|
PR BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT
|
Professional
|
Both
|
$254.42
|
|
|
Service Code
|
HCPCS 94070
|
| Min. Negotiated Rate |
$47.16 |
| Max. Negotiated Rate |
$162.11 |
| Rate for Payer: Amida Care Medicaid |
$47.16
|
| Rate for Payer: Cash Price |
$72.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$64.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$68.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$68.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.04
|
| Rate for Payer: Healthfirst Commercial |
$72.05
|
| Rate for Payer: Healthfirst Essential Plan |
$162.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.45
|
| Rate for Payer: Healthfirst QHP |
$72.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$50.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$72.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$61.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.04
|
| Rate for Payer: SOMOS Essential |
$54.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.05
|
|
|
PR BRNSCHSC TNDSC EBUS DX/TX INTERVENTION PERPH LES
|
Professional
|
Both
|
$268.56
|
|
|
Service Code
|
HCPCS 31654
|
| Min. Negotiated Rate |
$51.07 |
| Max. Negotiated Rate |
$164.16 |
| Rate for Payer: Cash Price |
$73.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$65.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$69.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.72
|
| Rate for Payer: Healthfirst Commercial |
$72.96
|
| Rate for Payer: Healthfirst Essential Plan |
$164.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.31
|
| Rate for Payer: Healthfirst QHP |
$72.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$72.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.72
|
| Rate for Payer: SOMOS Essential |
$54.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.96
|
|
|
PR BRONCHOPLASTY EXCISION STENOSIS & ANASTOMOSIS
|
Professional
|
Both
|
$6,230.60
|
|
|
Service Code
|
HCPCS 31775
|
| Min. Negotiated Rate |
$1,148.37 |
| Max. Negotiated Rate |
$3,691.19 |
| Rate for Payer: Cash Price |
$1,657.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,640.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,476.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,476.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,558.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,640.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,558.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,640.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,640.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,230.40
|
| Rate for Payer: Healthfirst Commercial |
$1,640.53
|
| Rate for Payer: Healthfirst Essential Plan |
$3,691.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,558.50
|
| Rate for Payer: Healthfirst QHP |
$1,640.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,148.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,640.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,394.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,148.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,640.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,230.40
|
| Rate for Payer: SOMOS Essential |
$1,230.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,640.53
|
|
|
PR BRONCHOPLASTY GRAFT REPAIR
|
Professional
|
Both
|
$5,918.57
|
|
|
Service Code
|
HCPCS 31770
|
| Min. Negotiated Rate |
$1,090.33 |
| Max. Negotiated Rate |
$3,504.64 |
| Rate for Payer: Cash Price |
$1,573.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,557.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,401.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,401.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,479.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,557.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,479.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,557.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,557.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,168.21
|
| Rate for Payer: Healthfirst Commercial |
$1,557.62
|
| Rate for Payer: Healthfirst Essential Plan |
$3,504.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,479.74
|
| Rate for Payer: Healthfirst QHP |
$1,557.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,090.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,557.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,323.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,090.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,557.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,168.21
|
| Rate for Payer: SOMOS Essential |
$1,168.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,557.62
|
|
|
PR BRONCHOSCOPIC THERMOPLASTY 2/> LOBES
|
Professional
|
Both
|
$805.04
|
|
|
Service Code
|
HCPCS 31661
|
| Min. Negotiated Rate |
$151.70 |
| Max. Negotiated Rate |
$487.62 |
| Rate for Payer: Cash Price |
$219.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$216.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$195.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$195.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$205.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$216.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$205.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$216.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$216.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$162.54
|
| Rate for Payer: Healthfirst Commercial |
$216.72
|
| Rate for Payer: Healthfirst Essential Plan |
$487.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$205.88
|
| Rate for Payer: Healthfirst QHP |
$216.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$151.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$216.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$184.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$151.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$216.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$162.54
|
| Rate for Payer: SOMOS Essential |
$162.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$216.72
|
|
|
PR BRONCHOSCOPIC THERMOPLASTY ONE LOBE
|
Professional
|
Both
|
$802.17
|
|
|
Service Code
|
HCPCS 31660
|
| Min. Negotiated Rate |
$142.86 |
| Max. Negotiated Rate |
$459.18 |
| Rate for Payer: Cash Price |
$207.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$204.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$183.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$183.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$193.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$204.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$193.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$204.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$204.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$153.06
|
| Rate for Payer: Healthfirst Commercial |
$204.08
|
| Rate for Payer: Healthfirst Essential Plan |
$459.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$193.88
|
| Rate for Payer: Healthfirst QHP |
$204.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$142.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$204.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$173.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$142.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$204.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$153.06
|
| Rate for Payer: SOMOS Essential |
$153.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$204.08
|
|
|
PR BRONCHOSCOPY BALLOON OCCLUSION
|
Professional
|
Both
|
$770.74
|
|
|
Service Code
|
HCPCS 31634
|
| Min. Negotiated Rate |
$145.45 |
| Max. Negotiated Rate |
$467.53 |
| Rate for Payer: Cash Price |
$208.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$207.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$187.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$187.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$197.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$207.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$197.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$207.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$207.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$155.84
|
| Rate for Payer: Healthfirst Commercial |
$207.79
|
| Rate for Payer: Healthfirst Essential Plan |
$467.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$197.40
|
| Rate for Payer: Healthfirst QHP |
$207.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$145.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$207.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$176.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$145.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$207.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$155.84
|
| Rate for Payer: SOMOS Essential |
$155.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$207.79
|
|
|
PR BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES
|
Professional
|
Both
|
$632.73
|
|
|
Service Code
|
HCPCS 31625
|
| Min. Negotiated Rate |
$119.61 |
| Max. Negotiated Rate |
$384.46 |
| Rate for Payer: Cash Price |
$173.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$170.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$153.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$170.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$170.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$128.15
|
| Rate for Payer: Healthfirst Commercial |
$170.87
|
| Rate for Payer: Healthfirst Essential Plan |
$384.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$162.33
|
| Rate for Payer: Healthfirst QHP |
$170.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$119.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$170.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$145.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$119.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$170.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$128.15
|
| Rate for Payer: SOMOS Essential |
$128.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$170.87
|
|
|
PR BRONCHOSCOPY EACH MAJOR BRONCHUS STENTED
|
Professional
|
Both
|
$316.30
|
|
|
Service Code
|
HCPCS 31637
|
| Min. Negotiated Rate |
$58.34 |
| Max. Negotiated Rate |
$187.51 |
| Rate for Payer: Cash Price |
$83.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$83.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$75.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$75.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$79.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$83.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$79.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.51
|
| Rate for Payer: Healthfirst Commercial |
$83.34
|
| Rate for Payer: Healthfirst Essential Plan |
$187.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$79.17
|
| Rate for Payer: Healthfirst QHP |
$83.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$83.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$83.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62.51
|
| Rate for Payer: SOMOS Essential |
$62.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$83.34
|
|
|
PR BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRON
|
Professional
|
Both
|
$756.63
|
|
|
Service Code
|
HCPCS 31629
|
| Min. Negotiated Rate |
$143.50 |
| Max. Negotiated Rate |
$461.25 |
| Rate for Payer: Cash Price |
$206.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$205.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$184.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$184.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$194.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$205.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$194.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$205.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$205.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$153.75
|
| Rate for Payer: Healthfirst Commercial |
$205.00
|
| Rate for Payer: Healthfirst Essential Plan |
$461.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$194.75
|
| Rate for Payer: Healthfirst QHP |
$205.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$143.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$205.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$174.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$143.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$205.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$153.75
|
| Rate for Payer: SOMOS Essential |
$153.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$205.00
|
|
|
PR BRONCHOSCOPY W/CPTR-ASST IMAGE-GUIDED NAVIGATION
|
Professional
|
Both
|
$391.48
|
|
|
Service Code
|
HCPCS 31627
|
| Min. Negotiated Rate |
$73.73 |
| Max. Negotiated Rate |
$236.99 |
| Rate for Payer: Cash Price |
$106.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$105.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$94.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$94.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$100.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$105.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$100.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.00
|
| Rate for Payer: Healthfirst Commercial |
$105.33
|
| Rate for Payer: Healthfirst Essential Plan |
$236.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$100.06
|
| Rate for Payer: Healthfirst QHP |
$105.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$73.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$105.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$89.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$73.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$105.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$79.00
|
| Rate for Payer: SOMOS Essential |
$79.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$105.33
|
|
|
PR BRONCHOSCOPY W/EXCISION TUMOR
|
Professional
|
Both
|
$1,017.21
|
|
|
Service Code
|
HCPCS 31640
|
| Min. Negotiated Rate |
$189.38 |
| Max. Negotiated Rate |
$608.72 |
| Rate for Payer: Cash Price |
$274.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$270.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$243.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$243.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$257.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$270.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$257.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$270.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$270.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$202.91
|
| Rate for Payer: Healthfirst Commercial |
$270.54
|
| Rate for Payer: Healthfirst Essential Plan |
$608.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$257.01
|
| Rate for Payer: Healthfirst QHP |
$270.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$189.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$270.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$229.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$189.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$270.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$202.91
|
| Rate for Payer: SOMOS Essential |
$202.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$270.54
|
|
|
PR BRONCHOSCOPY W/PLACEMENT TRACHEAL STENT
|
Professional
|
Both
|
$941.08
|
|
|
Service Code
|
HCPCS 31631
|
| Min. Negotiated Rate |
$176.11 |
| Max. Negotiated Rate |
$566.08 |
| Rate for Payer: Cash Price |
$253.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$251.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$226.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$226.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$239.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$251.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$239.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$251.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$188.69
|
| Rate for Payer: Healthfirst Commercial |
$251.59
|
| Rate for Payer: Healthfirst Essential Plan |
$566.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$239.01
|
| Rate for Payer: Healthfirst QHP |
$251.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$176.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$251.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$213.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$176.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$251.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$188.69
|
| Rate for Payer: SOMOS Essential |
$188.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$251.59
|
|
|
PR BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT
|
Professional
|
Both
|
$808.50
|
|
|
Service Code
|
HCPCS 31626
|
| Min. Negotiated Rate |
$154.46 |
| Max. Negotiated Rate |
$496.46 |
| Rate for Payer: Cash Price |
$220.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$220.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$198.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$198.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$209.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$220.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$209.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$220.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$220.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.49
|
| Rate for Payer: Healthfirst Commercial |
$220.65
|
| Rate for Payer: Healthfirst Essential Plan |
$496.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.62
|
| Rate for Payer: Healthfirst QHP |
$220.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$154.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$220.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$187.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$154.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$220.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$165.49
|
| Rate for Payer: SOMOS Essential |
$165.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$220.65
|
|
|
PR BRONCHOSCOPY W/REMOVAL FOREIGN BODY
|
Professional
|
Both
|
$716.59
|
|
|
Service Code
|
HCPCS 31635
|
| Min. Negotiated Rate |
$135.54 |
| Max. Negotiated Rate |
$435.67 |
| Rate for Payer: Cash Price |
$196.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$193.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$174.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$174.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$183.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$193.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$183.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$193.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$193.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$145.22
|
| Rate for Payer: Healthfirst Commercial |
$193.63
|
| Rate for Payer: Healthfirst Essential Plan |
$435.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$183.95
|
| Rate for Payer: Healthfirst QHP |
$193.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$135.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$193.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$164.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$135.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$193.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$145.22
|
| Rate for Payer: SOMOS Essential |
$145.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$193.63
|
|
|
PR BRONCHOSCOPY W/THER ASPIR TRACHBRNCL TREE 1ST
|
Professional
|
Both
|
$597.03
|
|
|
Service Code
|
HCPCS 31645
|
| Min. Negotiated Rate |
$113.36 |
| Max. Negotiated Rate |
$364.37 |
| Rate for Payer: Cash Price |
$163.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$161.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$145.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$145.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$153.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$161.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$153.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$161.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$161.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$121.45
|
| Rate for Payer: Healthfirst Commercial |
$161.94
|
| Rate for Payer: Healthfirst Essential Plan |
$364.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.84
|
| Rate for Payer: Healthfirst QHP |
$161.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$113.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$161.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$137.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$113.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$161.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$121.45
|
| Rate for Payer: SOMOS Essential |
$121.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$161.94
|
|
|
PR BRONCHOSCOPY W/THER ASPIR TRACHBRNCL TREE SBSQ
|
Professional
|
Both
|
$576.03
|
|
|
Service Code
|
HCPCS 31646
|
| Min. Negotiated Rate |
$109.97 |
| Max. Negotiated Rate |
$353.48 |
| Rate for Payer: Cash Price |
$157.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$141.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$149.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$149.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$117.83
|
| Rate for Payer: Healthfirst Commercial |
$157.10
|
| Rate for Payer: Healthfirst Essential Plan |
$353.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$149.25
|
| Rate for Payer: Healthfirst QHP |
$157.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$109.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$157.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$133.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$109.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$117.83
|
| Rate for Payer: SOMOS Essential |
$117.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.10
|
|
|
PR BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE
|
Professional
|
Both
|
$709.28
|
|
|
Service Code
|
HCPCS 31628
|
| Min. Negotiated Rate |
$133.75 |
| Max. Negotiated Rate |
$429.91 |
| Rate for Payer: Cash Price |
$193.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$191.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$171.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$171.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$181.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$191.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$181.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$143.30
|
| Rate for Payer: Healthfirst Commercial |
$191.07
|
| Rate for Payer: Healthfirst Essential Plan |
$429.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$181.52
|
| Rate for Payer: Healthfirst QHP |
$191.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$133.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$191.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$162.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$133.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$191.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$143.30
|
| Rate for Payer: SOMOS Essential |
$143.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.07
|
|
|
PR BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE
|
Professional
|
Both
|
$200.94
|
|
|
Service Code
|
HCPCS 31632
|
| Min. Negotiated Rate |
$36.72 |
| Max. Negotiated Rate |
$118.03 |
| Rate for Payer: Cash Price |
$53.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.34
|
| Rate for Payer: Healthfirst Commercial |
$52.46
|
| Rate for Payer: Healthfirst Essential Plan |
$118.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.84
|
| Rate for Payer: Healthfirst QHP |
$52.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.34
|
| Rate for Payer: SOMOS Essential |
$39.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.46
|
|
|
PR BRONCHOSCOPY W/TRANSBRONCL NDL ASPIR BX EA LOBE
|
Professional
|
Both
|
$254.24
|
|
|
Service Code
|
HCPCS 31633
|
| Min. Negotiated Rate |
$48.32 |
| Max. Negotiated Rate |
$155.32 |
| Rate for Payer: Cash Price |
$69.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$69.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$69.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$69.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$69.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.77
|
| Rate for Payer: Healthfirst Commercial |
$69.03
|
| Rate for Payer: Healthfirst Essential Plan |
$155.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.58
|
| Rate for Payer: Healthfirst QHP |
$69.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$69.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$69.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.77
|
| Rate for Payer: SOMOS Essential |
$51.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69.03
|
|
|
PR BSO W/OMENTECTOMY TAH DEBULKING W/LMPHADECTOMY
|
Professional
|
Both
|
$9,406.29
|
|
|
Service Code
|
HCPCS 58954
|
| Min. Negotiated Rate |
$1,761.49 |
| Max. Negotiated Rate |
$5,661.94 |
| Rate for Payer: Cash Price |
$2,547.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,516.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,264.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,264.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,390.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,516.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,390.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,516.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,516.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,887.32
|
| Rate for Payer: Healthfirst Commercial |
$2,516.42
|
| Rate for Payer: Healthfirst Essential Plan |
$5,661.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,390.60
|
| Rate for Payer: Healthfirst QHP |
$2,516.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,761.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,516.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,138.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,761.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,516.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,887.32
|
| Rate for Payer: SOMOS Essential |
$1,887.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,516.42
|
|
|
PR BSO W/OMENTECTOMY TAH&RAD DEBULKING DISSECTION
|
Professional
|
Both
|
$8,699.67
|
|
|
Service Code
|
HCPCS 58953
|
| Min. Negotiated Rate |
$1,627.20 |
| Max. Negotiated Rate |
$5,230.28 |
| Rate for Payer: Cash Price |
$2,352.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,324.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,092.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,092.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,208.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,324.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,208.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,324.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,324.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,743.43
|
| Rate for Payer: Healthfirst Commercial |
$2,324.57
|
| Rate for Payer: Healthfirst Essential Plan |
$5,230.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,208.34
|
| Rate for Payer: Healthfirst QHP |
$2,324.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,627.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,324.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,975.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,627.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,324.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,743.43
|
| Rate for Payer: SOMOS Essential |
$1,743.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,324.57
|
|
|
PR BSO W/TOT OMENTECTOMY & HYSTERECTOMY MALIGNANC
|
Professional
|
Both
|
$5,912.48
|
|
|
Service Code
|
HCPCS 58956
|
| Min. Negotiated Rate |
$1,107.93 |
| Max. Negotiated Rate |
$3,561.21 |
| Rate for Payer: Cash Price |
$1,601.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,582.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,424.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,424.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,503.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,582.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,503.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,582.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,582.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,187.07
|
| Rate for Payer: Healthfirst Commercial |
$1,582.76
|
| Rate for Payer: Healthfirst Essential Plan |
$3,561.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,503.62
|
| Rate for Payer: Healthfirst QHP |
$1,582.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,107.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,582.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,345.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,107.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,582.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,187.07
|
| Rate for Payer: SOMOS Essential |
$1,187.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,582.76
|
|
|
PR BUNDLE OF HIS RECORDING
|
Professional
|
Both
|
$909.37
|
|
|
Service Code
|
HCPCS 93600
|
| Min. Negotiated Rate |
$154.23 |
| Max. Negotiated Rate |
$154.23 |
| Rate for Payer: Amida Care Medicaid |
$154.23
|
|
|
PR BUNDLE OF HIS RECORDING
|
Professional
|
Both
|
$402.15
|
|
|
Service Code
|
HCPCS 93600 TC
|
| Min. Negotiated Rate |
$154.23 |
| Max. Negotiated Rate |
$154.23 |
| Rate for Payer: Amida Care Medicaid |
$154.23
|
|
