|
PR DIAB MANAGE TRN IND/GROUP
|
Professional
|
Both
|
$62.79
|
|
|
Service Code
|
HCPCS G0109
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$39.10 |
| Rate for Payer: Amida Care Medicaid |
$12.09
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.04
|
| Rate for Payer: Healthfirst Commercial |
$17.38
|
| Rate for Payer: Healthfirst Essential Plan |
$39.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.51
|
| Rate for Payer: Healthfirst QHP |
$17.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$17.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.04
|
| Rate for Payer: SOMOS Essential |
$13.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.38
|
|
|
PR DIAB MANAGE TRN PER INDIV
|
Professional
|
Both
|
$221.41
|
|
|
Service Code
|
HCPCS G0108
|
| Min. Negotiated Rate |
$42.45 |
| Max. Negotiated Rate |
$136.46 |
| Rate for Payer: Amida Care Medicaid |
$42.74
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$60.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$54.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$54.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$57.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$60.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$57.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.49
|
| Rate for Payer: Healthfirst Commercial |
$60.65
|
| Rate for Payer: Healthfirst Essential Plan |
$136.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$57.62
|
| Rate for Payer: Healthfirst QHP |
$60.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$42.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$60.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$51.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$42.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$60.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.49
|
| Rate for Payer: SOMOS Essential |
$45.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$60.65
|
|
|
PR DIAGNOSTIC ARTHROSCOPY SHOULDER +- SYNOVIAL BX
|
Professional
|
Both
|
$2,074.73
|
|
|
Service Code
|
HCPCS 29805
|
| Min. Negotiated Rate |
$394.27 |
| Max. Negotiated Rate |
$1,267.31 |
| Rate for Payer: Cash Price |
$561.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$563.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$506.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$506.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$535.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$563.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$535.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$563.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$563.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$422.44
|
| Rate for Payer: Healthfirst Commercial |
$563.25
|
| Rate for Payer: Healthfirst Essential Plan |
$1,267.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$535.09
|
| Rate for Payer: Healthfirst QHP |
$563.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$394.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$563.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$478.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$394.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$563.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$422.44
|
| Rate for Payer: SOMOS Essential |
$422.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$563.25
|
|
|
PR DIAGNOSTIC BONE MARROW ASPIRATIONS
|
Professional
|
Both
|
$278.29
|
|
|
Service Code
|
HCPCS 38220
|
| Min. Negotiated Rate |
$52.56 |
| Max. Negotiated Rate |
$168.93 |
| Rate for Payer: Cash Price |
$75.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$75.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$75.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$71.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.31
|
| Rate for Payer: Healthfirst Commercial |
$75.08
|
| Rate for Payer: Healthfirst Essential Plan |
$168.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$71.33
|
| Rate for Payer: Healthfirst QHP |
$75.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$75.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$75.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56.31
|
| Rate for Payer: SOMOS Essential |
$56.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.08
|
|
|
PR DIAGNOSTIC BONE MARROW BIOPSIES
|
Professional
|
Both
|
$286.86
|
|
|
Service Code
|
HCPCS 38221
|
| Min. Negotiated Rate |
$53.94 |
| Max. Negotiated Rate |
$173.38 |
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$77.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$69.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$69.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$73.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$77.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$73.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.80
|
| Rate for Payer: Healthfirst Commercial |
$77.06
|
| Rate for Payer: Healthfirst Essential Plan |
$173.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.21
|
| Rate for Payer: Healthfirst QHP |
$77.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$77.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$65.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$77.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$57.80
|
| Rate for Payer: SOMOS Essential |
$57.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$77.06
|
|
|
PR DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS
|
Professional
|
Both
|
$309.51
|
|
|
Service Code
|
HCPCS 38222
|
| Min. Negotiated Rate |
$58.01 |
| Max. Negotiated Rate |
$186.46 |
| Rate for Payer: Cash Price |
$83.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$82.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$78.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$82.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$78.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.15
|
| Rate for Payer: Healthfirst Commercial |
$82.87
|
| Rate for Payer: Healthfirst Essential Plan |
$186.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$78.73
|
| Rate for Payer: Healthfirst QHP |
$82.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$82.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$82.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62.15
|
| Rate for Payer: SOMOS Essential |
$62.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.87
|
|
|
PR DIAGNOSTIC DIGITAL BREAST TOMOSYNTHESIS, UNILATERAL OR BILATERAL
|
Professional
|
Both
|
$103.50
|
|
|
Service Code
|
HCPCS G0279 TC
|
| Min. Negotiated Rate |
$12.77 |
| Max. Negotiated Rate |
$41.04 |
| Rate for Payer: Cash Price |
$22.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.68
|
| Rate for Payer: Healthfirst Commercial |
$18.24
|
| Rate for Payer: Healthfirst Essential Plan |
$41.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.33
|
| Rate for Payer: Healthfirst QHP |
$18.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.68
|
| Rate for Payer: SOMOS Essential |
$13.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.24
|
|
|
PR DIAGNOSTIC DIGITAL BREAST TOMOSYNTHESIS, UNILATERAL OR BILATERAL
|
Professional
|
Both
|
$117.71
|
|
|
Service Code
|
HCPCS G0279 26
|
| Min. Negotiated Rate |
$21.74 |
| Max. Negotiated Rate |
$69.89 |
| Rate for Payer: Cash Price |
$31.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.30
|
| Rate for Payer: Healthfirst Commercial |
$31.06
|
| Rate for Payer: Healthfirst Essential Plan |
$69.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.51
|
| Rate for Payer: Healthfirst QHP |
$31.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.30
|
| Rate for Payer: SOMOS Essential |
$23.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.06
|
|
|
PR DIAGNOSTIC DIGITAL BREAST TOMOSYNTHESIS, UNILATERAL OR BILATERAL
|
Professional
|
Both
|
$221.24
|
|
|
Service Code
|
HCPCS G0279
|
| Min. Negotiated Rate |
$34.52 |
| Max. Negotiated Rate |
$110.95 |
| Rate for Payer: Cash Price |
$53.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.98
|
| Rate for Payer: Healthfirst Commercial |
$49.31
|
| Rate for Payer: Healthfirst Essential Plan |
$110.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.84
|
| Rate for Payer: Healthfirst QHP |
$49.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.98
|
| Rate for Payer: SOMOS Essential |
$36.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.31
|
|
|
PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE
|
Professional
|
Both
|
$274.68
|
|
|
Service Code
|
HCPCS 62270
|
| Min. Negotiated Rate |
$53.22 |
| Max. Negotiated Rate |
$171.07 |
| Rate for Payer: Cash Price |
$75.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$76.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$68.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$76.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.02
|
| Rate for Payer: Healthfirst Commercial |
$76.03
|
| Rate for Payer: Healthfirst Essential Plan |
$171.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.23
|
| Rate for Payer: Healthfirst QHP |
$76.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$76.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$64.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$76.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$57.02
|
| Rate for Payer: SOMOS Essential |
$57.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76.03
|
|
|
PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT
|
Professional
|
Both
|
$359.24
|
|
|
Service Code
|
HCPCS 62328
|
| Min. Negotiated Rate |
$66.03 |
| Max. Negotiated Rate |
$212.24 |
| Rate for Payer: Cash Price |
$95.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$94.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$84.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$84.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$89.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$94.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$89.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$94.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$94.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$70.75
|
| Rate for Payer: Healthfirst Commercial |
$94.33
|
| Rate for Payer: Healthfirst Essential Plan |
$212.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$89.61
|
| Rate for Payer: Healthfirst QHP |
$94.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$66.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$94.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$80.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$66.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$94.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$70.75
|
| Rate for Payer: SOMOS Essential |
$70.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$94.33
|
|
|
PR DIALYIS CIRCUIT VASC EMBOLI OCCLS EVASC IMG S&I
|
Professional
|
Both
|
$850.57
|
|
|
Service Code
|
HCPCS 36909
|
| Min. Negotiated Rate |
$157.25 |
| Max. Negotiated Rate |
$505.46 |
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$224.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$202.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$202.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$213.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$224.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$213.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$224.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$224.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$168.49
|
| Rate for Payer: Healthfirst Commercial |
$224.65
|
| Rate for Payer: Healthfirst Essential Plan |
$505.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$213.42
|
| Rate for Payer: Healthfirst QHP |
$224.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$157.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$224.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$190.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$157.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$224.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$168.49
|
| Rate for Payer: SOMOS Essential |
$168.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$224.65
|
|
|
PR DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL
|
Professional
|
Both
|
$346.36
|
|
|
Service Code
|
HCPCS 90945
|
| Min. Negotiated Rate |
$35.64 |
| Max. Negotiated Rate |
$214.29 |
| Rate for Payer: Amida Care Medicaid |
$35.64
|
| Rate for Payer: Cash Price |
$95.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$95.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$85.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$85.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$90.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$95.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$90.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$95.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$71.43
|
| Rate for Payer: Healthfirst Commercial |
$95.24
|
| Rate for Payer: Healthfirst Essential Plan |
$214.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$90.48
|
| Rate for Payer: Healthfirst QHP |
$95.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$66.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$95.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$80.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$66.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$95.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$71.43
|
| Rate for Payer: SOMOS Essential |
$71.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$95.24
|
|
|
PR DIALYSIS OTH/THN HEMODIALY REPEAT PHYS/QHP EVALS
|
Professional
|
Both
|
$495.67
|
|
|
Service Code
|
HCPCS 90947
|
| Min. Negotiated Rate |
$56.82 |
| Max. Negotiated Rate |
$301.07 |
| Rate for Payer: Amida Care Medicaid |
$56.82
|
| Rate for Payer: Cash Price |
$135.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$133.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$120.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$120.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$127.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$133.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$127.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$133.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$100.36
|
| Rate for Payer: Healthfirst Commercial |
$133.81
|
| Rate for Payer: Healthfirst Essential Plan |
$301.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.12
|
| Rate for Payer: Healthfirst QHP |
$133.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$93.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$133.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$113.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$93.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$133.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$100.36
|
| Rate for Payer: SOMOS Essential |
$100.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$133.81
|
|
|
PR DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS
|
Professional
|
Both
|
$210.81
|
|
|
Service Code
|
HCPCS 57170
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$123.34 |
| Rate for Payer: Cash Price |
$54.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$52.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.12
|
| Rate for Payer: Healthfirst Commercial |
$54.82
|
| Rate for Payer: Healthfirst Essential Plan |
$123.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.08
|
| Rate for Payer: Healthfirst QHP |
$54.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$54.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$46.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.12
|
| Rate for Payer: SOMOS Essential |
$41.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.82
|
|
|
PR DIGITAL ANALYSIS ELECTROENCEPHALOGRAM
|
Professional
|
Both
|
$400.68
|
|
|
Service Code
|
HCPCS 95957 26
|
| Min. Negotiated Rate |
$76.04 |
| Max. Negotiated Rate |
$244.42 |
| Rate for Payer: Cash Price |
$110.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$108.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$97.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$97.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$103.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$108.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$103.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$108.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$108.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$81.47
|
| Rate for Payer: Healthfirst Commercial |
$108.63
|
| Rate for Payer: Healthfirst Essential Plan |
$244.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$103.20
|
| Rate for Payer: Healthfirst QHP |
$108.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$76.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$108.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$92.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$76.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$108.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$81.47
|
| Rate for Payer: SOMOS Essential |
$81.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$108.63
|
|
|
PR DIGITAL ANALYSIS ELECTROENCEPHALOGRAM
|
Professional
|
Both
|
$759.89
|
|
|
Service Code
|
HCPCS 95957 TC
|
| Min. Negotiated Rate |
$156.33 |
| Max. Negotiated Rate |
$502.49 |
| Rate for Payer: Cash Price |
$229.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$223.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$201.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$201.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$212.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$223.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$212.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$223.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$223.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$167.50
|
| Rate for Payer: Healthfirst Commercial |
$223.33
|
| Rate for Payer: Healthfirst Essential Plan |
$502.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$212.16
|
| Rate for Payer: Healthfirst QHP |
$223.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$156.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$223.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$189.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$156.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$223.33
|
| 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 |
$223.33
|
|
|
PR DIGITAL ANALYSIS ELECTROENCEPHALOGRAM
|
Professional
|
Both
|
$1,160.57
|
|
|
Service Code
|
HCPCS 95957
|
| Min. Negotiated Rate |
$232.38 |
| Max. Negotiated Rate |
$746.93 |
| Rate for Payer: Cash Price |
$339.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$331.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$298.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$298.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$315.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$331.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$315.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$331.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$331.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$248.98
|
| Rate for Payer: Healthfirst Commercial |
$331.97
|
| Rate for Payer: Healthfirst Essential Plan |
$746.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$315.37
|
| Rate for Payer: Healthfirst QHP |
$331.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$232.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$331.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$282.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$232.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$331.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$248.98
|
| Rate for Payer: SOMOS Essential |
$248.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$331.97
|
|
|
PR DILAT ANAL SPHNCTR SPX UNDER ANES OTH/THN LOCAL
|
Professional
|
Both
|
$744.21
|
|
|
Service Code
|
HCPCS 45905
|
| Min. Negotiated Rate |
$140.48 |
| Max. Negotiated Rate |
$451.55 |
| Rate for Payer: Cash Price |
$201.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$200.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$180.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$180.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$190.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$200.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$190.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$150.52
|
| Rate for Payer: Healthfirst Commercial |
$200.69
|
| Rate for Payer: Healthfirst Essential Plan |
$451.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$190.66
|
| Rate for Payer: Healthfirst QHP |
$200.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$140.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$200.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$170.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$140.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$200.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$150.52
|
| Rate for Payer: SOMOS Essential |
$150.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$200.69
|
|
|
PR DILAT&CATHJ SALIVARY DUCT W/WO INJECTION
|
Professional
|
Both
|
$400.30
|
|
|
Service Code
|
HCPCS 42660
|
| Min. Negotiated Rate |
$64.06 |
| Max. Negotiated Rate |
$205.92 |
| Rate for Payer: Cash Price |
$103.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$91.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$86.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$91.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$86.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$91.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.64
|
| Rate for Payer: Healthfirst Commercial |
$91.52
|
| Rate for Payer: Healthfirst Essential Plan |
$205.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$86.94
|
| Rate for Payer: Healthfirst QHP |
$91.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$91.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$77.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$91.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$68.64
|
| Rate for Payer: SOMOS Essential |
$68.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$91.52
|
|
|
PR DILAT FEMALE URETHRA GENERAL/CNDJ SPINAL ANES
|
Professional
|
Both
|
$159.92
|
|
|
Service Code
|
HCPCS 53665
|
| Min. Negotiated Rate |
$29.13 |
| Max. Negotiated Rate |
$93.62 |
| Rate for Payer: Cash Price |
$42.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.21
|
| Rate for Payer: Healthfirst Commercial |
$41.61
|
| Rate for Payer: Healthfirst Essential Plan |
$93.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.53
|
| Rate for Payer: Healthfirst QHP |
$41.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.21
|
| Rate for Payer: SOMOS Essential |
$31.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.61
|
|
|
PR DILAT FEMALE URETHRA W/SUPPOSITORY&/INSTLJ INI
|
Professional
|
Both
|
$176.65
|
|
|
Service Code
|
HCPCS 53660
|
| Min. Negotiated Rate |
$32.81 |
| Max. Negotiated Rate |
$105.46 |
| Rate for Payer: Cash Price |
$47.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.15
|
| Rate for Payer: Healthfirst Commercial |
$46.87
|
| Rate for Payer: Healthfirst Essential Plan |
$105.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.53
|
| Rate for Payer: Healthfirst QHP |
$46.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.15
|
| Rate for Payer: SOMOS Essential |
$35.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.87
|
|
|
PR DILAT FEMALE URT W/SUPPOSITORY&/INSTLJ SBSQ
|
Professional
|
Both
|
$172.17
|
|
|
Service Code
|
HCPCS 53661
|
| Min. Negotiated Rate |
$31.69 |
| Max. Negotiated Rate |
$101.86 |
| Rate for Payer: Cash Price |
$46.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.95
|
| Rate for Payer: Healthfirst Commercial |
$45.27
|
| Rate for Payer: Healthfirst Essential Plan |
$101.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.01
|
| Rate for Payer: Healthfirst QHP |
$45.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.95
|
| Rate for Payer: SOMOS Essential |
$33.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.27
|
|
|
PR DILATION CERVICAL CANAL INSTRUMENTAL SPX
|
Professional
|
Both
|
$205.45
|
|
|
Service Code
|
HCPCS 57800
|
| Min. Negotiated Rate |
$39.14 |
| Max. Negotiated Rate |
$125.80 |
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$55.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$53.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.93
|
| Rate for Payer: Healthfirst Commercial |
$55.91
|
| Rate for Payer: Healthfirst Essential Plan |
$125.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$53.11
|
| Rate for Payer: Healthfirst QHP |
$55.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$55.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.93
|
| Rate for Payer: SOMOS Essential |
$41.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.91
|
|
|
PR DILATION & CURETTAGE CERVICAL STUMP
|
Professional
|
Both
|
$560.98
|
|
|
Service Code
|
HCPCS 57558
|
| Min. Negotiated Rate |
$104.41 |
| Max. Negotiated Rate |
$335.59 |
| Rate for Payer: Cash Price |
$152.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$149.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$134.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$134.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$141.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$149.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$141.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$149.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$149.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$111.86
|
| Rate for Payer: Healthfirst Commercial |
$149.15
|
| Rate for Payer: Healthfirst Essential Plan |
$335.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$141.69
|
| Rate for Payer: Healthfirst QHP |
$149.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$104.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$149.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$126.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$104.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$149.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$111.86
|
| Rate for Payer: SOMOS Essential |
$111.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$149.15
|
|
