|
PR REMOTE THERAPEUTIC MNTR 1ST SETUP&PT EDUCAJ EQP
|
Professional
|
Both
|
$84.53
|
|
|
Service Code
|
HCPCS 98975
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$54.31 |
| Rate for Payer: Cash Price |
$24.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.11
|
| Rate for Payer: Healthfirst Commercial |
$24.14
|
| Rate for Payer: Healthfirst Essential Plan |
$54.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.93
|
| Rate for Payer: Healthfirst QHP |
$24.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.11
|
| Rate for Payer: SOMOS Essential |
$18.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.14
|
|
|
PR REMOTE THER MNTR TX MGMT PHYS/QHP 1ST 20 MIN
|
Professional
|
Both
|
$124.53
|
|
|
Service Code
|
HCPCS 98980
|
| Min. Negotiated Rate |
$23.47 |
| Max. Negotiated Rate |
$75.44 |
| Rate for Payer: Cash Price |
$33.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.15
|
| Rate for Payer: Healthfirst Commercial |
$33.53
|
| Rate for Payer: Healthfirst Essential Plan |
$75.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.85
|
| Rate for Payer: Healthfirst QHP |
$33.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.15
|
| Rate for Payer: SOMOS Essential |
$25.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.53
|
|
|
PR REMOTE THER MNTR TX MGMT PHYS/QHP EA ADDL 20 MIN
|
Professional
|
Both
|
$121.84
|
|
|
Service Code
|
HCPCS 98981
|
| Min. Negotiated Rate |
$22.96 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.60
|
| Rate for Payer: Healthfirst Commercial |
$32.80
|
| Rate for Payer: Healthfirst Essential Plan |
$73.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.16
|
| Rate for Payer: Healthfirst QHP |
$32.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.60
|
| Rate for Payer: SOMOS Essential |
$24.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.80
|
|
|
PR REMOT IMAGE SUBMIT BY PT
|
Professional
|
Both
|
$36.79
|
|
|
Service Code
|
HCPCS G2010
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$22.32 |
| Rate for Payer: Cash Price |
$10.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.44
|
| Rate for Payer: Healthfirst Commercial |
$9.92
|
| Rate for Payer: Healthfirst Essential Plan |
$22.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.42
|
| Rate for Payer: Healthfirst QHP |
$9.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.44
|
| Rate for Payer: SOMOS Essential |
$7.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.92
|
|
|
PR REMOT IMG SUB BY PT, NON E/M
|
Professional
|
Both
|
$36.79
|
|
|
Service Code
|
HCPCS G2250
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$22.32 |
| Rate for Payer: Cash Price |
$10.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.44
|
| Rate for Payer: Healthfirst Commercial |
$9.92
|
| Rate for Payer: Healthfirst Essential Plan |
$22.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.42
|
| Rate for Payer: Healthfirst QHP |
$9.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.44
|
| Rate for Payer: SOMOS Essential |
$7.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.92
|
|
|
PR REMOVAL ANAL SETON OTHER MARKER
|
Professional
|
Both
|
$377.41
|
|
|
Service Code
|
HCPCS 46030
|
| Min. Negotiated Rate |
$70.53 |
| Max. Negotiated Rate |
$226.69 |
| Rate for Payer: Cash Price |
$100.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$100.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$90.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$90.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$95.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$100.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$95.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.56
|
| Rate for Payer: Healthfirst Commercial |
$100.75
|
| Rate for Payer: Healthfirst Essential Plan |
$226.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$95.71
|
| Rate for Payer: Healthfirst QHP |
$100.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$70.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$100.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$85.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$70.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$100.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$75.56
|
| Rate for Payer: SOMOS Essential |
$75.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$100.75
|
|
|
PR REMOVAL ANKLE IMPLANT
|
Professional
|
Both
|
$2,486.19
|
|
|
Service Code
|
HCPCS 27704
|
| Min. Negotiated Rate |
$467.65 |
| Max. Negotiated Rate |
$1,503.16 |
| Rate for Payer: Cash Price |
$673.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$668.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$601.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$601.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$634.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$668.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$634.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$668.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$668.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$501.05
|
| Rate for Payer: Healthfirst Commercial |
$668.07
|
| Rate for Payer: Healthfirst Essential Plan |
$1,503.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$634.67
|
| Rate for Payer: Healthfirst QHP |
$668.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$467.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$668.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$567.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$467.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$668.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$501.05
|
| Rate for Payer: SOMOS Essential |
$501.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$668.07
|
|
|
PR REMOVAL ANTERIOR INSTRUMENTATION
|
Professional
|
Both
|
$5,128.03
|
|
|
Service Code
|
HCPCS 22855
|
| Min. Negotiated Rate |
$949.00 |
| Max. Negotiated Rate |
$3,050.35 |
| Rate for Payer: Cash Price |
$1,366.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,355.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,220.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,220.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,287.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,355.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,287.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,355.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,355.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,016.78
|
| Rate for Payer: Healthfirst Commercial |
$1,355.71
|
| Rate for Payer: Healthfirst Essential Plan |
$3,050.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,287.92
|
| Rate for Payer: Healthfirst QHP |
$1,355.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$949.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,355.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,152.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$949.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,355.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,016.78
|
| Rate for Payer: SOMOS Essential |
$1,016.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,355.71
|
|
|
PR REMOVAL BILIARY DRG CATHETER REQ FLUOR GID RS&I
|
Professional
|
Both
|
$395.99
|
|
|
Service Code
|
HCPCS 47537
|
| Min. Negotiated Rate |
$74.17 |
| Max. Negotiated Rate |
$238.39 |
| Rate for Payer: Cash Price |
$106.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$105.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$95.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$95.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$100.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$105.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$100.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.46
|
| Rate for Payer: Healthfirst Commercial |
$105.95
|
| Rate for Payer: Healthfirst Essential Plan |
$238.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$100.65
|
| Rate for Payer: Healthfirst QHP |
$105.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$105.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$90.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$74.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$105.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$79.46
|
| Rate for Payer: SOMOS Essential |
$79.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$105.95
|
|
|
PR REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I
|
Professional
|
Both
|
$637.53
|
|
|
Service Code
|
HCPCS 47544
|
| Min. Negotiated Rate |
$119.78 |
| Max. Negotiated Rate |
$385.00 |
| Rate for Payer: Cash Price |
$171.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$171.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$154.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$154.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$171.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$171.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$128.33
|
| Rate for Payer: Healthfirst Commercial |
$171.11
|
| Rate for Payer: Healthfirst Essential Plan |
$385.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$162.55
|
| Rate for Payer: Healthfirst QHP |
$171.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$119.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$171.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$145.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$119.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$171.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$128.33
|
| Rate for Payer: SOMOS Essential |
$128.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$171.11
|
|
|
PR REMOVAL/BIVALVING FULL ARM/FULL LEG CAST
|
Professional
|
Both
|
$192.71
|
|
|
Service Code
|
HCPCS 29705
|
| Min. Negotiated Rate |
$36.72 |
| Max. Negotiated Rate |
$118.03 |
| Rate for Payer: Cash Price |
$51.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.34
|
| Rate for Payer: Healthfirst Commercial |
$52.46
|
| Rate for Payer: Healthfirst Essential Plan |
$118.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.84
|
| Rate for Payer: Healthfirst QHP |
$52.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.34
|
| Rate for Payer: SOMOS Essential |
$39.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.46
|
|
|
PR REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST
|
Professional
|
Both
|
$143.33
|
|
|
Service Code
|
HCPCS 29700
|
| Min. Negotiated Rate |
$27.04 |
| Max. Negotiated Rate |
$86.92 |
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.97
|
| Rate for Payer: Healthfirst Commercial |
$38.63
|
| Rate for Payer: Healthfirst Essential Plan |
$86.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.70
|
| Rate for Payer: Healthfirst QHP |
$38.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.97
|
| Rate for Payer: SOMOS Essential |
$28.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.63
|
|
|
PR REMOVAL CERCLAGE SUTURE UNDER ANESTHESIA
|
Professional
|
Both
|
$617.12
|
|
|
Service Code
|
HCPCS 59871
|
| Min. Negotiated Rate |
$112.75 |
| Max. Negotiated Rate |
$362.41 |
| Rate for Payer: Cash Price |
$163.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$161.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$144.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$144.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$153.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$161.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$153.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$161.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$161.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$120.80
|
| Rate for Payer: Healthfirst Commercial |
$161.07
|
| Rate for Payer: Healthfirst Essential Plan |
$362.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.02
|
| Rate for Payer: Healthfirst QHP |
$161.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$112.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$161.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$136.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$112.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$161.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$120.80
|
| Rate for Payer: SOMOS Essential |
$120.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$161.07
|
|
|
PR REMOVAL CONTOURING BENIGN TUMOR FACIAL BONE
|
Professional
|
Both
|
$2,683.87
|
|
|
Service Code
|
HCPCS 21029
|
| Min. Negotiated Rate |
$515.10 |
| Max. Negotiated Rate |
$1,655.68 |
| Rate for Payer: Cash Price |
$736.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$735.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$662.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$662.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$699.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$735.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$699.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$735.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$551.89
|
| Rate for Payer: Healthfirst Commercial |
$735.86
|
| Rate for Payer: Healthfirst Essential Plan |
$1,655.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$699.07
|
| Rate for Payer: Healthfirst QHP |
$735.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$515.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$735.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$625.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$515.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$735.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$551.89
|
| Rate for Payer: SOMOS Essential |
$551.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$735.86
|
|
|
PR REMOVAL CRNL NRV NSTIM ELTRDS & PULSE GENERATO
|
Professional
|
Both
|
$3,520.79
|
|
|
Service Code
|
HCPCS 64570
|
| Min. Negotiated Rate |
$651.08 |
| Max. Negotiated Rate |
$2,092.75 |
| Rate for Payer: Cash Price |
$935.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$930.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$837.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$837.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$883.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$930.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$883.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$930.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$930.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$697.58
|
| Rate for Payer: Healthfirst Commercial |
$930.11
|
| Rate for Payer: Healthfirst Essential Plan |
$2,092.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$883.60
|
| Rate for Payer: Healthfirst QHP |
$930.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$651.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$930.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$790.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$651.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$930.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$697.58
|
| Rate for Payer: SOMOS Essential |
$697.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$930.11
|
|
|
PR REMOVAL DEEP DRUG DELIVERY DEVICE
|
Professional
|
Both
|
$283.68
|
|
|
Service Code
|
HCPCS 20701
|
| Min. Negotiated Rate |
$51.82 |
| Max. Negotiated Rate |
$166.57 |
| Rate for Payer: Cash Price |
$75.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$74.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$66.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$66.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$74.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.52
|
| Rate for Payer: Healthfirst Commercial |
$74.03
|
| Rate for Payer: Healthfirst Essential Plan |
$166.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.33
|
| Rate for Payer: Healthfirst QHP |
$74.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$74.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$55.52
|
| Rate for Payer: SOMOS Essential |
$55.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.03
|
|
|
PR REMOVAL EMBEDDED FOREIGN BODY EYELID
|
Professional
|
Both
|
$489.13
|
|
|
Service Code
|
HCPCS 67938
|
| Min. Negotiated Rate |
$90.10 |
| Max. Negotiated Rate |
$289.62 |
| Rate for Payer: Cash Price |
$133.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$128.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$115.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$115.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$122.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$128.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$122.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$128.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.54
|
| Rate for Payer: Healthfirst Commercial |
$128.72
|
| Rate for Payer: Healthfirst Essential Plan |
$289.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$122.28
|
| Rate for Payer: Healthfirst QHP |
$128.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$90.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$128.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$109.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$90.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$128.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$96.54
|
| Rate for Payer: SOMOS Essential |
$96.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$128.72
|
|
|
PR REMOVAL ENTIRE OI IMPLT SKL MAG TC ATTCH ESP<100
|
Professional
|
Both
|
$2,298.24
|
|
|
Service Code
|
HCPCS 69727
|
| Min. Negotiated Rate |
$429.62 |
| Max. Negotiated Rate |
$1,380.94 |
| Rate for Payer: Cash Price |
$623.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$613.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$552.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$552.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$583.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$613.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$583.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$613.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$613.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$460.31
|
| Rate for Payer: Healthfirst Commercial |
$613.75
|
| Rate for Payer: Healthfirst Essential Plan |
$1,380.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$583.06
|
| Rate for Payer: Healthfirst QHP |
$613.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$429.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$613.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$521.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$429.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$613.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$460.31
|
| Rate for Payer: SOMOS Essential |
$460.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$613.75
|
|
|
PR REMOVAL ENTIRE OI IMPLT SKL PERQ ATTACHMENT ESP
|
Professional
|
Both
|
$2,060.45
|
|
|
Service Code
|
HCPCS 69726
|
| Min. Negotiated Rate |
$385.22 |
| Max. Negotiated Rate |
$1,238.22 |
| Rate for Payer: Cash Price |
$558.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$550.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$495.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$495.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$522.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$550.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$522.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$550.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$550.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$412.74
|
| Rate for Payer: Healthfirst Commercial |
$550.32
|
| Rate for Payer: Healthfirst Essential Plan |
$1,238.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$522.80
|
| Rate for Payer: Healthfirst QHP |
$550.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$385.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$550.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$467.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$385.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$550.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$412.74
|
| Rate for Payer: SOMOS Essential |
$412.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$550.32
|
|
|
PR REMOVAL ESOPHAGEAL SPHINCTER AGMNTJ DEVICE
|
Professional
|
Both
|
$3,038.53
|
|
|
Service Code
|
HCPCS 43285
|
| Min. Negotiated Rate |
$563.75 |
| Max. Negotiated Rate |
$1,812.06 |
| Rate for Payer: Cash Price |
$811.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$805.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$724.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$724.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$765.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$805.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$765.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$805.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$805.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$604.02
|
| Rate for Payer: Healthfirst Commercial |
$805.36
|
| Rate for Payer: Healthfirst Essential Plan |
$1,812.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$765.09
|
| Rate for Payer: Healthfirst QHP |
$805.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$563.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$805.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$684.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$563.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$805.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$604.02
|
| Rate for Payer: SOMOS Essential |
$604.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$805.36
|
|
|
PR REMOVAL EXTERNAL FIXATION SYSTEM UNDER ANES
|
Professional
|
Both
|
$1,497.13
|
|
|
Service Code
|
HCPCS 20694
|
| Min. Negotiated Rate |
$286.29 |
| Max. Negotiated Rate |
$920.23 |
| Rate for Payer: Cash Price |
$408.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$408.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$368.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$368.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$388.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$408.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$388.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$408.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$408.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$306.74
|
| Rate for Payer: Healthfirst Commercial |
$408.99
|
| Rate for Payer: Healthfirst Essential Plan |
$920.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$388.54
|
| Rate for Payer: Healthfirst QHP |
$408.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$286.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$408.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$347.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$286.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$408.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$306.74
|
| Rate for Payer: SOMOS Essential |
$306.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$408.99
|
|
|
PR REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL
|
Professional
|
Both
|
$119.77
|
|
|
Service Code
|
HCPCS 65205
|
| Min. Negotiated Rate |
$22.35 |
| Max. Negotiated Rate |
$71.84 |
| Rate for Payer: Cash Price |
$32.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.95
|
| Rate for Payer: Healthfirst Commercial |
$31.93
|
| Rate for Payer: Healthfirst Essential Plan |
$71.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.33
|
| Rate for Payer: Healthfirst QHP |
$31.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.95
|
| Rate for Payer: SOMOS Essential |
$23.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.93
|
|
|
PR REMOVAL FOREIGN BODY DEEP PENILE TISSUE
|
Professional
|
Both
|
$1,793.47
|
|
|
Service Code
|
HCPCS 54115
|
| Min. Negotiated Rate |
$343.71 |
| Max. Negotiated Rate |
$1,104.80 |
| Rate for Payer: Cash Price |
$493.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$491.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$441.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$441.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$466.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$491.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$466.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$491.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$491.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$368.26
|
| Rate for Payer: Healthfirst Commercial |
$491.02
|
| Rate for Payer: Healthfirst Essential Plan |
$1,104.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$466.47
|
| Rate for Payer: Healthfirst QHP |
$491.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$343.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$491.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$417.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$343.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$491.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$368.26
|
| Rate for Payer: SOMOS Essential |
$368.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$491.02
|
|
|
PR REMOVAL FOREIGN BODY DEEP THIGH/KNEE
|
Professional
|
Both
|
$1,779.19
|
|
|
Service Code
|
HCPCS 27372
|
| Min. Negotiated Rate |
$336.59 |
| Max. Negotiated Rate |
$1,081.89 |
| Rate for Payer: Cash Price |
$481.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$480.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$432.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$432.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$456.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$480.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$456.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$480.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$480.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$360.63
|
| Rate for Payer: Healthfirst Commercial |
$480.84
|
| Rate for Payer: Healthfirst Essential Plan |
$1,081.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$456.80
|
| Rate for Payer: Healthfirst QHP |
$480.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$336.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$480.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$408.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$336.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$480.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$360.63
|
| Rate for Payer: SOMOS Essential |
$360.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$480.84
|
|
|
PR REMOVAL FOREIGN BODY FOOT COMPLICATED
|
Professional
|
Both
|
$1,522.50
|
|
|
Service Code
|
HCPCS 28193
|
| Min. Negotiated Rate |
$291.77 |
| Max. Negotiated Rate |
$937.85 |
| Rate for Payer: Cash Price |
$419.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$416.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$375.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$375.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$395.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$416.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$395.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$416.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$416.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$312.62
|
| Rate for Payer: Healthfirst Commercial |
$416.82
|
| Rate for Payer: Healthfirst Essential Plan |
$937.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$395.98
|
| Rate for Payer: Healthfirst QHP |
$416.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$291.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$416.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$354.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$291.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$416.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$312.62
|
| Rate for Payer: SOMOS Essential |
$312.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$416.82
|
|
