|
PR REMOVAL FOREIGN BODY FOOT DEEP
|
Professional
|
Both
|
$1,295.53
|
|
|
Service Code
|
HCPCS 28192
|
| Min. Negotiated Rate |
$251.24 |
| Max. Negotiated Rate |
$807.57 |
| Rate for Payer: Cash Price |
$357.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$358.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$323.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$323.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$340.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$358.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$340.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$358.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$358.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$269.19
|
| Rate for Payer: Healthfirst Commercial |
$358.92
|
| Rate for Payer: Healthfirst Essential Plan |
$807.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$340.97
|
| Rate for Payer: Healthfirst QHP |
$358.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$251.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$358.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$305.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$251.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$358.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$269.19
|
| Rate for Payer: SOMOS Essential |
$269.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$358.92
|
|
|
PR REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS
|
Professional
|
Both
|
$552.41
|
|
|
Service Code
|
HCPCS 28190
|
| Min. Negotiated Rate |
$106.30 |
| Max. Negotiated Rate |
$341.69 |
| Rate for Payer: Cash Price |
$152.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$151.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$136.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$136.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$144.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$151.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$144.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$151.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$151.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.89
|
| Rate for Payer: Healthfirst Commercial |
$151.86
|
| Rate for Payer: Healthfirst Essential Plan |
$341.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$144.27
|
| Rate for Payer: Healthfirst QHP |
$151.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$106.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$151.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$129.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$106.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$151.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$113.89
|
| Rate for Payer: SOMOS Essential |
$113.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$151.86
|
|
|
PR REMOVAL FOREIGN BODY INTRANASAL GENERAL ANES
|
Professional
|
Both
|
$903.49
|
|
|
Service Code
|
HCPCS 30310
|
| Min. Negotiated Rate |
$167.53 |
| Max. Negotiated Rate |
$538.49 |
| Rate for Payer: Cash Price |
$245.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$239.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$215.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$215.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$227.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$239.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$227.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$239.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$239.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$179.50
|
| Rate for Payer: Healthfirst Commercial |
$239.33
|
| Rate for Payer: Healthfirst Essential Plan |
$538.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$227.36
|
| Rate for Payer: Healthfirst QHP |
$239.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$167.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$239.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$203.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$167.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$239.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$179.50
|
| Rate for Payer: SOMOS Essential |
$179.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$239.33
|
|
|
PR REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE
|
Professional
|
Both
|
$540.96
|
|
|
Service Code
|
HCPCS 30300
|
| Min. Negotiated Rate |
$98.69 |
| Max. Negotiated Rate |
$317.23 |
| Rate for Payer: Cash Price |
$145.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$140.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$126.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$133.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$140.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$133.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.74
|
| Rate for Payer: Healthfirst Commercial |
$140.99
|
| Rate for Payer: Healthfirst Essential Plan |
$317.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.94
|
| Rate for Payer: Healthfirst QHP |
$140.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$140.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$119.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$140.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.74
|
| Rate for Payer: SOMOS Essential |
$105.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$140.99
|
|
|
PR REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE
|
Professional
|
Both
|
$632.42
|
|
|
Service Code
|
HCPCS 20520
|
| Min. Negotiated Rate |
$121.40 |
| Max. Negotiated Rate |
$390.22 |
| Rate for Payer: Cash Price |
$173.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$173.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$156.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$156.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$164.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$173.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$173.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$173.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$130.07
|
| Rate for Payer: Healthfirst Commercial |
$173.43
|
| Rate for Payer: Healthfirst Essential Plan |
$390.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$164.76
|
| Rate for Payer: Healthfirst QHP |
$173.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$121.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$173.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$147.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$121.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$173.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$130.07
|
| Rate for Payer: SOMOS Essential |
$130.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$173.43
|
|
|
PR REMOVAL FOREIGN BODY PELVIS/HIP DEEP
|
Professional
|
Both
|
$2,766.68
|
|
|
Service Code
|
HCPCS 27087
|
| Min. Negotiated Rate |
$517.71 |
| Max. Negotiated Rate |
$1,664.06 |
| Rate for Payer: Cash Price |
$742.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$739.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$665.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$665.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$702.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$739.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$702.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$739.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$739.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$554.68
|
| Rate for Payer: Healthfirst Commercial |
$739.58
|
| Rate for Payer: Healthfirst Essential Plan |
$1,664.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$702.60
|
| Rate for Payer: Healthfirst QHP |
$739.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$517.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$739.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$628.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$517.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$739.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$554.68
|
| Rate for Payer: SOMOS Essential |
$554.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$739.58
|
|
|
PR REMOVAL FOREIGN BODY PHARYNX
|
Professional
|
Both
|
$548.07
|
|
|
Service Code
|
HCPCS 42809
|
| Min. Negotiated Rate |
$102.77 |
| Max. Negotiated Rate |
$330.35 |
| Rate for Payer: Cash Price |
$149.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$146.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$132.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$132.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$139.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$146.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$139.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$146.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$146.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$110.11
|
| Rate for Payer: Healthfirst Commercial |
$146.82
|
| Rate for Payer: Healthfirst Essential Plan |
$330.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$139.48
|
| Rate for Payer: Healthfirst QHP |
$146.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$102.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$146.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$124.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$102.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$146.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$110.11
|
| Rate for Payer: SOMOS Essential |
$110.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$146.82
|
|
|
PR REMOVAL FOREIGN BODY SCROTUM
|
Professional
|
Both
|
$1,494.85
|
|
|
Service Code
|
HCPCS 55120
|
| Min. Negotiated Rate |
$287.07 |
| Max. Negotiated Rate |
$922.73 |
| Rate for Payer: Cash Price |
$412.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$410.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$369.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$369.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$389.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$410.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$389.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$410.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$410.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$307.57
|
| Rate for Payer: Healthfirst Commercial |
$410.10
|
| Rate for Payer: Healthfirst Essential Plan |
$922.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$389.60
|
| Rate for Payer: Healthfirst QHP |
$410.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$287.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$410.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$348.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$287.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$410.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$307.57
|
| Rate for Payer: SOMOS Essential |
$307.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$410.10
|
|
|
PR REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS
|
Professional
|
Both
|
$735.95
|
|
|
Service Code
|
HCPCS 23330
|
| Min. Negotiated Rate |
$140.67 |
| Max. Negotiated Rate |
$452.16 |
| Rate for Payer: Cash Price |
$201.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$200.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$180.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$180.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$190.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$200.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$190.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$150.72
|
| Rate for Payer: Healthfirst Commercial |
$200.96
|
| Rate for Payer: Healthfirst Essential Plan |
$452.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$190.91
|
| Rate for Payer: Healthfirst QHP |
$200.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$140.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$200.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$170.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$140.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$200.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$150.72
|
| Rate for Payer: SOMOS Essential |
$150.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$200.96
|
|
|
PR REMOVAL FOREIGN BODY UPPER ARM/ELBOW DEEP
|
Professional
|
Both
|
$1,633.21
|
|
|
Service Code
|
HCPCS 24201
|
| Min. Negotiated Rate |
$338.17 |
| Max. Negotiated Rate |
$1,086.97 |
| Rate for Payer: Cash Price |
$483.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$483.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$434.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$434.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$458.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$483.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$458.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$483.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$362.32
|
| Rate for Payer: Healthfirst Commercial |
$483.10
|
| Rate for Payer: Healthfirst Essential Plan |
$1,086.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$458.94
|
| Rate for Payer: Healthfirst QHP |
$483.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$338.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$483.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$410.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$338.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$483.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$362.32
|
| Rate for Payer: SOMOS Essential |
$362.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$483.10
|
|
|
PR REMOVAL HIP PROSTHESIS SEPARATE PROCEDURE
|
Professional
|
Both
|
$3,684.21
|
|
|
Service Code
|
HCPCS 27090
|
| Min. Negotiated Rate |
$689.85 |
| Max. Negotiated Rate |
$2,217.38 |
| Rate for Payer: Cash Price |
$990.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$985.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$886.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$886.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$936.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$985.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$936.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$985.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$985.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$739.12
|
| Rate for Payer: Healthfirst Commercial |
$985.50
|
| Rate for Payer: Healthfirst Essential Plan |
$2,217.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$936.23
|
| Rate for Payer: Healthfirst QHP |
$985.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$689.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$985.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$837.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$689.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$985.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$739.12
|
| Rate for Payer: SOMOS Essential |
$739.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$985.50
|
|
|
PR REMOVAL HYPOGLOSSAL NERVE NSTIM RA PG&RESPIR SNR
|
Professional
|
Both
|
$3,128.34
|
|
|
Service Code
|
HCPCS 64584
|
| Min. Negotiated Rate |
$588.39 |
| Max. Negotiated Rate |
$1,891.26 |
| Rate for Payer: Cash Price |
$847.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$840.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$756.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$756.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$798.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$840.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$798.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$840.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$840.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$630.42
|
| Rate for Payer: Healthfirst Commercial |
$840.56
|
| Rate for Payer: Healthfirst Essential Plan |
$1,891.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$798.53
|
| Rate for Payer: Healthfirst QHP |
$840.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$588.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$840.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$714.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$588.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$840.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$630.42
|
| Rate for Payer: SOMOS Essential |
$630.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$840.56
|
|
|
PR REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT
|
Professional
|
Both
|
$138.53
|
|
|
Service Code
|
HCPCS 69210
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$81.47 |
| Rate for Payer: Cash Price |
$37.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.16
|
| Rate for Payer: Healthfirst Commercial |
$36.21
|
| Rate for Payer: Healthfirst Essential Plan |
$81.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.40
|
| Rate for Payer: Healthfirst QHP |
$36.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.16
|
| Rate for Payer: SOMOS Essential |
$27.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.21
|
|
|
PR REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT
|
Professional
|
Both
|
$67.41
|
|
|
Service Code
|
HCPCS 69209
|
| Min. Negotiated Rate |
$12.93 |
| Max. Negotiated Rate |
$41.56 |
| Rate for Payer: Cash Price |
$19.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.85
|
| Rate for Payer: Healthfirst Commercial |
$18.47
|
| Rate for Payer: Healthfirst Essential Plan |
$41.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.55
|
| Rate for Payer: Healthfirst QHP |
$18.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.85
|
| Rate for Payer: SOMOS Essential |
$13.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.47
|
|
|
PR REMOVAL IMPACTED VAG FB SPX W/ANES OTH/THN LOCAL
|
Professional
|
Both
|
$760.83
|
|
|
Service Code
|
HCPCS 57415
|
| Min. Negotiated Rate |
$142.56 |
| Max. Negotiated Rate |
$458.24 |
| Rate for Payer: Cash Price |
$207.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$203.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$183.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$183.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$193.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$203.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$193.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$203.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$152.75
|
| Rate for Payer: Healthfirst Commercial |
$203.66
|
| Rate for Payer: Healthfirst Essential Plan |
$458.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$193.48
|
| Rate for Payer: Healthfirst QHP |
$203.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$142.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$203.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$173.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$142.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$203.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$152.75
|
| Rate for Payer: SOMOS Essential |
$152.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$203.66
|
|
|
PR REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES
|
Professional
|
Both
|
$401.49
|
|
|
Service Code
|
HCPCS 11976
|
| Min. Negotiated Rate |
$74.22 |
| Max. Negotiated Rate |
$238.57 |
| Rate for Payer: Cash Price |
$107.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$106.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$95.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$95.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$100.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$106.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$100.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.52
|
| Rate for Payer: Healthfirst Commercial |
$106.03
|
| Rate for Payer: Healthfirst Essential Plan |
$238.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$100.73
|
| Rate for Payer: Healthfirst QHP |
$106.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$106.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$90.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$74.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$106.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$79.52
|
| Rate for Payer: SOMOS Essential |
$79.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$106.03
|
|
|
PR REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY
|
Professional
|
Both
|
$946.44
|
|
|
Service Code
|
HCPCS 33241
|
| Min. Negotiated Rate |
$175.71 |
| Max. Negotiated Rate |
$564.77 |
| Rate for Payer: Cash Price |
$253.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$251.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$225.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$225.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$238.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$251.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$238.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$251.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$188.26
|
| Rate for Payer: Healthfirst Commercial |
$251.01
|
| Rate for Payer: Healthfirst Essential Plan |
$564.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$238.46
|
| Rate for Payer: Healthfirst QHP |
$251.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$175.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$251.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$213.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$175.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$251.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$188.26
|
| Rate for Payer: SOMOS Essential |
$188.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$251.01
|
|
|
PR REMOVAL IMPLANT DEEP
|
Professional
|
Both
|
$1,827.70
|
|
|
Service Code
|
HCPCS 20680
|
| Min. Negotiated Rate |
$346.15 |
| Max. Negotiated Rate |
$1,112.62 |
| Rate for Payer: Cash Price |
$497.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$494.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$445.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$445.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$469.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$494.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$469.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$494.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$494.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$370.88
|
| Rate for Payer: Healthfirst Commercial |
$494.50
|
| Rate for Payer: Healthfirst Essential Plan |
$1,112.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$469.77
|
| Rate for Payer: Healthfirst QHP |
$494.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$346.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$494.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$420.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$346.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$494.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$370.88
|
| Rate for Payer: SOMOS Essential |
$370.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$494.50
|
|
|
PR REMOVAL IMPLANTED INTRA-ARTERIAL INFUSION PUMP
|
Professional
|
Both
|
$1,413.27
|
|
|
Service Code
|
HCPCS 36262
|
| Min. Negotiated Rate |
$265.02 |
| Max. Negotiated Rate |
$851.85 |
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$378.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$340.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$340.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$359.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$378.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$359.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$378.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$378.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$283.95
|
| Rate for Payer: Healthfirst Commercial |
$378.60
|
| Rate for Payer: Healthfirst Essential Plan |
$851.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$359.67
|
| Rate for Payer: Healthfirst QHP |
$378.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$265.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$378.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$321.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$265.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$378.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$283.95
|
| Rate for Payer: SOMOS Essential |
$283.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$378.60
|
|
|
PR REMOVAL IMPLANT FROM FINGER/HAND
|
Professional
|
Both
|
$1,549.59
|
|
|
Service Code
|
HCPCS 26320
|
| Min. Negotiated Rate |
$295.21 |
| Max. Negotiated Rate |
$948.89 |
| Rate for Payer: Cash Price |
$421.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$421.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$379.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$379.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$400.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$421.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$400.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$421.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$421.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$316.30
|
| Rate for Payer: Healthfirst Commercial |
$421.73
|
| Rate for Payer: Healthfirst Essential Plan |
$948.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$400.64
|
| Rate for Payer: Healthfirst QHP |
$421.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$295.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$421.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$358.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$295.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$421.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$316.30
|
| Rate for Payer: SOMOS Essential |
$316.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$421.73
|
|
|
PR REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$624.37
|
|
|
Service Code
|
HCPCS 20670
|
| Min. Negotiated Rate |
$119.13 |
| Max. Negotiated Rate |
$382.93 |
| Rate for Payer: Cash Price |
$170.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$170.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$153.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$161.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$170.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$161.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$170.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$127.64
|
| Rate for Payer: Healthfirst Commercial |
$170.19
|
| Rate for Payer: Healthfirst Essential Plan |
$382.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$161.68
|
| Rate for Payer: Healthfirst QHP |
$170.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$119.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$170.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$144.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$119.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$170.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$127.64
|
| Rate for Payer: SOMOS Essential |
$127.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$170.19
|
|
|
PR REMOVAL INDWELLING URETERAL STENT PRQ
|
Professional
|
Both
|
$932.86
|
|
|
Service Code
|
HCPCS 50384
|
| Min. Negotiated Rate |
$174.92 |
| Max. Negotiated Rate |
$562.25 |
| Rate for Payer: Cash Price |
$250.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$249.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$224.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$224.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$237.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$249.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$237.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$249.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$249.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$187.42
|
| Rate for Payer: Healthfirst Commercial |
$249.89
|
| Rate for Payer: Healthfirst Essential Plan |
$562.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$237.40
|
| Rate for Payer: Healthfirst QHP |
$249.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$174.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$249.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$212.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$174.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$249.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$187.42
|
| Rate for Payer: SOMOS Essential |
$187.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$249.89
|
|
|
PR REMOVAL INTACT BREAST IMPLANT
|
Professional
|
Both
|
$2,430.68
|
|
|
Service Code
|
HCPCS 19328
|
| Min. Negotiated Rate |
$459.31 |
| Max. Negotiated Rate |
$1,476.36 |
| Rate for Payer: Cash Price |
$656.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$656.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$590.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$590.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$623.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$656.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$623.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$656.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$656.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$492.12
|
| Rate for Payer: Healthfirst Commercial |
$656.16
|
| Rate for Payer: Healthfirst Essential Plan |
$1,476.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$623.35
|
| Rate for Payer: Healthfirst QHP |
$656.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$459.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$656.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$557.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$459.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$656.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$492.12
|
| Rate for Payer: SOMOS Essential |
$492.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$656.16
|
|
|
PR REMOVAL INTRA-AORTIC BALLOON ASSIST DEVICE PRQ
|
Professional
|
Both
|
$148.65
|
|
|
Service Code
|
HCPCS 33968
|
| Min. Negotiated Rate |
$27.63 |
| Max. Negotiated Rate |
$88.81 |
| Rate for Payer: Cash Price |
$39.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.60
|
| Rate for Payer: Healthfirst Commercial |
$39.47
|
| Rate for Payer: Healthfirst Essential Plan |
$88.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.50
|
| Rate for Payer: Healthfirst QHP |
$39.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.60
|
| Rate for Payer: SOMOS Essential |
$29.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.47
|
|
|
PR REMOVAL INTRA-ARTICULAR DRUG DELIVERY DEVICE
|
Professional
|
Both
|
$547.93
|
|
|
Service Code
|
HCPCS 20705
|
| Min. Negotiated Rate |
$101.59 |
| Max. Negotiated Rate |
$326.54 |
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$145.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$130.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$130.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$137.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$145.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$137.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$145.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$145.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$108.85
|
| Rate for Payer: Healthfirst Commercial |
$145.13
|
| Rate for Payer: Healthfirst Essential Plan |
$326.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$137.87
|
| Rate for Payer: Healthfirst QHP |
$145.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$101.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$145.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$123.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$101.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$145.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$108.85
|
| Rate for Payer: SOMOS Essential |
$108.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$145.13
|
|
