURE MEASUREMENT DURING FILLING
|
Professional
|
Both
|
$1,292.52
|
|
|
Service Code
|
HCPCS 51726
|
| Min. Negotiated Rate |
$223.73 |
| Max. Negotiated Rate |
$719.14 |
| Rate for Payer: Cash Price |
$350.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$319.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$287.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$287.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$303.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$319.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$303.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$319.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$319.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$239.72
|
| Rate for Payer: Healthfirst Commercial |
$319.62
|
| Rate for Payer: Healthfirst Essential Plan |
$719.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$303.64
|
| Rate for Payer: Healthfirst QHP |
$319.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$223.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$319.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$271.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$223.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$319.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$239.72
|
| Rate for Payer: SOMOS Essential |
$239.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$319.62
|
|
|
PR BLADDER PRESSURE MEASUREMENT DURING FILLING
|
Professional
|
Both
|
$944.16
|
|
|
Service Code
|
HCPCS 51726 TC
|
| Min. Negotiated Rate |
$158.46 |
| Max. Negotiated Rate |
$509.33 |
| Rate for Payer: Cash Price |
$257.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$226.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$203.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$203.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$215.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$226.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$215.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$226.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$226.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$169.78
|
| Rate for Payer: Healthfirst Commercial |
$226.37
|
| Rate for Payer: Healthfirst Essential Plan |
$509.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$215.05
|
| Rate for Payer: Healthfirst QHP |
$226.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$158.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$226.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$192.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$158.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$226.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$169.78
|
| Rate for Payer: SOMOS Essential |
$169.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$226.37
|
|
|
PR BLADDER PRESSURE MEASUREMENT DURING FILLING
|
Professional
|
Both
|
$348.39
|
|
|
Service Code
|
HCPCS 51726 26
|
| Min. Negotiated Rate |
$65.28 |
| Max. Negotiated Rate |
$209.81 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$93.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$88.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$93.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$88.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.94
|
| Rate for Payer: Healthfirst Commercial |
$93.25
|
| Rate for Payer: Healthfirst Essential Plan |
$209.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$88.59
|
| Rate for Payer: Healthfirst QHP |
$93.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$65.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$93.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$79.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$65.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$93.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.94
|
| Rate for Payer: SOMOS Essential |
$69.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$93.25
|
|
|
PR BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ ALGNC
|
Professional
|
Both
|
$341.74
|
|
|
Service Code
|
HCPCS 38205
|
| Min. Negotiated Rate |
$64.41 |
| Max. Negotiated Rate |
$207.02 |
| Rate for Payer: Cash Price |
$93.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.01
|
| Rate for Payer: Healthfirst Commercial |
$92.01
|
| Rate for Payer: Healthfirst Essential Plan |
$207.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.41
|
| Rate for Payer: Healthfirst QHP |
$92.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.01
|
| Rate for Payer: SOMOS Essential |
$69.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.01
|
|
|
PR BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ AUTOL
|
Professional
|
Both
|
$338.87
|
|
|
Service Code
|
HCPCS 38206
|
| Min. Negotiated Rate |
$63.32 |
| Max. Negotiated Rate |
$203.53 |
| Rate for Payer: Cash Price |
$91.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$90.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$90.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.84
|
| Rate for Payer: Healthfirst Commercial |
$90.46
|
| Rate for Payer: Healthfirst Essential Plan |
$203.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.94
|
| Rate for Payer: Healthfirst QHP |
$90.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$90.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$76.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.84
|
| Rate for Payer: SOMOS Essential |
$67.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.46
|
|
|
PR BLDR IRRIGATION SMPL LAVAGE &/INSTLJ
|
Professional
|
Both
|
$127.23
|
|
|
Service Code
|
HCPCS 51700
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$75.47 |
| Rate for Payer: Cash Price |
$34.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.16
|
| Rate for Payer: Healthfirst Commercial |
$33.54
|
| Rate for Payer: Healthfirst Essential Plan |
$75.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.86
|
| Rate for Payer: Healthfirst QHP |
$33.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.16
|
| Rate for Payer: SOMOS Essential |
$25.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.54
|
|
|
PR BLEPHAROPLASTY LOWER EYELID
|
Professional
|
Both
|
$2,142.95
|
|
|
Service Code
|
HCPCS 15820
|
| Min. Negotiated Rate |
$408.41 |
| Max. Negotiated Rate |
$1,312.74 |
| Rate for Payer: Cash Price |
$591.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$583.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$525.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$525.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$554.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$583.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$554.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$583.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$583.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$437.58
|
| Rate for Payer: Healthfirst Commercial |
$583.44
|
| Rate for Payer: Healthfirst Essential Plan |
$1,312.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$554.27
|
| Rate for Payer: Healthfirst QHP |
$583.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$408.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$583.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$495.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$408.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$583.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$437.58
|
| Rate for Payer: SOMOS Essential |
$437.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$583.44
|
|
|
PR BLEPHAROPLASTY LOWER EYELID HERNIATED FAT PAD
|
Professional
|
Both
|
$2,308.04
|
|
|
Service Code
|
HCPCS 15821
|
| Min. Negotiated Rate |
$437.01 |
| Max. Negotiated Rate |
$1,404.67 |
| Rate for Payer: Cash Price |
$633.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$624.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$561.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$561.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$593.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$624.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$593.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$624.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$624.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$468.23
|
| Rate for Payer: Healthfirst Commercial |
$624.30
|
| Rate for Payer: Healthfirst Essential Plan |
$1,404.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$593.09
|
| Rate for Payer: Healthfirst QHP |
$624.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$437.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$624.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$530.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$437.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$624.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$468.23
|
| Rate for Payer: SOMOS Essential |
$468.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$624.30
|
|
|
PR BLEPHAROPLASTY UPPER EYELID
|
Professional
|
Both
|
$1,689.94
|
|
|
Service Code
|
HCPCS 15822
|
| Min. Negotiated Rate |
$318.78 |
| Max. Negotiated Rate |
$1,024.65 |
| Rate for Payer: Cash Price |
$462.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$455.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$409.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$409.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$432.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$455.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$432.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$455.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$455.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$341.55
|
| Rate for Payer: Healthfirst Commercial |
$455.40
|
| Rate for Payer: Healthfirst Essential Plan |
$1,024.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$432.63
|
| Rate for Payer: Healthfirst QHP |
$455.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$318.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$455.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$387.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$318.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$455.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$341.55
|
| Rate for Payer: SOMOS Essential |
$341.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$455.40
|
|
|
PR BLEPHAROPLASTY UPPER EYELID W/EXCESSIVE SKIN
|
Professional
|
Both
|
$2,301.08
|
|
|
Service Code
|
HCPCS 15823
|
| Min. Negotiated Rate |
$436.62 |
| Max. Negotiated Rate |
$1,403.44 |
| Rate for Payer: Cash Price |
$632.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$623.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$561.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$561.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$592.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$623.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$592.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$623.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$623.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$467.81
|
| Rate for Payer: Healthfirst Commercial |
$623.75
|
| Rate for Payer: Healthfirst Essential Plan |
$1,403.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$592.56
|
| Rate for Payer: Healthfirst QHP |
$623.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$436.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$623.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$530.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$436.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$623.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$467.81
|
| Rate for Payer: SOMOS Essential |
$467.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$623.75
|
|
