|
PR ENUCLEATION EYE IMPLT MUSC X ATTACHED IMPLT
|
Professional
|
Both
|
$3,683.93
|
|
|
Service Code
|
HCPCS 65103
|
| Min. Negotiated Rate |
$689.23 |
| Max. Negotiated Rate |
$2,215.37 |
| Rate for Payer: Cash Price |
$1,009.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$984.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$886.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$886.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$935.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$984.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$935.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$984.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$984.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$738.46
|
| Rate for Payer: Healthfirst Commercial |
$984.61
|
| Rate for Payer: Healthfirst Essential Plan |
$2,215.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$935.38
|
| Rate for Payer: Healthfirst QHP |
$984.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$689.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$984.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$836.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$689.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$984.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$738.46
|
| Rate for Payer: SOMOS Essential |
$738.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$984.61
|
|
|
PR ENUCLEATION OF EYE W/O IMPLANT
|
Professional
|
Both
|
$3,583.51
|
|
|
Service Code
|
HCPCS 65101
|
| Min. Negotiated Rate |
$666.65 |
| Max. Negotiated Rate |
$2,142.81 |
| Rate for Payer: Cash Price |
$978.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$952.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$857.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$857.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$904.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$952.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$904.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$952.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$952.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$714.27
|
| Rate for Payer: Healthfirst Commercial |
$952.36
|
| Rate for Payer: Healthfirst Essential Plan |
$2,142.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$904.74
|
| Rate for Payer: Healthfirst QHP |
$952.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$666.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$952.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$809.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$666.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$952.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$714.27
|
| Rate for Payer: SOMOS Essential |
$714.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$952.36
|
|
|
PR ENZYME HISTOCHEMISTRY
|
Professional
|
Both
|
$471.21
|
|
|
Service Code
|
HCPCS 88319 TC
|
| Min. Negotiated Rate |
$89.45 |
| Max. Negotiated Rate |
$287.50 |
| Rate for Payer: Cash Price |
$130.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$115.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$115.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$121.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$121.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.83
|
| Rate for Payer: Healthfirst Commercial |
$127.78
|
| Rate for Payer: Healthfirst Essential Plan |
$287.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$121.39
|
| Rate for Payer: Healthfirst QHP |
$127.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$89.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$127.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$108.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$89.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$95.83
|
| Rate for Payer: SOMOS Essential |
$95.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.78
|
|
|
PR ENZYME HISTOCHEMISTRY
|
Professional
|
Both
|
$103.60
|
|
|
Service Code
|
HCPCS 88319 26
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$63.43 |
| Rate for Payer: Cash Price |
$28.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.14
|
| Rate for Payer: Healthfirst Commercial |
$28.19
|
| Rate for Payer: Healthfirst Essential Plan |
$63.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.78
|
| Rate for Payer: Healthfirst QHP |
$28.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.14
|
| Rate for Payer: SOMOS Essential |
$21.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.19
|
|
|
PR ENZYME HISTOCHEMISTRY
|
Professional
|
Both
|
$574.84
|
|
|
Service Code
|
HCPCS 88319
|
| Min. Negotiated Rate |
$109.18 |
| Max. Negotiated Rate |
$350.93 |
| Rate for Payer: Cash Price |
$159.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$155.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$140.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$140.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$148.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$155.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$148.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$155.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$155.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$116.98
|
| Rate for Payer: Healthfirst Commercial |
$155.97
|
| Rate for Payer: Healthfirst Essential Plan |
$350.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$148.17
|
| Rate for Payer: Healthfirst QHP |
$155.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$109.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$155.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$132.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$109.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$155.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$116.98
|
| Rate for Payer: SOMOS Essential |
$116.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$155.97
|
|
|
PR EPHYS EVAL PACG CVDFB LDS INITIAL IMPLAN/REPLACE
|
Professional
|
Both
|
$758.07
|
|
|
Service Code
|
HCPCS 93640 26
|
| Min. Negotiated Rate |
$139.52 |
| Max. Negotiated Rate |
$448.45 |
| Rate for Payer: Amida Care Medicaid |
$383.89
|
| Rate for Payer: Cash Price |
$201.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$199.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$179.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$179.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$189.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$199.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$189.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$199.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$149.48
|
| Rate for Payer: Healthfirst Commercial |
$199.31
|
| Rate for Payer: Healthfirst Essential Plan |
$448.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$189.34
|
| Rate for Payer: Healthfirst QHP |
$199.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$139.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$199.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$169.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$139.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$199.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$149.48
|
| Rate for Payer: SOMOS Essential |
$149.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$199.31
|
|
|
PR EPHYS EVAL PACG CVDFB LDS INITIAL IMPLAN/REPLACE
|
Professional
|
Both
|
$2,218.48
|
|
|
Service Code
|
HCPCS 93640
|
| Min. Negotiated Rate |
$383.89 |
| Max. Negotiated Rate |
$383.89 |
| Rate for Payer: Amida Care Medicaid |
$383.89
|
|
|
PR EPHYS EVAL PACG CVDFB LDS INITIAL IMPLAN/REPLACE
|
Professional
|
Both
|
$1,460.41
|
|
|
Service Code
|
HCPCS 93640 TC
|
| Min. Negotiated Rate |
$383.89 |
| Max. Negotiated Rate |
$383.89 |
| Rate for Payer: Amida Care Medicaid |
$383.89
|
|
|
PR EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN
|
Professional
|
Both
|
$2,794.09
|
|
|
Service Code
|
HCPCS 93641
|
| Min. Negotiated Rate |
$485.00 |
| Max. Negotiated Rate |
$485.00 |
| Rate for Payer: Amida Care Medicaid |
$485.00
|
|
|
PR EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN
|
Professional
|
Both
|
$1,333.68
|
|
|
Service Code
|
HCPCS 93641 26
|
| Min. Negotiated Rate |
$242.75 |
| Max. Negotiated Rate |
$780.28 |
| Rate for Payer: Amida Care Medicaid |
$485.00
|
| Rate for Payer: Cash Price |
$353.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$346.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$312.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$312.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$329.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$346.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$329.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$346.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$346.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$260.09
|
| Rate for Payer: Healthfirst Commercial |
$346.79
|
| Rate for Payer: Healthfirst Essential Plan |
$780.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$329.45
|
| Rate for Payer: Healthfirst QHP |
$346.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$242.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$346.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$294.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$242.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$346.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$260.09
|
| Rate for Payer: SOMOS Essential |
$260.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$346.79
|
|
|
PR EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN
|
Professional
|
Both
|
$1,460.41
|
|
|
Service Code
|
HCPCS 93641 TC
|
| Min. Negotiated Rate |
$485.00 |
| Max. Negotiated Rate |
$485.00 |
| Rate for Payer: Amida Care Medicaid |
$485.00
|
|
|
PR EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS
|
Professional
|
Both
|
$1,085.60
|
|
|
Service Code
|
HCPCS 93642 26
|
| Min. Negotiated Rate |
$199.29 |
| Max. Negotiated Rate |
$640.58 |
| Rate for Payer: Amida Care Medicaid |
$402.04
|
| Rate for Payer: Cash Price |
$287.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$284.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$256.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$256.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$270.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$284.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$270.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$284.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$284.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$213.53
|
| Rate for Payer: Healthfirst Commercial |
$284.70
|
| Rate for Payer: Healthfirst Essential Plan |
$640.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$270.46
|
| Rate for Payer: Healthfirst QHP |
$284.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$199.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$284.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$242.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$199.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$284.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$213.53
|
| Rate for Payer: SOMOS Essential |
$213.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$284.70
|
|
|
PR EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS
|
Professional
|
Both
|
$360.26
|
|
|
Service Code
|
HCPCS 93642 TC
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$402.04 |
| Rate for Payer: Amida Care Medicaid |
$402.04
|
| Rate for Payer: Cash Price |
$96.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$95.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$86.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$95.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$95.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$71.84
|
| Rate for Payer: Healthfirst Commercial |
$95.79
|
| Rate for Payer: Healthfirst Essential Plan |
$215.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$91.00
|
| Rate for Payer: Healthfirst QHP |
$95.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$67.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$95.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$81.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$67.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$95.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$71.84
|
| Rate for Payer: SOMOS Essential |
$71.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$95.79
|
|
|
PR EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS
|
Professional
|
Both
|
$1,445.85
|
|
|
Service Code
|
HCPCS 93642
|
| Min. Negotiated Rate |
$266.34 |
| Max. Negotiated Rate |
$856.10 |
| Rate for Payer: Amida Care Medicaid |
$402.04
|
| Rate for Payer: Cash Price |
$384.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$380.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$342.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$342.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$361.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$380.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$361.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$380.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$380.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$285.37
|
| Rate for Payer: Healthfirst Commercial |
$380.49
|
| Rate for Payer: Healthfirst Essential Plan |
$856.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$361.47
|
| Rate for Payer: Healthfirst QHP |
$380.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$266.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$380.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$323.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$266.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$380.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$285.37
|
| Rate for Payer: SOMOS Essential |
$285.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$380.49
|
|
|
PR EPHYS EVAL SUBQ IMPLANTABLE DEFIBRILLATOR
|
Professional
|
Both
|
$774.55
|
|
|
Service Code
|
HCPCS 93644
|
| Min. Negotiated Rate |
$145.94 |
| Max. Negotiated Rate |
$469.10 |
| Rate for Payer: Amida Care Medicaid |
$198.99
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$208.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$187.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$187.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$198.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$208.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$198.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$208.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$208.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$156.37
|
| Rate for Payer: Healthfirst Commercial |
$208.49
|
| Rate for Payer: Healthfirst Essential Plan |
$469.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$198.07
|
| Rate for Payer: Healthfirst QHP |
$208.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$145.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$208.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$177.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$145.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$208.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$156.37
|
| Rate for Payer: SOMOS Essential |
$156.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$208.49
|
|
|
PR EPHYS EVAL SUBQ IMPLANTABLE DEFIBRILLATOR
|
Professional
|
Both
|
$556.19
|
|
|
Service Code
|
HCPCS 93644 26
|
| Min. Negotiated Rate |
$105.30 |
| Max. Negotiated Rate |
$338.47 |
| Rate for Payer: Amida Care Medicaid |
$198.99
|
| Rate for Payer: Cash Price |
$152.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$150.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$135.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$142.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$142.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.82
|
| Rate for Payer: Healthfirst Commercial |
$150.43
|
| Rate for Payer: Healthfirst Essential Plan |
$338.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$142.91
|
| Rate for Payer: Healthfirst QHP |
$150.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$150.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$127.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$112.82
|
| Rate for Payer: SOMOS Essential |
$112.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150.43
|
|
|
PR EPHYS EVAL SUBQ IMPLANTABLE DEFIBRILLATOR
|
Professional
|
Both
|
$218.37
|
|
|
Service Code
|
HCPCS 93644 TC
|
| Min. Negotiated Rate |
$40.65 |
| Max. Negotiated Rate |
$198.99 |
| Rate for Payer: Amida Care Medicaid |
$198.99
|
| Rate for Payer: Cash Price |
$59.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$58.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$52.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$58.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.55
|
| Rate for Payer: Healthfirst Commercial |
$58.07
|
| Rate for Payer: Healthfirst Essential Plan |
$130.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$55.17
|
| Rate for Payer: Healthfirst QHP |
$58.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$58.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$49.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$58.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$43.55
|
| Rate for Payer: SOMOS Essential |
$43.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.07
|
|
|
PR EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/<
|
Professional
|
Both
|
$2,963.38
|
|
|
Service Code
|
HCPCS 15115
|
| Min. Negotiated Rate |
$568.58 |
| Max. Negotiated Rate |
$1,827.59 |
| Rate for Payer: Cash Price |
$811.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$812.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$731.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$731.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$771.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$812.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$771.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$812.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$812.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$609.20
|
| Rate for Payer: Healthfirst Commercial |
$812.26
|
| Rate for Payer: Healthfirst Essential Plan |
$1,827.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$771.65
|
| Rate for Payer: Healthfirst QHP |
$812.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$568.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$812.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$690.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$568.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$812.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$609.20
|
| Rate for Payer: SOMOS Essential |
$609.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$812.26
|
|
|
PR EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100 CM
|
Professional
|
Both
|
$620.31
|
|
|
Service Code
|
HCPCS 15116
|
| Min. Negotiated Rate |
$113.59 |
| Max. Negotiated Rate |
$365.11 |
| Rate for Payer: Cash Price |
$163.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$162.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$146.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$146.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$154.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$162.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$154.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$162.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$162.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$121.70
|
| Rate for Payer: Healthfirst Commercial |
$162.27
|
| Rate for Payer: Healthfirst Essential Plan |
$365.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$154.16
|
| Rate for Payer: Healthfirst QHP |
$162.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$113.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$162.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$137.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$113.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$162.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$121.70
|
| Rate for Payer: SOMOS Essential |
$121.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$162.27
|
|
|
PR EPIDIDYMECTOMY BILATERAL
|
Professional
|
Both
|
$2,386.30
|
|
|
Service Code
|
HCPCS 54861
|
| Min. Negotiated Rate |
$455.01 |
| Max. Negotiated Rate |
$1,462.52 |
| Rate for Payer: Cash Price |
$655.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$650.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$585.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$585.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$617.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$650.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$617.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$650.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$650.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$487.51
|
| Rate for Payer: Healthfirst Commercial |
$650.01
|
| Rate for Payer: Healthfirst Essential Plan |
$1,462.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$617.51
|
| Rate for Payer: Healthfirst QHP |
$650.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$455.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$650.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$552.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$455.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$650.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$487.51
|
| Rate for Payer: SOMOS Essential |
$487.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$650.01
|
|
|
PR EPIDIDYMECTOMY UNILATERAL
|
Professional
|
Both
|
$1,763.27
|
|
|
Service Code
|
HCPCS 54860
|
| Min. Negotiated Rate |
$336.92 |
| Max. Negotiated Rate |
$1,082.95 |
| Rate for Payer: Cash Price |
$484.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$481.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$433.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$433.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$457.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$481.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$457.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$481.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$481.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$360.98
|
| Rate for Payer: Healthfirst Commercial |
$481.31
|
| Rate for Payer: Healthfirst Essential Plan |
$1,082.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$457.24
|
| Rate for Payer: Healthfirst QHP |
$481.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$336.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$481.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$409.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$336.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$481.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$360.98
|
| Rate for Payer: SOMOS Essential |
$360.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$481.31
|
|
|
PR EPIDIDYMOVASOSTOMY ANAST EPIDIDYMIS BI
|
Professional
|
Both
|
$4,426.28
|
|
|
Service Code
|
HCPCS 54901
|
| Min. Negotiated Rate |
$841.21 |
| Max. Negotiated Rate |
$2,703.89 |
| Rate for Payer: Cash Price |
$1,208.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,201.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,081.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,081.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,141.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,201.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,141.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,201.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,201.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$901.30
|
| Rate for Payer: Healthfirst Commercial |
$1,201.73
|
| Rate for Payer: Healthfirst Essential Plan |
$2,703.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,141.64
|
| Rate for Payer: Healthfirst QHP |
$1,201.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$841.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,201.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,021.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$841.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,201.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$901.30
|
| Rate for Payer: SOMOS Essential |
$901.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,201.73
|
|
|
PR EPIDIDYMOVASOSTOMY ANAST EPIDIDYMIS UNI
|
Professional
|
Both
|
$3,353.56
|
|
|
Service Code
|
HCPCS 54900
|
| Min. Negotiated Rate |
$638.83 |
| Max. Negotiated Rate |
$2,053.39 |
| Rate for Payer: Cash Price |
$916.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$912.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$821.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$821.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$866.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$912.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$866.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$912.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$912.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$684.47
|
| Rate for Payer: Healthfirst Commercial |
$912.62
|
| Rate for Payer: Healthfirst Essential Plan |
$2,053.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$866.99
|
| Rate for Payer: Healthfirst QHP |
$912.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$638.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$912.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$775.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$638.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$912.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$684.47
|
| Rate for Payer: SOMOS Essential |
$684.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$912.62
|
|
|
PR EPIDRM AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD
|
Professional
|
Both
|
$3,119.80
|
|
|
Service Code
|
HCPCS 15110
|
| Min. Negotiated Rate |
$587.11 |
| Max. Negotiated Rate |
$1,887.14 |
| Rate for Payer: Cash Price |
$844.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$838.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$754.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$754.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$796.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$838.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$796.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$838.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$838.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$629.05
|
| Rate for Payer: Healthfirst Commercial |
$838.73
|
| Rate for Payer: Healthfirst Essential Plan |
$1,887.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$796.79
|
| Rate for Payer: Healthfirst QHP |
$838.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$587.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$838.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$712.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$587.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$838.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$629.05
|
| Rate for Payer: SOMOS Essential |
$629.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$838.73
|
|
|
PR EPIDRM AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD
|
Professional
|
Both
|
$454.58
|
|
|
Service Code
|
HCPCS 15111
|
| Min. Negotiated Rate |
$84.14 |
| Max. Negotiated Rate |
$270.45 |
| Rate for Payer: Cash Price |
$120.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$120.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$114.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$120.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$114.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$90.15
|
| Rate for Payer: Healthfirst Commercial |
$120.20
|
| Rate for Payer: Healthfirst Essential Plan |
$270.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$114.19
|
| Rate for Payer: Healthfirst QHP |
$120.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$84.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$120.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$102.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$84.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$120.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$90.15
|
| Rate for Payer: SOMOS Essential |
$90.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$120.20
|
|
