|
PR CDP-SOT 6 CONDITIONS W/I&R W/MCT & ADT
|
Professional
|
Both
|
$263.94
|
|
|
Service Code
|
HCPCS 92549
|
| Min. Negotiated Rate |
$50.37 |
| Max. Negotiated Rate |
$161.91 |
| Rate for Payer: Cash Price |
$72.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$71.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$64.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$68.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$71.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$68.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.97
|
| Rate for Payer: Healthfirst Commercial |
$71.96
|
| Rate for Payer: Healthfirst Essential Plan |
$161.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.36
|
| Rate for Payer: Healthfirst QHP |
$71.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$50.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$71.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$61.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$71.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$53.97
|
| Rate for Payer: SOMOS Essential |
$53.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.96
|
|
|
PR CDP-SOT 6 CONDITIONS W/I&R W/MCT & ADT
|
Professional
|
Both
|
$174.97
|
|
|
Service Code
|
HCPCS 92549 26
|
| Min. Negotiated Rate |
$33.64 |
| Max. Negotiated Rate |
$108.14 |
| Rate for Payer: Cash Price |
$48.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$48.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.05
|
| Rate for Payer: Healthfirst Commercial |
$48.06
|
| Rate for Payer: Healthfirst Essential Plan |
$108.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.66
|
| Rate for Payer: Healthfirst QHP |
$48.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.05
|
| Rate for Payer: SOMOS Essential |
$36.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.06
|
|
|
PR CEFTRIAXONE SODIUM INJECTION
|
Professional
|
Both
|
$15.19
|
|
|
Service Code
|
HCPCS J0696
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.32
|
| Rate for Payer: Healthfirst Commercial |
$0.43
|
| Rate for Payer: Healthfirst Essential Plan |
$0.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.41
|
| Rate for Payer: Healthfirst QHP |
$0.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: SOMOS Essential |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.43
|
|
|
PR CENTRALIZATION WRST ULNA
|
Professional
|
Both
|
$4,188.14
|
|
|
Service Code
|
HCPCS 25335
|
| Min. Negotiated Rate |
$787.34 |
| Max. Negotiated Rate |
$2,530.73 |
| Rate for Payer: Cash Price |
$1,129.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,124.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,012.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,012.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,068.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,124.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,068.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,124.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,124.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$843.58
|
| Rate for Payer: Healthfirst Commercial |
$1,124.77
|
| Rate for Payer: Healthfirst Essential Plan |
$2,530.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,068.53
|
| Rate for Payer: Healthfirst QHP |
$1,124.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$787.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,124.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$956.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$787.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,124.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$843.58
|
| Rate for Payer: SOMOS Essential |
$843.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,124.77
|
|
|
PR CERCLAGE CERVIX PREGNANCY ABDOMINAL
|
Professional
|
Both
|
$1,115.59
|
|
|
Service Code
|
HCPCS 59325
|
| Min. Negotiated Rate |
$204.27 |
| Max. Negotiated Rate |
$656.60 |
| Rate for Payer: Cash Price |
$295.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$291.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$262.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$262.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$277.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$291.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$277.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$291.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$291.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$218.87
|
| Rate for Payer: Healthfirst Commercial |
$291.82
|
| Rate for Payer: Healthfirst Essential Plan |
$656.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$277.23
|
| Rate for Payer: Healthfirst QHP |
$291.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$204.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$291.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$248.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$204.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$291.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$218.87
|
| Rate for Payer: SOMOS Essential |
$218.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$291.82
|
|
|
PR CERCLAGE CERVIX PREGNANCY VAGINAL
|
Professional
|
Both
|
$699.97
|
|
|
Service Code
|
HCPCS 59320
|
| Min. Negotiated Rate |
$129.10 |
| Max. Negotiated Rate |
$414.97 |
| Rate for Payer: Cash Price |
$185.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$165.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$165.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$184.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$138.32
|
| Rate for Payer: Healthfirst Commercial |
$184.43
|
| Rate for Payer: Healthfirst Essential Plan |
$414.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$175.21
|
| Rate for Payer: Healthfirst QHP |
$184.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$129.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$184.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$156.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$129.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.32
|
| Rate for Payer: SOMOS Essential |
$138.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.43
|
|
|
PR CERCLAGE UTERINE CERVIX NONOBSTETRICAL
|
Professional
|
Both
|
$1,562.65
|
|
|
Service Code
|
HCPCS 57700
|
| Min. Negotiated Rate |
$289.84 |
| Max. Negotiated Rate |
$931.63 |
| Rate for Payer: Cash Price |
$423.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$414.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$372.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$372.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$393.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$414.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$393.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$414.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$414.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$310.55
|
| Rate for Payer: Healthfirst Commercial |
$414.06
|
| Rate for Payer: Healthfirst Essential Plan |
$931.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$393.36
|
| Rate for Payer: Healthfirst QHP |
$414.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$289.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$414.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$351.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$289.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$414.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$310.55
|
| Rate for Payer: SOMOS Essential |
$310.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$414.06
|
|
|
PR CERVICAL LYMPHADEC MODIFIED RADICAL NECK DSJ
|
Professional
|
Both
|
$6,271.34
|
|
|
Service Code
|
HCPCS 38724
|
| Min. Negotiated Rate |
$1,174.93 |
| Max. Negotiated Rate |
$3,776.56 |
| Rate for Payer: Cash Price |
$1,694.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,678.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,510.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,510.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,594.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,678.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,594.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,678.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,678.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,258.85
|
| Rate for Payer: Healthfirst Commercial |
$1,678.47
|
| Rate for Payer: Healthfirst Essential Plan |
$3,776.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,594.55
|
| Rate for Payer: Healthfirst QHP |
$1,678.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,174.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,678.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,426.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,174.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,678.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,258.85
|
| Rate for Payer: SOMOS Essential |
$1,258.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,678.47
|
|
|
PR CERVICAL LYMPHADENECTOMY
|
Professional
|
Both
|
$5,829.39
|
|
|
Service Code
|
HCPCS 38720
|
| Min. Negotiated Rate |
$1,096.09 |
| Max. Negotiated Rate |
$3,523.14 |
| Rate for Payer: Cash Price |
$1,579.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,565.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,409.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,409.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,487.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,565.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,487.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,565.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,565.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,174.38
|
| Rate for Payer: Healthfirst Commercial |
$1,565.84
|
| Rate for Payer: Healthfirst Essential Plan |
$3,523.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,487.55
|
| Rate for Payer: Healthfirst QHP |
$1,565.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,096.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,565.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,330.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,096.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,565.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,174.38
|
| Rate for Payer: SOMOS Essential |
$1,174.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,565.84
|
|
|
PR CERVICAL & OCULAR VEMP TESTING W/I&R
|
Professional
|
Both
|
$254.70
|
|
|
Service Code
|
HCPCS 92519
|
| Min. Negotiated Rate |
$48.33 |
| Max. Negotiated Rate |
$155.34 |
| Rate for Payer: Amida Care Medicaid |
$83.55
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$69.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$69.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$69.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$69.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.78
|
| Rate for Payer: Healthfirst Commercial |
$69.04
|
| Rate for Payer: Healthfirst Essential Plan |
$155.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.59
|
| Rate for Payer: Healthfirst QHP |
$69.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$69.04
|
| 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) |
$48.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$69.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.78
|
| Rate for Payer: SOMOS Essential |
$51.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69.04
|
|
|
PR CERVICAL VEMP TESTING W/I&R
|
Professional
|
Both
|
$170.07
|
|
|
Service Code
|
HCPCS 92517
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$102.87 |
| Rate for Payer: Amida Care Medicaid |
$53.56
|
| Rate for Payer: Cash Price |
$46.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.29
|
| Rate for Payer: Healthfirst Commercial |
$45.72
|
| Rate for Payer: Healthfirst Essential Plan |
$102.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.43
|
| Rate for Payer: Healthfirst QHP |
$45.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.29
|
| Rate for Payer: SOMOS Essential |
$34.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.72
|
|
|
PR CERVICOPLASTY
|
Professional
|
Both
|
$3,494.96
|
|
|
Service Code
|
HCPCS 15819
|
| Rate for Payer: Cash Price |
$945.20
|
|
|
PR CESAREAN DELIVERY ATTEMPTED VBAC
|
Professional
|
Both
|
$4,372.27
|
|
|
Service Code
|
HCPCS 59620
|
| Min. Negotiated Rate |
$795.40 |
| Max. Negotiated Rate |
$2,556.65 |
| Rate for Payer: Cash Price |
$1,152.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,136.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,022.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,022.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,079.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,136.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,079.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,136.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,136.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$852.22
|
| Rate for Payer: Healthfirst Commercial |
$1,136.29
|
| Rate for Payer: Healthfirst Essential Plan |
$2,556.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,079.48
|
| Rate for Payer: Healthfirst QHP |
$1,136.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$795.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,136.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$965.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$795.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,136.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$852.22
|
| Rate for Payer: SOMOS Essential |
$852.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,136.29
|
|
|
PR CESAREAN DELIVERY ONLY
|
Professional
|
Both
|
$4,207.98
|
|
|
Service Code
|
HCPCS 59514
|
| Min. Negotiated Rate |
$766.49 |
| Max. Negotiated Rate |
$2,463.70 |
| Rate for Payer: Cash Price |
$1,109.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,094.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$985.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$985.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,040.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,094.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,040.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,094.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,094.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$821.24
|
| Rate for Payer: Healthfirst Commercial |
$1,094.98
|
| Rate for Payer: Healthfirst Essential Plan |
$2,463.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,040.23
|
| Rate for Payer: Healthfirst QHP |
$1,094.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$766.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,094.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$930.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$766.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,094.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$821.24
|
| Rate for Payer: SOMOS Essential |
$821.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,094.98
|
|
|
PR CESAREAN DELIVERY ONLY W/POSTPARTUM CARE
|
Professional
|
Both
|
$6,052.31
|
|
|
Service Code
|
HCPCS 59515
|
| Min. Negotiated Rate |
$1,135.45 |
| Max. Negotiated Rate |
$3,649.66 |
| Rate for Payer: Cash Price |
$1,645.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,622.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,459.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,459.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,540.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,622.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,540.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,622.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,622.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,216.55
|
| Rate for Payer: Healthfirst Commercial |
$1,622.07
|
| Rate for Payer: Healthfirst Essential Plan |
$3,649.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,540.97
|
| Rate for Payer: Healthfirst QHP |
$1,622.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,135.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,622.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,378.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,135.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,622.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,216.55
|
| Rate for Payer: SOMOS Essential |
$1,216.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,622.07
|
|
|
PR CESAREAN DLVRY & POSTPARTUM CARE ATTEMPTED VBA
|
Professional
|
Both
|
$6,293.18
|
|
|
Service Code
|
HCPCS 59622
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$3,778.09 |
| Rate for Payer: Cash Price |
$1,708.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,679.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,511.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,511.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,595.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,679.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,595.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,679.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,679.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,259.36
|
| Rate for Payer: Healthfirst Commercial |
$1,679.15
|
| Rate for Payer: Healthfirst Essential Plan |
$3,778.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,595.19
|
| Rate for Payer: Healthfirst QHP |
$1,679.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,175.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,679.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,427.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,175.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,679.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,259.36
|
| Rate for Payer: SOMOS Essential |
$1,259.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,679.15
|
|
|
PR CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL
|
Professional
|
Both
|
$521.54
|
|
|
Service Code
|
HCPCS 37214
|
| Min. Negotiated Rate |
$97.66 |
| Max. Negotiated Rate |
$313.90 |
| Rate for Payer: Cash Price |
$138.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$139.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$125.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$132.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$139.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$132.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$139.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$104.63
|
| Rate for Payer: Healthfirst Commercial |
$139.51
|
| Rate for Payer: Healthfirst Essential Plan |
$313.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$132.53
|
| Rate for Payer: Healthfirst QHP |
$139.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$97.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$139.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$118.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$97.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$139.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$104.63
|
| Rate for Payer: SOMOS Essential |
$104.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$139.51
|
|
|
PR CHANGE CYSTOSTOMY TUBE COMPLICATED
|
Professional
|
Both
|
$337.65
|
|
|
Service Code
|
HCPCS 51710
|
| Min. Negotiated Rate |
$63.66 |
| Max. Negotiated Rate |
$204.62 |
| Rate for Payer: Cash Price |
$91.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$90.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$86.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$90.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$86.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.20
|
| Rate for Payer: Healthfirst Commercial |
$90.94
|
| Rate for Payer: Healthfirst Essential Plan |
$204.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$86.39
|
| Rate for Payer: Healthfirst QHP |
$90.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$90.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$77.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$68.20
|
| Rate for Payer: SOMOS Essential |
$68.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.94
|
|
|
PR CHANGE CYSTOSTOMY TUBE SIMPLE
|
Professional
|
Both
|
$216.13
|
|
|
Service Code
|
HCPCS 51705
|
| Min. Negotiated Rate |
$41.84 |
| Max. Negotiated Rate |
$134.48 |
| Rate for Payer: Cash Price |
$59.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$59.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.83
|
| Rate for Payer: Healthfirst Commercial |
$59.77
|
| Rate for Payer: Healthfirst Essential Plan |
$134.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.78
|
| Rate for Payer: Healthfirst QHP |
$59.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.83
|
| Rate for Payer: SOMOS Essential |
$44.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.77
|
|
|
PR CHEMICAL CAUTERIZATION OF GRANULATION TISSUE
|
Professional
|
Both
|
$160.69
|
|
|
Service Code
|
HCPCS 17250
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$97.40 |
| Rate for Payer: Cash Price |
$44.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.47
|
| Rate for Payer: Healthfirst Commercial |
$43.29
|
| Rate for Payer: Healthfirst Essential Plan |
$97.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.13
|
| Rate for Payer: Healthfirst QHP |
$43.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.47
|
| Rate for Payer: SOMOS Essential |
$32.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.29
|
|
|
PR CHEMICAL EXFOLIATION ACNE
|
Professional
|
Both
|
$393.26
|
|
|
Service Code
|
HCPCS 17360
|
| Min. Negotiated Rate |
$74.73 |
| Max. Negotiated Rate |
$240.21 |
| Rate for Payer: Cash Price |
$106.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$106.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$101.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$106.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$101.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.07
|
| Rate for Payer: Healthfirst Commercial |
$106.76
|
| Rate for Payer: Healthfirst Essential Plan |
$240.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$101.42
|
| Rate for Payer: Healthfirst QHP |
$106.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$106.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$90.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$74.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$106.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$80.07
|
| Rate for Payer: SOMOS Essential |
$80.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$106.76
|
|
|
PR CHEMICAL PEEL FACIAL DERMAL
|
Professional
|
Both
|
$1,736.77
|
|
|
Service Code
|
HCPCS 15789
|
| Min. Negotiated Rate |
$334.24 |
| Max. Negotiated Rate |
$1,074.33 |
| Rate for Payer: Cash Price |
$477.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$477.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$429.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$429.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$453.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$477.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$453.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$477.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$477.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$358.11
|
| Rate for Payer: Healthfirst Commercial |
$477.48
|
| Rate for Payer: Healthfirst Essential Plan |
$1,074.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$453.61
|
| Rate for Payer: Healthfirst QHP |
$477.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$334.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$477.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$405.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$334.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$477.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$358.11
|
| Rate for Payer: SOMOS Essential |
$358.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$477.48
|
|
|
PR CHEMICAL PEEL FACIAL EPIDERMAL
|
Professional
|
Both
|
$918.12
|
|
|
Service Code
|
HCPCS 15788
|
| Min. Negotiated Rate |
$176.37 |
| Max. Negotiated Rate |
$566.91 |
| Rate for Payer: Cash Price |
$253.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$251.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$226.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$226.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$239.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$251.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$239.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$251.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$188.97
|
| Rate for Payer: Healthfirst Commercial |
$251.96
|
| Rate for Payer: Healthfirst Essential Plan |
$566.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$239.36
|
| Rate for Payer: Healthfirst QHP |
$251.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$176.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$251.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$214.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$176.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$251.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$188.97
|
| Rate for Payer: SOMOS Essential |
$188.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$251.96
|
|
|
PR CHEMICAL PEEL NONFACIAL DERMAL
|
Professional
|
Both
|
$1,509.80
|
|
|
Service Code
|
HCPCS 15793
|
| Min. Negotiated Rate |
$292.11 |
| Max. Negotiated Rate |
$938.92 |
| Rate for Payer: Cash Price |
$417.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$417.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$375.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$375.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$396.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$417.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$396.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$417.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$417.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$312.98
|
| Rate for Payer: Healthfirst Commercial |
$417.30
|
| Rate for Payer: Healthfirst Essential Plan |
$938.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$396.44
|
| Rate for Payer: Healthfirst QHP |
$417.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$292.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$417.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$354.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$292.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$417.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$312.98
|
| Rate for Payer: SOMOS Essential |
$312.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$417.30
|
|
|
PR CHEMICAL PEEL NONFACIAL EPIDERMAL
|
Professional
|
Both
|
$891.17
|
|
|
Service Code
|
HCPCS 15792
|
| Min. Negotiated Rate |
$171.75 |
| Max. Negotiated Rate |
$552.06 |
| Rate for Payer: Cash Price |
$247.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$245.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$220.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$220.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$233.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$245.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$233.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$245.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$245.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$184.02
|
| Rate for Payer: Healthfirst Commercial |
$245.36
|
| Rate for Payer: Healthfirst Essential Plan |
$552.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$233.09
|
| Rate for Payer: Healthfirst QHP |
$245.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$171.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$245.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$208.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$171.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$245.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$184.02
|
| Rate for Payer: SOMOS Essential |
$184.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$245.36
|
|
