|
PR IMPL OI IMPLT SKULL MAG TC ATTACHMENT ESP<100
|
Professional
|
Both
|
$2,677.22
|
|
|
Service Code
|
HCPCS 69716
|
| Min. Negotiated Rate |
$501.15 |
| Max. Negotiated Rate |
$1,610.84 |
| Rate for Payer: Cash Price |
$724.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$715.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$644.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$644.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$680.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$715.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$680.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$715.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$715.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$536.95
|
| Rate for Payer: Healthfirst Commercial |
$715.93
|
| Rate for Payer: Healthfirst Essential Plan |
$1,610.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$680.13
|
| Rate for Payer: Healthfirst QHP |
$715.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$501.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$715.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$608.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$501.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$715.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$536.95
|
| Rate for Payer: SOMOS Essential |
$536.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$715.93
|
|
|
PR IMPL OI IMPLT SKULL MAG TC ATTACHMENT ESP>=100
|
Professional
|
Both
|
$2,901.99
|
|
|
Service Code
|
HCPCS 69729
|
| Min. Negotiated Rate |
$542.97 |
| Max. Negotiated Rate |
$1,745.26 |
| Rate for Payer: Cash Price |
$786.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$775.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$698.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$698.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$736.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$775.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$736.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$775.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$775.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$581.75
|
| Rate for Payer: Healthfirst Commercial |
$775.67
|
| Rate for Payer: Healthfirst Essential Plan |
$1,745.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$736.89
|
| Rate for Payer: Healthfirst QHP |
$775.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$542.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$775.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$659.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$542.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$775.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$581.75
|
| Rate for Payer: SOMOS Essential |
$581.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$775.67
|
|
|
PR IMPLTJ BRAIN INTRACAVITARY CHEMOTHERAPY AGENT
|
Professional
|
Both
|
$419.65
|
|
|
Service Code
|
HCPCS 61517
|
| Min. Negotiated Rate |
$76.85 |
| Max. Negotiated Rate |
$247.03 |
| Rate for Payer: Cash Price |
$110.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$109.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$98.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$98.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$104.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$109.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$104.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.34
|
| Rate for Payer: Healthfirst Commercial |
$109.79
|
| Rate for Payer: Healthfirst Essential Plan |
$247.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$104.30
|
| Rate for Payer: Healthfirst QHP |
$109.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$76.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$109.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$93.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$76.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$109.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.34
|
| Rate for Payer: SOMOS Essential |
$82.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$109.79
|
|
|
PR IMPLTJ INTRAVITREAL DRUG DLVR SYS RMVL VTS
|
Professional
|
Both
|
$3,479.81
|
|
|
Service Code
|
HCPCS 67027
|
| Min. Negotiated Rate |
$659.99 |
| Max. Negotiated Rate |
$2,121.39 |
| Rate for Payer: Cash Price |
$957.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$942.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$848.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$848.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$895.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$942.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$895.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$942.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$942.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$707.13
|
| Rate for Payer: Healthfirst Commercial |
$942.84
|
| Rate for Payer: Healthfirst Essential Plan |
$2,121.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$895.70
|
| Rate for Payer: Healthfirst QHP |
$942.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$659.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$942.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$801.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$659.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$942.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$707.13
|
| Rate for Payer: SOMOS Essential |
$707.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$942.84
|
|
|
PR IMPLTJ OI IMPLT SKULL PERQ ATTACHMENT ESP
|
Professional
|
Both
|
$2,133.04
|
|
|
Service Code
|
HCPCS 69714
|
| Min. Negotiated Rate |
$401.02 |
| Max. Negotiated Rate |
$1,289.00 |
| Rate for Payer: Cash Price |
$580.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$572.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$515.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$515.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$544.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$572.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$544.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$572.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$572.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$429.67
|
| Rate for Payer: Healthfirst Commercial |
$572.89
|
| Rate for Payer: Healthfirst Essential Plan |
$1,289.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$544.25
|
| Rate for Payer: Healthfirst QHP |
$572.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$401.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$572.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$486.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$401.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$572.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$429.67
|
| Rate for Payer: SOMOS Essential |
$429.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$572.89
|
|
|
PR IMPLTJ REVJ/RPSG ITHCL/EDRL CATH PMP W/O LAM
|
Professional
|
Both
|
$1,750.63
|
|
|
Service Code
|
HCPCS 62350
|
| Min. Negotiated Rate |
$331.16 |
| Max. Negotiated Rate |
$1,064.45 |
| Rate for Payer: Cash Price |
$474.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$473.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$425.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$425.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$449.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$473.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$449.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$473.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$473.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$354.82
|
| Rate for Payer: Healthfirst Commercial |
$473.09
|
| Rate for Payer: Healthfirst Essential Plan |
$1,064.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$449.44
|
| Rate for Payer: Healthfirst QHP |
$473.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$331.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$473.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$402.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$331.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$473.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$354.82
|
| Rate for Payer: SOMOS Essential |
$354.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$473.09
|
|
|
PR IMPLTJ REVJ/RPSG ITHCL/EDRL CATH W/LAM
|
Professional
|
Both
|
$4,246.45
|
|
|
Service Code
|
HCPCS 62351
|
| Min. Negotiated Rate |
$794.82 |
| Max. Negotiated Rate |
$2,554.76 |
| Rate for Payer: Cash Price |
$1,144.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,135.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,021.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,021.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,078.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,135.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,078.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,135.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,135.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$851.59
|
| Rate for Payer: Healthfirst Commercial |
$1,135.45
|
| Rate for Payer: Healthfirst Essential Plan |
$2,554.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,078.68
|
| Rate for Payer: Healthfirst QHP |
$1,135.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$794.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,135.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$965.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$794.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,135.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$851.59
|
| Rate for Payer: SOMOS Essential |
$851.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,135.45
|
|
|
PR IMPLTJ/RPLCMT FS NON-PRGRBL PUMP
|
Professional
|
Both
|
$2,063.01
|
|
|
Service Code
|
HCPCS 62361
|
| Min. Negotiated Rate |
$383.60 |
| Max. Negotiated Rate |
$1,233.00 |
| Rate for Payer: Cash Price |
$551.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$548.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$493.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$493.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$520.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$548.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$520.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$548.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$548.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$411.00
|
| Rate for Payer: Healthfirst Commercial |
$548.00
|
| Rate for Payer: Healthfirst Essential Plan |
$1,233.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$520.60
|
| Rate for Payer: Healthfirst QHP |
$548.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$383.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$548.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$465.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$383.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$548.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$411.00
|
| Rate for Payer: SOMOS Essential |
$411.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$548.00
|
|
|
PR IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS PRGRBL PUMP
|
Professional
|
Both
|
$1,722.95
|
|
|
Service Code
|
HCPCS 62362
|
| Min. Negotiated Rate |
$322.80 |
| Max. Negotiated Rate |
$1,037.57 |
| Rate for Payer: Cash Price |
$464.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$415.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$415.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$438.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$438.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$461.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$345.86
|
| Rate for Payer: Healthfirst Commercial |
$461.14
|
| Rate for Payer: Healthfirst Essential Plan |
$1,037.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$438.08
|
| Rate for Payer: Healthfirst QHP |
$461.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$322.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$391.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$322.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$345.86
|
| Rate for Payer: SOMOS Essential |
$345.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.14
|
|
|
PR IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS SUBQ RSVR
|
Professional
|
Both
|
$1,426.60
|
|
|
Service Code
|
HCPCS 62360
|
| Min. Negotiated Rate |
$262.67 |
| Max. Negotiated Rate |
$844.29 |
| Rate for Payer: Cash Price |
$373.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$375.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$337.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$337.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$356.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$375.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$356.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$375.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$375.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$281.43
|
| Rate for Payer: Healthfirst Commercial |
$375.24
|
| Rate for Payer: Healthfirst Essential Plan |
$844.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$356.48
|
| Rate for Payer: Healthfirst QHP |
$375.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$262.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$375.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$318.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$262.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$375.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$281.43
|
| Rate for Payer: SOMOS Essential |
$281.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$375.24
|
|
|
PR IMPLTJ TOTAL RPLCMT HEART SYS W/RCP CARDIECTOMY
|
Professional
|
Both
|
$11,329.61
|
|
|
Service Code
|
HCPCS 33927
|
| Min. Negotiated Rate |
$2,071.78 |
| Max. Negotiated Rate |
$6,659.30 |
| Rate for Payer: Cash Price |
$2,997.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,959.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,663.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,663.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,811.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,959.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,811.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,959.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,959.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,219.77
|
| Rate for Payer: Healthfirst Commercial |
$2,959.69
|
| Rate for Payer: Healthfirst Essential Plan |
$6,659.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,811.71
|
| Rate for Payer: Healthfirst QHP |
$2,959.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,071.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,959.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,515.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,071.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,959.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,219.77
|
| Rate for Payer: SOMOS Essential |
$2,219.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,959.69
|
|
|
PR IMPRESSION & PREPARATION AURICULAR PROSTHESIS
|
Professional
|
Both
|
$5,317.41
|
|
|
Service Code
|
HCPCS 21086
|
| Min. Negotiated Rate |
$1,021.94 |
| Max. Negotiated Rate |
$3,284.80 |
| Rate for Payer: Cash Price |
$1,446.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,459.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,313.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,313.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,386.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,459.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,386.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,459.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,459.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,094.93
|
| Rate for Payer: Healthfirst Commercial |
$1,459.91
|
| Rate for Payer: Healthfirst Essential Plan |
$3,284.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,386.91
|
| Rate for Payer: Healthfirst QHP |
$1,459.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,021.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,459.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,240.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,021.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,459.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,094.93
|
| Rate for Payer: SOMOS Essential |
$1,094.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,459.91
|
|
|
PR IMPRESSION & PREPARATION INTERIM OBTURATOR PROST
|
Professional
|
Both
|
$4,842.43
|
|
|
Service Code
|
HCPCS 21079
|
| Min. Negotiated Rate |
$935.18 |
| Max. Negotiated Rate |
$3,005.93 |
| Rate for Payer: Cash Price |
$1,321.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,335.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,202.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,202.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,269.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,335.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,269.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,335.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,335.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,001.98
|
| Rate for Payer: Healthfirst Commercial |
$1,335.97
|
| Rate for Payer: Healthfirst Essential Plan |
$3,005.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,269.17
|
| Rate for Payer: Healthfirst QHP |
$1,335.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$935.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,335.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,135.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$935.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,335.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,001.98
|
| Rate for Payer: SOMOS Essential |
$1,001.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,335.97
|
|
|
PR IMPRESSION & PREPARATION NASAL PROSTHESIS
|
Professional
|
Both
|
$5,317.41
|
|
|
Service Code
|
HCPCS 21087
|
| Min. Negotiated Rate |
$1,021.94 |
| Max. Negotiated Rate |
$3,284.80 |
| Rate for Payer: Cash Price |
$1,446.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,459.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,313.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,313.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,386.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,459.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,386.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,459.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,459.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,094.93
|
| Rate for Payer: Healthfirst Commercial |
$1,459.91
|
| Rate for Payer: Healthfirst Essential Plan |
$3,284.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,386.91
|
| Rate for Payer: Healthfirst QHP |
$1,459.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,021.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,459.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,240.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,021.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,459.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,094.93
|
| Rate for Payer: SOMOS Essential |
$1,094.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,459.91
|
|
|
PR IMPRESSION & PREPARATION ORAL SURGICAL SPLINT
|
Professional
|
Both
|
$2,012.19
|
|
|
Service Code
|
HCPCS 21085
|
| Min. Negotiated Rate |
$386.37 |
| Max. Negotiated Rate |
$1,241.91 |
| Rate for Payer: Cash Price |
$549.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$551.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$496.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$496.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$524.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$551.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$524.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$551.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$551.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$413.97
|
| Rate for Payer: Healthfirst Commercial |
$551.96
|
| Rate for Payer: Healthfirst Essential Plan |
$1,241.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$524.36
|
| Rate for Payer: Healthfirst QHP |
$551.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$386.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$551.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$469.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$386.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$551.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$413.97
|
| Rate for Payer: SOMOS Essential |
$413.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$551.96
|
|
|
PR IMPRESSION & PREPARATION ORBITAL PROSTHESIS
|
Professional
|
Both
|
$7,209.83
|
|
|
Service Code
|
HCPCS 21077
|
| Min. Negotiated Rate |
$1,385.20 |
| Max. Negotiated Rate |
$4,452.44 |
| Rate for Payer: Cash Price |
$1,963.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,978.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,780.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,780.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,879.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,978.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,879.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,978.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,978.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,484.14
|
| Rate for Payer: Healthfirst Commercial |
$1,978.86
|
| Rate for Payer: Healthfirst Essential Plan |
$4,452.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,879.92
|
| Rate for Payer: Healthfirst QHP |
$1,978.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,385.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,978.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,682.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,385.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,978.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,484.14
|
| Rate for Payer: SOMOS Essential |
$1,484.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,978.86
|
|
|
PR IMPRESSION & PREPARATION PALATAL LIFT PROSTHESIS
|
Professional
|
Both
|
$4,274.52
|
|
|
Service Code
|
HCPCS 21083
|
| Min. Negotiated Rate |
$825.52 |
| Max. Negotiated Rate |
$2,653.45 |
| Rate for Payer: Cash Price |
$1,167.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,179.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,061.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,061.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,120.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,179.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,120.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,179.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,179.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$884.48
|
| Rate for Payer: Healthfirst Commercial |
$1,179.31
|
| Rate for Payer: Healthfirst Essential Plan |
$2,653.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,120.34
|
| Rate for Payer: Healthfirst QHP |
$1,179.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$825.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,179.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,002.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$825.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,179.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$884.48
|
| Rate for Payer: SOMOS Essential |
$884.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,179.31
|
|
|
PR IMPRESSION & PREPARATION SPEECH AID PROSTHESIS
|
Professional
|
Both
|
$4,944.10
|
|
|
Service Code
|
HCPCS 21084
|
| Min. Negotiated Rate |
$953.67 |
| Max. Negotiated Rate |
$3,065.38 |
| Rate for Payer: Cash Price |
$1,350.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,362.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,226.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,226.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,294.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,362.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,294.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,362.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,362.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,021.79
|
| Rate for Payer: Healthfirst Commercial |
$1,362.39
|
| Rate for Payer: Healthfirst Essential Plan |
$3,065.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,294.27
|
| Rate for Payer: Healthfirst QHP |
$1,362.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$953.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,362.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,158.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$953.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,362.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,021.79
|
| Rate for Payer: SOMOS Essential |
$1,021.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,362.39
|
|
|
PR IMPRESSION&PREPARATION SURG OBTURATOR PROSTHES
|
Professional
|
Both
|
$2,936.78
|
|
|
Service Code
|
HCPCS 21076
|
| Min. Negotiated Rate |
$567.66 |
| Max. Negotiated Rate |
$1,824.64 |
| Rate for Payer: Cash Price |
$799.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$810.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$729.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$729.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$770.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$810.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$770.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$810.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$810.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$608.21
|
| Rate for Payer: Healthfirst Commercial |
$810.95
|
| Rate for Payer: Healthfirst Essential Plan |
$1,824.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$770.40
|
| Rate for Payer: Healthfirst QHP |
$810.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$567.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$810.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$689.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$567.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$810.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$608.21
|
| Rate for Payer: SOMOS Essential |
$608.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$810.95
|
|
|
PR IMPRESSION & PREPJ DEFINITIVE OBTURATOR PROSTHES
|
Professional
|
Both
|
$5,510.33
|
|
|
Service Code
|
HCPCS 21080
|
| Min. Negotiated Rate |
$1,051.76 |
| Max. Negotiated Rate |
$3,380.65 |
| Rate for Payer: Cash Price |
$1,490.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,502.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,352.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,352.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,427.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,502.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,427.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,502.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,502.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,126.88
|
| Rate for Payer: Healthfirst Commercial |
$1,502.51
|
| Rate for Payer: Healthfirst Essential Plan |
$3,380.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,427.38
|
| Rate for Payer: Healthfirst QHP |
$1,502.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,051.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,502.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,277.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,051.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,502.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,126.88
|
| Rate for Payer: SOMOS Essential |
$1,126.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,502.51
|
|
|
PR IMPRESSION & PREPJ MANDIBULAR RESECTION PROSTHES
|
Professional
|
Both
|
$5,039.93
|
|
|
Service Code
|
HCPCS 21081
|
| Min. Negotiated Rate |
$964.86 |
| Max. Negotiated Rate |
$3,101.33 |
| Rate for Payer: Cash Price |
$1,369.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,378.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,240.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,240.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,309.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,378.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,309.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,378.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,378.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,033.78
|
| Rate for Payer: Healthfirst Commercial |
$1,378.37
|
| Rate for Payer: Healthfirst Essential Plan |
$3,101.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,309.45
|
| Rate for Payer: Healthfirst QHP |
$1,378.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$964.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,378.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,171.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$964.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,378.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,033.78
|
| Rate for Payer: SOMOS Essential |
$1,033.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,378.37
|
|
|
PR IMPRESSION & PREPJ PALATAL AUGMENTATION PROSTHES
|
Professional
|
Both
|
$4,609.68
|
|
|
Service Code
|
HCPCS 21082
|
| Min. Negotiated Rate |
$894.81 |
| Max. Negotiated Rate |
$2,876.18 |
| Rate for Payer: Cash Price |
$1,263.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,278.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,150.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,150.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,214.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,278.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,214.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,278.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,278.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$958.73
|
| Rate for Payer: Healthfirst Commercial |
$1,278.30
|
| Rate for Payer: Healthfirst Essential Plan |
$2,876.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,214.38
|
| Rate for Payer: Healthfirst QHP |
$1,278.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$894.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,278.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,086.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$894.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,278.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$958.73
|
| Rate for Payer: SOMOS Essential |
$958.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,278.30
|
|
|
PR INC DEEP W/OPENING BONE CORTEX HUMERUS/ELBOW
|
Professional
|
Both
|
$2,274.41
|
|
|
Service Code
|
HCPCS 23935
|
| Min. Negotiated Rate |
$432.14 |
| Max. Negotiated Rate |
$1,389.04 |
| Rate for Payer: Cash Price |
$619.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$617.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$555.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$555.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$586.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$617.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$586.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$617.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$617.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$463.01
|
| Rate for Payer: Healthfirst Commercial |
$617.35
|
| Rate for Payer: Healthfirst Essential Plan |
$1,389.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$586.48
|
| Rate for Payer: Healthfirst QHP |
$617.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$432.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$617.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$524.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$432.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$617.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$463.01
|
| Rate for Payer: SOMOS Essential |
$463.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$617.35
|
|
|
PR INC DEEP W/OPNG BONE CORTEX FEMUR/KNEE
|
Professional
|
Both
|
$2,833.22
|
|
|
Service Code
|
HCPCS 27303
|
| Min. Negotiated Rate |
$537.66 |
| Max. Negotiated Rate |
$1,728.18 |
| Rate for Payer: Cash Price |
$770.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$768.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$691.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$691.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$729.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$768.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$729.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$768.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$768.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$576.06
|
| Rate for Payer: Healthfirst Commercial |
$768.08
|
| Rate for Payer: Healthfirst Essential Plan |
$1,728.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$729.68
|
| Rate for Payer: Healthfirst QHP |
$768.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$537.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$768.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$652.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$537.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$768.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$576.06
|
| Rate for Payer: SOMOS Essential |
$576.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$768.08
|
|
|
PR INCISE&RETRIEVAL SUBQ CRANIOPLASTY BONE GRAFT
|
Professional
|
Both
|
$607.39
|
|
|
Service Code
|
HCPCS 62148
|
| Min. Negotiated Rate |
$110.34 |
| Max. Negotiated Rate |
$354.67 |
| Rate for Payer: Cash Price |
$158.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$141.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$149.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$149.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$118.22
|
| Rate for Payer: Healthfirst Commercial |
$157.63
|
| Rate for Payer: Healthfirst Essential Plan |
$354.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$149.75
|
| Rate for Payer: Healthfirst QHP |
$157.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$110.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$157.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$133.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$110.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$118.22
|
| Rate for Payer: SOMOS Essential |
$118.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.63
|
|
