|
PR FIT CONTACT LENS TX OCULAR SURFACE DISEASE
|
Professional
|
Both
|
$127.89
|
|
|
Service Code
|
HCPCS 92071
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$78.01 |
| Rate for Payer: Amida Care Medicaid |
$14.19
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.00
|
| Rate for Payer: Healthfirst Commercial |
$34.67
|
| Rate for Payer: Healthfirst Essential Plan |
$78.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.94
|
| Rate for Payer: Healthfirst QHP |
$34.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.00
|
| Rate for Payer: SOMOS Essential |
$26.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.67
|
|
|
PR FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVI
|
Professional
|
Both
|
$198.66
|
|
|
Service Code
|
HCPCS 57160
|
| Min. Negotiated Rate |
$37.19 |
| Max. Negotiated Rate |
$119.54 |
| Rate for Payer: Cash Price |
$53.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.85
|
| Rate for Payer: Healthfirst Commercial |
$53.13
|
| Rate for Payer: Healthfirst Essential Plan |
$119.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.47
|
| Rate for Payer: Healthfirst QHP |
$53.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.85
|
| Rate for Payer: SOMOS Essential |
$39.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.13
|
|
|
PR FITTING CONTACT LENS FOR MGMT OF KERATOCONUS 1ST
|
Professional
|
Both
|
$365.79
|
|
|
Service Code
|
HCPCS 92072
|
| Min. Negotiated Rate |
$45.27 |
| Max. Negotiated Rate |
$220.97 |
| Rate for Payer: Amida Care Medicaid |
$45.27
|
| Rate for Payer: Cash Price |
$99.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$98.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$88.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$88.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$98.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.66
|
| Rate for Payer: Healthfirst Commercial |
$98.21
|
| Rate for Payer: Healthfirst Essential Plan |
$220.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$93.30
|
| Rate for Payer: Healthfirst QHP |
$98.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$98.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$83.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$73.66
|
| Rate for Payer: SOMOS Essential |
$73.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.21
|
|
|
PR FIXATION CONTRALATERAL TESTIS SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,256.05
|
|
|
Service Code
|
HCPCS 54620
|
| Min. Negotiated Rate |
$238.48 |
| Max. Negotiated Rate |
$766.55 |
| Rate for Payer: Cash Price |
$342.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$340.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$306.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$306.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$323.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$340.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$340.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$340.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$255.52
|
| Rate for Payer: Healthfirst Commercial |
$340.69
|
| Rate for Payer: Healthfirst Essential Plan |
$766.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$323.66
|
| Rate for Payer: Healthfirst QHP |
$340.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$238.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$340.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$289.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$238.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$340.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$255.52
|
| Rate for Payer: SOMOS Essential |
$255.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$340.69
|
|
|
PR FLAP ISLAND PEDICLE ANATOMIC NAMED AXIAL ARTERY
|
Professional
|
Both
|
$3,612.74
|
|
|
Service Code
|
HCPCS 15740
|
| Min. Negotiated Rate |
$687.44 |
| Max. Negotiated Rate |
$2,209.64 |
| Rate for Payer: Cash Price |
$984.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$982.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$883.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$883.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$982.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$982.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$982.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$736.54
|
| Rate for Payer: Healthfirst Commercial |
$982.06
|
| Rate for Payer: Healthfirst Essential Plan |
$2,209.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$932.96
|
| Rate for Payer: Healthfirst QHP |
$982.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$687.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$982.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$834.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$687.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$982.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$736.54
|
| Rate for Payer: SOMOS Essential |
$736.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$982.06
|
|
|
PR FLAP NEUROVASCULAR PEDICLE
|
Professional
|
Both
|
$4,043.69
|
|
|
Service Code
|
HCPCS 15750
|
| Min. Negotiated Rate |
$770.48 |
| Max. Negotiated Rate |
$2,476.53 |
| Rate for Payer: Cash Price |
$1,106.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,100.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$990.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$990.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,045.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,100.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,045.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$825.51
|
| Rate for Payer: Healthfirst Commercial |
$1,100.68
|
| Rate for Payer: Healthfirst Essential Plan |
$2,476.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,045.65
|
| Rate for Payer: Healthfirst QHP |
$1,100.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$770.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,100.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$935.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$770.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,100.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$825.51
|
| Rate for Payer: SOMOS Essential |
$825.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,100.68
|
|
|
PR FLEXIBLE ENDOSCOPIC EVAL LARYN SENS C/V REC I&R
|
Professional
|
Both
|
$132.97
|
|
|
Service Code
|
HCPCS 92615
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$80.59 |
| Rate for Payer: Amida Care Medicaid |
$17.47
|
| Rate for Payer: Cash Price |
$36.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.86
|
| Rate for Payer: Healthfirst Commercial |
$35.82
|
| Rate for Payer: Healthfirst Essential Plan |
$80.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.03
|
| Rate for Payer: Healthfirst QHP |
$35.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.86
|
| Rate for Payer: SOMOS Essential |
$26.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.82
|
|
|
PR FLEXIBLE ENDOSCOPIC EVAL LARYN SENSORY C/V REC
|
Professional
|
Both
|
$265.90
|
|
|
Service Code
|
HCPCS 92614
|
| Min. Negotiated Rate |
$39.39 |
| Max. Negotiated Rate |
$160.92 |
| Rate for Payer: Amida Care Medicaid |
$39.39
|
| Rate for Payer: Cash Price |
$72.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$71.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$64.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$67.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$71.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$67.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.64
|
| Rate for Payer: Healthfirst Commercial |
$71.52
|
| Rate for Payer: Healthfirst Essential Plan |
$160.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$67.94
|
| Rate for Payer: Healthfirst QHP |
$71.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$50.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$71.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$60.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$71.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$53.64
|
| Rate for Payer: SOMOS Essential |
$53.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.52
|
|
|
PR FLEXIBLE ENDOSCOPIC EVAL SWALLOW C/V REC
|
Professional
|
Both
|
$267.47
|
|
|
Service Code
|
HCPCS 92612
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$163.03 |
| Rate for Payer: Amida Care Medicaid |
$51.51
|
| Rate for Payer: Cash Price |
$73.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$65.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$68.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$68.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.34
|
| Rate for Payer: Healthfirst Commercial |
$72.46
|
| Rate for Payer: Healthfirst Essential Plan |
$163.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.84
|
| Rate for Payer: Healthfirst QHP |
$72.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$50.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$72.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$61.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.34
|
| Rate for Payer: SOMOS Essential |
$54.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.46
|
|
|
PR FLEXIBLE ENDOSCOPIC EVAL SWALLOW C/V REC I&R
|
Professional
|
Both
|
$148.75
|
|
|
Service Code
|
HCPCS 92613
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$90.29 |
| Rate for Payer: Amida Care Medicaid |
$20.20
|
| Rate for Payer: Cash Price |
$40.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.10
|
| Rate for Payer: Healthfirst Commercial |
$40.13
|
| Rate for Payer: Healthfirst Essential Plan |
$90.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.12
|
| Rate for Payer: Healthfirst QHP |
$40.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.10
|
| Rate for Payer: SOMOS Essential |
$30.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.13
|
|
|
PR FLEXIBLE NDSC EVAL SWLNG&LARYN SENS C/V I&R
|
Professional
|
Both
|
$163.07
|
|
|
Service Code
|
HCPCS 92617
|
| Min. Negotiated Rate |
$21.85 |
| Max. Negotiated Rate |
$99.11 |
| Rate for Payer: Amida Care Medicaid |
$21.85
|
| Rate for Payer: Cash Price |
$45.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$44.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.04
|
| Rate for Payer: Healthfirst Commercial |
$44.05
|
| Rate for Payer: Healthfirst Essential Plan |
$99.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.85
|
| Rate for Payer: Healthfirst QHP |
$44.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.04
|
| Rate for Payer: SOMOS Essential |
$33.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.05
|
|
|
PR FLEXIBLE NDSC EVAL SWLNG&LARYN SENS C/V REC
|
Professional
|
Both
|
$399.39
|
|
|
Service Code
|
HCPCS 92616
|
| Min. Negotiated Rate |
$53.53 |
| Max. Negotiated Rate |
$246.08 |
| Rate for Payer: Amida Care Medicaid |
$53.53
|
| Rate for Payer: Cash Price |
$109.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$109.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$98.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$98.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$103.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$109.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$103.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.03
|
| Rate for Payer: Healthfirst Commercial |
$109.37
|
| Rate for Payer: Healthfirst Essential Plan |
$246.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$103.90
|
| Rate for Payer: Healthfirst QHP |
$109.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$76.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$109.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$92.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$76.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$109.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.03
|
| Rate for Payer: SOMOS Essential |
$82.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$109.37
|
|
|
PR FLEXOR ORIGIN SLIDE F/ARM&/WRST TENDON TRANSFE
|
Professional
|
Both
|
$4,063.47
|
|
|
Service Code
|
HCPCS 25316
|
| Min. Negotiated Rate |
$764.13 |
| Max. Negotiated Rate |
$2,456.12 |
| Rate for Payer: Cash Price |
$1,097.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,091.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$982.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$982.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,037.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,091.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,037.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,091.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,091.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$818.71
|
| Rate for Payer: Healthfirst Commercial |
$1,091.61
|
| Rate for Payer: Healthfirst Essential Plan |
$2,456.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,037.03
|
| Rate for Payer: Healthfirst QHP |
$1,091.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$764.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,091.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$927.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$764.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,091.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$818.71
|
| Rate for Payer: SOMOS Essential |
$818.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,091.61
|
|
|
PR FLEXOR ORIGIN SLIDE FOREARM &/WRIST
|
Professional
|
Both
|
$3,418.03
|
|
|
Service Code
|
HCPCS 25315
|
| Min. Negotiated Rate |
$643.25 |
| Max. Negotiated Rate |
$2,067.59 |
| Rate for Payer: Cash Price |
$924.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$918.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$827.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$827.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$872.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$918.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$872.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$918.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$918.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$689.20
|
| Rate for Payer: Healthfirst Commercial |
$918.93
|
| Rate for Payer: Healthfirst Essential Plan |
$2,067.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$872.98
|
| Rate for Payer: Healthfirst QHP |
$918.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$643.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$918.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$781.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$643.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$918.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$689.20
|
| Rate for Payer: SOMOS Essential |
$689.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$918.93
|
|
|
PR FLEXOR-PLASTY ELBOW
|
Professional
|
Both
|
$3,191.20
|
|
|
Service Code
|
HCPCS 24330
|
| Min. Negotiated Rate |
$601.66 |
| Max. Negotiated Rate |
$1,933.92 |
| Rate for Payer: Cash Price |
$863.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$859.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$773.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$773.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$816.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$859.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$816.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$859.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$859.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$644.64
|
| Rate for Payer: Healthfirst Commercial |
$859.52
|
| Rate for Payer: Healthfirst Essential Plan |
$1,933.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$816.54
|
| Rate for Payer: Healthfirst QHP |
$859.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$601.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$859.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$730.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$601.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$859.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$644.64
|
| Rate for Payer: SOMOS Essential |
$644.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$859.52
|
|
|
PR FLEXOR-PLASTY ELBOW W/EXTENSOR ADVANCEMENT
|
Professional
|
Both
|
$3,484.22
|
|
|
Service Code
|
HCPCS 24331
|
| Min. Negotiated Rate |
$656.87 |
| Max. Negotiated Rate |
$2,111.36 |
| Rate for Payer: Cash Price |
$941.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$938.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$844.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$844.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$891.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$938.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$891.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$938.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$938.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$703.78
|
| Rate for Payer: Healthfirst Commercial |
$938.38
|
| Rate for Payer: Healthfirst Essential Plan |
$2,111.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.46
|
| Rate for Payer: Healthfirst QHP |
$938.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$656.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$938.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$797.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$656.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$938.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$703.78
|
| Rate for Payer: SOMOS Essential |
$703.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$938.38
|
|
|
PR FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT
|
Professional
|
Both
|
$140.74
|
|
|
Service Code
|
HCPCS 92230
|
| Min. Negotiated Rate |
$24.35 |
| Max. Negotiated Rate |
$78.28 |
| Rate for Payer: Cash Price |
$38.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.09
|
| Rate for Payer: Healthfirst Commercial |
$34.79
|
| Rate for Payer: Healthfirst Essential Plan |
$78.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.05
|
| Rate for Payer: Healthfirst QHP |
$34.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.09
|
| Rate for Payer: SOMOS Essential |
$26.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.79
|
|
|
PR FLUORESCEIN ANGRPH W/MULTIFRAME IMG I&R UNI/BI
|
Professional
|
Both
|
$165.66
|
|
|
Service Code
|
HCPCS 92235 26
|
| Min. Negotiated Rate |
$31.83 |
| Max. Negotiated Rate |
$102.31 |
| Rate for Payer: Amida Care Medicaid |
$98.86
|
| Rate for Payer: Cash Price |
$45.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.10
|
| Rate for Payer: Healthfirst Commercial |
$45.47
|
| Rate for Payer: Healthfirst Essential Plan |
$102.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.20
|
| Rate for Payer: Healthfirst QHP |
$45.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.10
|
| Rate for Payer: SOMOS Essential |
$34.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.47
|
|
|
PR FLUORESCEIN ANGRPH W/MULTIFRAME IMG I&R UNI/BI
|
Professional
|
Both
|
$576.66
|
|
|
Service Code
|
HCPCS 92235
|
| Min. Negotiated Rate |
$98.86 |
| Max. Negotiated Rate |
$405.90 |
| Rate for Payer: Amida Care Medicaid |
$98.86
|
| Rate for Payer: Cash Price |
$188.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$180.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$162.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$162.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$171.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$171.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$180.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$135.30
|
| Rate for Payer: Healthfirst Commercial |
$180.40
|
| Rate for Payer: Healthfirst Essential Plan |
$405.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$171.38
|
| Rate for Payer: Healthfirst QHP |
$180.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$126.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$180.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$153.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$126.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$135.30
|
| Rate for Payer: SOMOS Essential |
$135.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.40
|
|
|
PR FLUORESCEIN ANGRPH W/MULTIFRAME IMG I&R UNI/BI
|
Professional
|
Both
|
$410.97
|
|
|
Service Code
|
HCPCS 92235 TC
|
| Min. Negotiated Rate |
$94.44 |
| Max. Negotiated Rate |
$303.57 |
| Rate for Payer: Amida Care Medicaid |
$98.86
|
| Rate for Payer: Cash Price |
$142.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$134.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$121.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$121.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$128.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$134.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$128.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$134.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$134.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$101.19
|
| Rate for Payer: Healthfirst Commercial |
$134.92
|
| Rate for Payer: Healthfirst Essential Plan |
$303.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$128.17
|
| Rate for Payer: Healthfirst QHP |
$134.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$94.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$134.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$114.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$94.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$134.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$101.19
|
| Rate for Payer: SOMOS Essential |
$101.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$134.92
|
|
|
PR FLUORESCEIN&ICG ANGRPH MULTIFRAME IMG I&R UNI/BI
|
Professional
|
Both
|
$881.06
|
|
|
Service Code
|
HCPCS 92242 TC
|
| Min. Negotiated Rate |
$185.26 |
| Max. Negotiated Rate |
$709.67 |
| Rate for Payer: Amida Care Medicaid |
$185.26
|
| Rate for Payer: Cash Price |
$269.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$315.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$283.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$283.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$299.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$315.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$299.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$315.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$315.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$236.56
|
| Rate for Payer: Healthfirst Commercial |
$315.41
|
| Rate for Payer: Healthfirst Essential Plan |
$709.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$299.64
|
| Rate for Payer: Healthfirst QHP |
$315.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$220.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$315.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$268.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$220.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$315.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$236.56
|
| Rate for Payer: SOMOS Essential |
$236.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$315.41
|
|
|
PR FLUORESCEIN&ICG ANGRPH MULTIFRAME IMG I&R UNI/BI
|
Professional
|
Both
|
$217.63
|
|
|
Service Code
|
HCPCS 92242 26
|
| Min. Negotiated Rate |
$41.05 |
| Max. Negotiated Rate |
$185.26 |
| Rate for Payer: Amida Care Medicaid |
$185.26
|
| Rate for Payer: Cash Price |
$58.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$58.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$52.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$58.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.99
|
| Rate for Payer: Healthfirst Commercial |
$58.65
|
| Rate for Payer: Healthfirst Essential Plan |
$131.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$55.72
|
| Rate for Payer: Healthfirst QHP |
$58.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$58.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$49.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$58.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$43.99
|
| Rate for Payer: SOMOS Essential |
$43.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.65
|
|
|
PR FLUORESCEIN&ICG ANGRPH MULTIFRAME IMG I&R UNI/BI
|
Professional
|
Both
|
$1,098.65
|
|
|
Service Code
|
HCPCS 92242
|
| Min. Negotiated Rate |
$185.26 |
| Max. Negotiated Rate |
$841.63 |
| Rate for Payer: Amida Care Medicaid |
$185.26
|
| Rate for Payer: Cash Price |
$327.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$374.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$336.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$336.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$355.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$374.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$355.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$374.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$374.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$280.55
|
| Rate for Payer: Healthfirst Commercial |
$374.06
|
| Rate for Payer: Healthfirst Essential Plan |
$841.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$355.36
|
| Rate for Payer: Healthfirst QHP |
$374.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$261.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$374.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$317.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$261.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$374.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$280.55
|
| Rate for Payer: SOMOS Essential |
$280.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$374.06
|
|
|
PR FOLLICLE PUNCTURE OOCYTE RETRIEVAL ANY METHOD
|
Professional
|
Both
|
$849.70
|
|
|
Service Code
|
HCPCS 58970
|
| Min. Negotiated Rate |
$158.94 |
| Max. Negotiated Rate |
$510.86 |
| Rate for Payer: Cash Price |
$228.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$227.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$204.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$204.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$215.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$227.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$215.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$227.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$227.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$170.29
|
| Rate for Payer: Healthfirst Commercial |
$227.05
|
| Rate for Payer: Healthfirst Essential Plan |
$510.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$215.70
|
| Rate for Payer: Healthfirst QHP |
$227.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$158.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$227.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$192.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$158.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$227.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$170.29
|
| Rate for Payer: SOMOS Essential |
$170.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.05
|
|
|
PR FOLLOWUP EVAL OF FOOT PT LOP
|
Professional
|
Both
|
$79.10
|
|
|
Service Code
|
HCPCS G0246
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$48.15 |
| Rate for Payer: Cash Price |
$21.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.05
|
| Rate for Payer: Healthfirst Commercial |
$21.40
|
| Rate for Payer: Healthfirst Essential Plan |
$48.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.33
|
| Rate for Payer: Healthfirst QHP |
$21.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$21.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$18.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16.05
|
| Rate for Payer: SOMOS Essential |
$16.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.40
|
|
