|
PR RECONSTRUCTION VENA CAVA ANY METHOD
|
Professional
|
Both
|
$6,752.27
|
|
|
Service Code
|
HCPCS 34502
|
| Min. Negotiated Rate |
$1,256.20 |
| Max. Negotiated Rate |
$4,037.78 |
| Rate for Payer: Cash Price |
$1,818.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,794.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,615.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,615.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,704.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,794.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,704.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,794.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,794.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,345.93
|
| Rate for Payer: Healthfirst Commercial |
$1,794.57
|
| Rate for Payer: Healthfirst Essential Plan |
$4,037.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,704.84
|
| Rate for Payer: Healthfirst QHP |
$1,794.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,256.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,794.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,525.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,256.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,794.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,345.93
|
| Rate for Payer: SOMOS Essential |
$1,345.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,794.57
|
|
|
PR RECTAL SESATION TONE & COMPLIANCE TEST
|
Professional
|
Both
|
$189.95
|
|
|
Service Code
|
HCPCS 91120 26
|
| Min. Negotiated Rate |
$36.26 |
| Max. Negotiated Rate |
$116.55 |
| Rate for Payer: Cash Price |
$52.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$51.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.85
|
| Rate for Payer: Healthfirst Commercial |
$51.80
|
| Rate for Payer: Healthfirst Essential Plan |
$116.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.21
|
| Rate for Payer: Healthfirst QHP |
$51.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$51.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.85
|
| Rate for Payer: SOMOS Essential |
$38.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.80
|
|
|
PR RECTAL SESATION TONE & COMPLIANCE TEST
|
Professional
|
Both
|
$2,000.85
|
|
|
Service Code
|
HCPCS 91120 TC
|
| Min. Negotiated Rate |
$350.67 |
| Max. Negotiated Rate |
$1,127.14 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$500.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$450.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$450.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$475.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$500.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$475.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$500.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$500.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$375.71
|
| Rate for Payer: Healthfirst Commercial |
$500.95
|
| Rate for Payer: Healthfirst Essential Plan |
$1,127.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$475.90
|
| Rate for Payer: Healthfirst QHP |
$500.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$350.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$500.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$425.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$350.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$500.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$375.71
|
| Rate for Payer: SOMOS Essential |
$375.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$500.95
|
|
|
PR RECTAL SESATION TONE & COMPLIANCE TEST
|
Professional
|
Both
|
$2,190.79
|
|
|
Service Code
|
HCPCS 91120
|
| Min. Negotiated Rate |
$386.93 |
| Max. Negotiated Rate |
$1,243.71 |
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$552.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$497.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$497.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$525.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$552.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$525.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$552.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$552.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$414.57
|
| Rate for Payer: Healthfirst Commercial |
$552.76
|
| Rate for Payer: Healthfirst Essential Plan |
$1,243.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$525.12
|
| Rate for Payer: Healthfirst QHP |
$552.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$386.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$552.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$469.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$386.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$552.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$414.57
|
| Rate for Payer: SOMOS Essential |
$414.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$552.76
|
|
|
PR REDUCTION FOREHEAD CONTOURING ONLY
|
Professional
|
Both
|
$3,289.34
|
|
|
Service Code
|
HCPCS 21137
|
| Min. Negotiated Rate |
$619.98 |
| Max. Negotiated Rate |
$1,992.80 |
| Rate for Payer: Cash Price |
$886.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$885.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$797.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$797.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$841.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$885.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$841.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$885.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$885.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$664.27
|
| Rate for Payer: Healthfirst Commercial |
$885.69
|
| Rate for Payer: Healthfirst Essential Plan |
$1,992.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$841.41
|
| Rate for Payer: Healthfirst QHP |
$885.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$619.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$885.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$752.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$619.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$885.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$664.27
|
| Rate for Payer: SOMOS Essential |
$664.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$885.69
|
|
|
PR REDUCTION MASSETER MUSCLE & BONE EXTRAORAL
|
Professional
|
Both
|
$850.92
|
|
|
Service Code
|
HCPCS 21295
|
| Min. Negotiated Rate |
$163.09 |
| Max. Negotiated Rate |
$524.21 |
| Rate for Payer: Cash Price |
$234.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$232.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$209.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$221.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$232.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$221.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$232.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$232.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$174.74
|
| Rate for Payer: Healthfirst Commercial |
$232.98
|
| Rate for Payer: Healthfirst Essential Plan |
$524.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$221.33
|
| Rate for Payer: Healthfirst QHP |
$232.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$163.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$232.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$198.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$163.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$232.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$174.74
|
| Rate for Payer: SOMOS Essential |
$174.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$232.98
|
|
|
PR REDUCTION MASSETER MUSCLE & BONE INTRAORAL
|
Professional
|
Both
|
$1,763.83
|
|
|
Service Code
|
HCPCS 21296
|
| Min. Negotiated Rate |
$331.79 |
| Max. Negotiated Rate |
$1,066.45 |
| Rate for Payer: Cash Price |
$480.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$473.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$426.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$426.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$450.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$473.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$450.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$473.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$473.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$355.49
|
| Rate for Payer: Healthfirst Commercial |
$473.98
|
| Rate for Payer: Healthfirst Essential Plan |
$1,066.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$450.28
|
| Rate for Payer: Healthfirst QHP |
$473.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$331.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$473.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$402.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$331.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$473.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$355.49
|
| Rate for Payer: SOMOS Essential |
$355.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$473.98
|
|
|
PR REDUCTION OVERCORRECTION PTOSIS
|
Professional
|
Both
|
$1,816.40
|
|
|
Service Code
|
HCPCS 67909
|
| Min. Negotiated Rate |
$345.88 |
| Max. Negotiated Rate |
$1,111.75 |
| Rate for Payer: Cash Price |
$497.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$494.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$444.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$444.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$469.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$494.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$469.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$494.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$494.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$370.58
|
| Rate for Payer: Healthfirst Commercial |
$494.11
|
| Rate for Payer: Healthfirst Essential Plan |
$1,111.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$469.40
|
| Rate for Payer: Healthfirst QHP |
$494.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$345.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$494.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$419.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$345.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$494.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$370.58
|
| Rate for Payer: SOMOS Essential |
$370.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$494.11
|
|
|
PR REEXPL PEL WND W/RMVL PREPERITONEAL PEL PACKING
|
Professional
|
Both
|
$1,708.11
|
|
|
Service Code
|
HCPCS 49014
|
| Min. Negotiated Rate |
$316.05 |
| Max. Negotiated Rate |
$1,015.88 |
| Rate for Payer: Cash Price |
$453.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$451.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$406.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$406.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$428.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$451.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$428.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$451.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$451.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$338.62
|
| Rate for Payer: Healthfirst Commercial |
$451.50
|
| Rate for Payer: Healthfirst Essential Plan |
$1,015.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$428.93
|
| Rate for Payer: Healthfirst QHP |
$451.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$316.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$451.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$383.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$316.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$451.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$338.62
|
| Rate for Payer: SOMOS Essential |
$338.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$451.50
|
|
|
PR REFILLING & MAINTENANCE PORTABLE PUMP
|
Professional
|
Both
|
$547.16
|
|
|
Service Code
|
HCPCS 96521
|
| Min. Negotiated Rate |
$96.24 |
| Max. Negotiated Rate |
$309.33 |
| Rate for Payer: Cash Price |
$146.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$137.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$123.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$130.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$137.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$130.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.11
|
| Rate for Payer: Healthfirst Commercial |
$137.48
|
| Rate for Payer: Healthfirst Essential Plan |
$309.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.61
|
| Rate for Payer: Healthfirst QHP |
$137.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$96.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$137.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$116.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$96.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$137.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$103.11
|
| Rate for Payer: SOMOS Essential |
$103.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.48
|
|
|
PR REFILL&MAINTENANCE PUMP DRUG DLVR SPINAL/BRAIN
|
Professional
|
Both
|
$390.46
|
|
|
Service Code
|
HCPCS 95990
|
| Min. Negotiated Rate |
$71.56 |
| Max. Negotiated Rate |
$230.02 |
| Rate for Payer: Cash Price |
$107.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$102.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$92.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$97.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$102.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$97.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$76.67
|
| Rate for Payer: Healthfirst Commercial |
$102.23
|
| Rate for Payer: Healthfirst Essential Plan |
$230.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$97.12
|
| Rate for Payer: Healthfirst QHP |
$102.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$71.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$102.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$86.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$71.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$76.67
|
| Rate for Payer: SOMOS Essential |
$76.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.23
|
|
|
PR REFILL&MAINTENANCE PUMP DRUG DLVR SYSTEMIC
|
Professional
|
Both
|
$505.47
|
|
|
Service Code
|
HCPCS 96522
|
| Min. Negotiated Rate |
$91.35 |
| Max. Negotiated Rate |
$293.62 |
| Rate for Payer: Cash Price |
$139.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$130.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$117.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$117.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$123.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$130.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$123.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.88
|
| Rate for Payer: Healthfirst Commercial |
$130.50
|
| Rate for Payer: Healthfirst Essential Plan |
$293.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$123.97
|
| Rate for Payer: Healthfirst QHP |
$130.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$91.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$130.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$110.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$91.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$130.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$97.88
|
| Rate for Payer: SOMOS Essential |
$97.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.50
|
|
|
PR REIMPLANTATION ANOMALOUS PULMONARY ARTERY
|
Professional
|
Both
|
$6,823.01
|
|
|
Service Code
|
HCPCS 33788
|
| Min. Negotiated Rate |
$1,256.42 |
| Max. Negotiated Rate |
$4,038.48 |
| Rate for Payer: Cash Price |
$1,813.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,794.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,615.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,615.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,705.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,794.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,705.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,794.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,794.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,346.16
|
| Rate for Payer: Healthfirst Commercial |
$1,794.88
|
| Rate for Payer: Healthfirst Essential Plan |
$4,038.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,705.14
|
| Rate for Payer: Healthfirst QHP |
$1,794.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,256.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,794.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,525.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,256.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,794.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,346.16
|
| Rate for Payer: SOMOS Essential |
$1,346.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,794.88
|
|
|
PR REINSERTION OCULAR IMPLT RNFCMT &/ ATTACH MUSCLE
|
Professional
|
Both
|
$4,054.40
|
|
|
Service Code
|
HCPCS 65155
|
| Min. Negotiated Rate |
$757.74 |
| Max. Negotiated Rate |
$2,435.60 |
| Rate for Payer: Cash Price |
$1,107.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,082.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$974.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$974.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,028.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,082.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,028.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,082.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,082.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$811.87
|
| Rate for Payer: Healthfirst Commercial |
$1,082.49
|
| Rate for Payer: Healthfirst Essential Plan |
$2,435.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,028.37
|
| Rate for Payer: Healthfirst QHP |
$1,082.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$757.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,082.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$920.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$757.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,082.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$811.87
|
| Rate for Payer: SOMOS Essential |
$811.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,082.49
|
|
|
PR REINSERTION OCULAR IMPLT W/WO CONJUNCTIVAL GRAFT
|
Professional
|
Both
|
$2,966.15
|
|
|
Service Code
|
HCPCS 65150
|
| Min. Negotiated Rate |
$549.48 |
| Max. Negotiated Rate |
$1,766.18 |
| Rate for Payer: Cash Price |
$807.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$784.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$706.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$706.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$745.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$784.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$745.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$784.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$784.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$588.73
|
| Rate for Payer: Healthfirst Commercial |
$784.97
|
| Rate for Payer: Healthfirst Essential Plan |
$1,766.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$745.72
|
| Rate for Payer: Healthfirst QHP |
$784.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$549.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$784.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$667.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$549.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$784.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$588.73
|
| Rate for Payer: SOMOS Essential |
$588.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$784.97
|
|
|
PR REINSERTION SPINAL FIXATION DEVICE
|
Professional
|
Both
|
$6,013.18
|
|
|
Service Code
|
HCPCS 22849
|
| Min. Negotiated Rate |
$1,114.51 |
| Max. Negotiated Rate |
$3,582.36 |
| Rate for Payer: Cash Price |
$1,603.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,592.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,432.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,432.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,512.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,592.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,512.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,592.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,592.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,194.12
|
| Rate for Payer: Healthfirst Commercial |
$1,592.16
|
| Rate for Payer: Healthfirst Essential Plan |
$3,582.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,512.55
|
| Rate for Payer: Healthfirst QHP |
$1,592.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,114.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,592.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,353.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,114.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,592.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,194.12
|
| Rate for Payer: SOMOS Essential |
$1,194.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,592.16
|
|
|
PR RELEASE ENCIRCLING MATERIAL POSTERIOR SEGMENT
|
Professional
|
Both
|
$2,055.48
|
|
|
Service Code
|
HCPCS 67115
|
| Min. Negotiated Rate |
$392.16 |
| Max. Negotiated Rate |
$1,260.52 |
| Rate for Payer: Cash Price |
$567.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$560.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$504.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$504.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$532.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$560.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$532.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$560.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$560.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$420.17
|
| Rate for Payer: Healthfirst Commercial |
$560.23
|
| Rate for Payer: Healthfirst Essential Plan |
$1,260.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$532.22
|
| Rate for Payer: Healthfirst QHP |
$560.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$392.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$560.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$476.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$392.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$560.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$420.17
|
| Rate for Payer: SOMOS Essential |
$420.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$560.23
|
|
|
PR RELEASE INTRINSIC MUSCLES HAND EACH MUSCLE
|
Professional
|
Both
|
$2,855.51
|
|
|
Service Code
|
HCPCS 26593
|
| Min. Negotiated Rate |
$530.96 |
| Max. Negotiated Rate |
$1,706.67 |
| Rate for Payer: Cash Price |
$771.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$758.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$682.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$682.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$720.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$758.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$720.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$758.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$758.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$568.89
|
| Rate for Payer: Healthfirst Commercial |
$758.52
|
| Rate for Payer: Healthfirst Essential Plan |
$1,706.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$720.59
|
| Rate for Payer: Healthfirst QHP |
$758.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$530.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$758.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$644.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$530.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$758.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$568.89
|
| Rate for Payer: SOMOS Essential |
$568.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$758.52
|
|
|
PR RELEASE/RECESSION HAMSTRING PROXIMAL
|
Professional
|
Both
|
$3,039.65
|
|
|
Service Code
|
HCPCS 27097
|
| Min. Negotiated Rate |
$572.85 |
| Max. Negotiated Rate |
$1,841.29 |
| Rate for Payer: Cash Price |
$820.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$818.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$736.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$736.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$777.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$818.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$777.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$818.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$818.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$613.76
|
| Rate for Payer: Healthfirst Commercial |
$818.35
|
| Rate for Payer: Healthfirst Essential Plan |
$1,841.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$777.43
|
| Rate for Payer: Healthfirst QHP |
$818.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$572.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$818.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$695.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$572.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$818.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$613.76
|
| Rate for Payer: SOMOS Essential |
$613.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$818.35
|
|
|
PR RELEASE TARSAL TUNNEL
|
Professional
|
Both
|
$1,530.10
|
|
|
Service Code
|
HCPCS 28035
|
| Min. Negotiated Rate |
$295.69 |
| Max. Negotiated Rate |
$950.45 |
| Rate for Payer: Cash Price |
$418.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$422.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$380.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$380.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$401.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$422.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$401.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$422.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$422.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$316.81
|
| Rate for Payer: Healthfirst Commercial |
$422.42
|
| Rate for Payer: Healthfirst Essential Plan |
$950.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$401.30
|
| Rate for Payer: Healthfirst QHP |
$422.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$295.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$422.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$359.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$295.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$422.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$316.81
|
| Rate for Payer: SOMOS Essential |
$316.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$422.42
|
|
|
PR RELEASE THENAR MUSCLE
|
Professional
|
Both
|
$2,995.23
|
|
|
Service Code
|
HCPCS 26508
|
| Min. Negotiated Rate |
$553.77 |
| Max. Negotiated Rate |
$1,779.97 |
| Rate for Payer: Cash Price |
$809.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$791.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$711.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$711.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$751.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$791.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$751.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$791.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$791.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$593.33
|
| Rate for Payer: Healthfirst Commercial |
$791.10
|
| Rate for Payer: Healthfirst Essential Plan |
$1,779.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$751.54
|
| Rate for Payer: Healthfirst QHP |
$791.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$553.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$791.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$672.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$553.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$791.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$593.33
|
| Rate for Payer: SOMOS Essential |
$593.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$791.10
|
|
|
PR RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR
|
Professional
|
Both
|
$1,807.65
|
|
|
Service Code
|
HCPCS 33223
|
| Min. Negotiated Rate |
$333.07 |
| Max. Negotiated Rate |
$1,070.60 |
| Rate for Payer: Cash Price |
$480.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$475.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$428.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$428.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$452.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$475.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$452.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$475.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$475.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$356.87
|
| Rate for Payer: Healthfirst Commercial |
$475.82
|
| Rate for Payer: Healthfirst Essential Plan |
$1,070.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$452.03
|
| Rate for Payer: Healthfirst QHP |
$475.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$333.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$475.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$404.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$333.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$475.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$356.87
|
| Rate for Payer: SOMOS Essential |
$356.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$475.82
|
|
|
PR RELOCATION OF SKIN POCKET FOR PACEMAKER
|
Professional
|
Both
|
$1,513.89
|
|
|
Service Code
|
HCPCS 33222
|
| Min. Negotiated Rate |
$280.74 |
| Max. Negotiated Rate |
$902.36 |
| Rate for Payer: Cash Price |
$404.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$401.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$360.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$360.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$381.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$401.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$381.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$401.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$401.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$300.79
|
| Rate for Payer: Healthfirst Commercial |
$401.05
|
| Rate for Payer: Healthfirst Essential Plan |
$902.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$381.00
|
| Rate for Payer: Healthfirst QHP |
$401.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$280.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$401.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$340.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$280.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$401.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$300.79
|
| Rate for Payer: SOMOS Essential |
$300.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$401.05
|
|
|
PR REM INTERROG ICPMS <30 D PHYS/QHP
|
Professional
|
Both
|
$104.83
|
|
|
Service Code
|
HCPCS 93297
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$153.65 |
| Rate for Payer: Amida Care Medicaid |
$13.24
|
| Rate for Payer: Cash Price |
$69.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$68.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.22
|
| Rate for Payer: Healthfirst Commercial |
$68.29
|
| Rate for Payer: Healthfirst Essential Plan |
$153.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$64.88
|
| Rate for Payer: Healthfirst QHP |
$68.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$68.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$68.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.22
|
| Rate for Payer: SOMOS Essential |
$51.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.29
|
|
|
PR REM INTERROG PM/LDLS PM <90 D PHYS/QHP
|
Professional
|
Both
|
$120.61
|
|
|
Service Code
|
HCPCS 93294
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$72.16 |
| Rate for Payer: Amida Care Medicaid |
$19.13
|
| Rate for Payer: Cash Price |
$32.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.05
|
| Rate for Payer: Healthfirst Commercial |
$32.07
|
| Rate for Payer: Healthfirst Essential Plan |
$72.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.47
|
| Rate for Payer: Healthfirst QHP |
$32.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.05
|
| Rate for Payer: SOMOS Essential |
$24.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.07
|
|
