|
PR REMOVAL INTRAMEDULLARY DRUG DELIVERY DEVICE
|
Professional
|
Both
|
$450.59
|
|
|
Service Code
|
HCPCS 20703
|
| Min. Negotiated Rate |
$85.93 |
| Max. Negotiated Rate |
$276.21 |
| Rate for Payer: Cash Price |
$122.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$122.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$110.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$116.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$122.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$116.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.07
|
| Rate for Payer: Healthfirst Commercial |
$122.76
|
| Rate for Payer: Healthfirst Essential Plan |
$276.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$116.62
|
| Rate for Payer: Healthfirst QHP |
$122.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$85.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$122.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$104.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$85.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$122.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$92.07
|
| Rate for Payer: SOMOS Essential |
$92.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.76
|
|
|
PR REMOVAL INTRAUTERINE DEVICE IUD
|
Professional
|
Both
|
$285.67
|
|
|
Service Code
|
HCPCS 58301
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$171.31 |
| Rate for Payer: Cash Price |
$77.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$76.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$68.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$76.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.10
|
| Rate for Payer: Healthfirst Commercial |
$76.14
|
| Rate for Payer: Healthfirst Essential Plan |
$171.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.33
|
| Rate for Payer: Healthfirst QHP |
$76.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$76.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$64.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$76.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$57.10
|
| Rate for Payer: SOMOS Essential |
$57.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76.14
|
|
|
PR REMOVAL LENS MATERIAL EXTRACAPSULAR
|
Professional
|
Both
|
$3,224.17
|
|
|
Service Code
|
HCPCS 66940
|
| Min. Negotiated Rate |
$613.07 |
| Max. Negotiated Rate |
$1,970.57 |
| Rate for Payer: Cash Price |
$888.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$875.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$788.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$788.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$832.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$875.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$832.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$875.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$875.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$656.86
|
| Rate for Payer: Healthfirst Commercial |
$875.81
|
| Rate for Payer: Healthfirst Essential Plan |
$1,970.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$832.02
|
| Rate for Payer: Healthfirst QHP |
$875.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$613.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$875.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$744.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$613.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$875.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$656.86
|
| Rate for Payer: SOMOS Essential |
$656.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$875.81
|
|
|
PR REMOVAL LENS MATRL INTRACAPSULAR DISLOCATED LENS
|
Professional
|
Both
|
$3,521.84
|
|
|
Service Code
|
HCPCS 66930
|
| Min. Negotiated Rate |
$668.17 |
| Max. Negotiated Rate |
$2,147.69 |
| Rate for Payer: Cash Price |
$969.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$954.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$859.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$859.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$954.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$954.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$715.90
|
| Rate for Payer: Healthfirst Commercial |
$954.53
|
| Rate for Payer: Healthfirst Essential Plan |
$2,147.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$906.80
|
| Rate for Payer: Healthfirst QHP |
$954.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$668.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$954.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$811.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$668.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$954.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$715.90
|
| Rate for Payer: SOMOS Essential |
$715.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$954.53
|
|
|
PR REMOVAL LUNG PNEUMONECTOMY EXTRAPLEURAL
|
Professional
|
Both
|
$15,700.48
|
|
|
Service Code
|
HCPCS 32445
|
| Min. Negotiated Rate |
$2,889.12 |
| Max. Negotiated Rate |
$9,286.47 |
| Rate for Payer: Cash Price |
$4,173.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,127.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,714.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,714.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,920.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,127.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,920.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,127.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,127.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,095.49
|
| Rate for Payer: Healthfirst Commercial |
$4,127.32
|
| Rate for Payer: Healthfirst Essential Plan |
$9,286.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,920.95
|
| Rate for Payer: Healthfirst QHP |
$4,127.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,889.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,127.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,508.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,889.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,127.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,095.49
|
| Rate for Payer: SOMOS Essential |
$3,095.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,127.32
|
|
|
PR REMOVAL LUNG PNEUMONECTOMY RESXN SGMNT TRACHEA
|
Professional
|
Both
|
$13,592.78
|
|
|
Service Code
|
HCPCS 32442
|
| Min. Negotiated Rate |
$2,495.65 |
| Max. Negotiated Rate |
$8,021.72 |
| Rate for Payer: Cash Price |
$3,605.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,565.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,208.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,208.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,386.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,565.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,386.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,565.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,565.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,673.91
|
| Rate for Payer: Healthfirst Commercial |
$3,565.21
|
| Rate for Payer: Healthfirst Essential Plan |
$8,021.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,386.95
|
| Rate for Payer: Healthfirst QHP |
$3,565.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,495.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,565.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,030.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,495.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,565.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,673.91
|
| Rate for Payer: SOMOS Essential |
$2,673.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,565.21
|
|
|
PR REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
|
Professional
|
Both
|
$323.93
|
|
|
Service Code
|
HCPCS 11982
|
| Min. Negotiated Rate |
$58.84 |
| Max. Negotiated Rate |
$189.13 |
| Rate for Payer: Cash Price |
$85.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$84.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$75.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$75.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$79.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$84.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$79.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.05
|
| Rate for Payer: Healthfirst Commercial |
$84.06
|
| Rate for Payer: Healthfirst Essential Plan |
$189.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$79.86
|
| Rate for Payer: Healthfirst QHP |
$84.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$84.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$71.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$84.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.05
|
| Rate for Payer: SOMOS Essential |
$63.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.06
|
|
|
PR REMOVAL OCULAR IMPLANT
|
Professional
|
Both
|
$3,290.63
|
|
|
Service Code
|
HCPCS 65175
|
| Min. Negotiated Rate |
$612.35 |
| Max. Negotiated Rate |
$1,968.28 |
| Rate for Payer: Cash Price |
$896.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$874.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$787.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$787.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$831.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$874.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$831.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$874.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$874.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$656.09
|
| Rate for Payer: Healthfirst Commercial |
$874.79
|
| Rate for Payer: Healthfirst Essential Plan |
$1,968.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$831.05
|
| Rate for Payer: Healthfirst QHP |
$874.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$612.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$874.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$743.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$612.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$874.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$656.09
|
| Rate for Payer: SOMOS Essential |
$656.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$874.79
|
|
|
PR REMOVAL OF IMPACTED WAX MD
|
Professional
|
Both
|
$145.46
|
|
|
Service Code
|
HCPCS G0268
|
| Min. Negotiated Rate |
$26.05 |
| Max. Negotiated Rate |
$83.75 |
| Rate for Payer: Cash Price |
$38.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.91
|
| Rate for Payer: Healthfirst Commercial |
$37.22
|
| Rate for Payer: Healthfirst Essential Plan |
$83.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.36
|
| Rate for Payer: Healthfirst QHP |
$37.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.91
|
| Rate for Payer: SOMOS Essential |
$27.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.22
|
|
|
PR REMOVAL OF LUNG PNEUMONECTOMY
|
Professional
|
Both
|
$6,972.04
|
|
|
Service Code
|
HCPCS 32440
|
| Min. Negotiated Rate |
$1,288.71 |
| Max. Negotiated Rate |
$4,142.30 |
| Rate for Payer: Cash Price |
$1,858.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,841.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,656.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,656.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,748.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,841.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,748.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,841.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,841.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,380.77
|
| Rate for Payer: Healthfirst Commercial |
$1,841.02
|
| Rate for Payer: Healthfirst Essential Plan |
$4,142.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,748.97
|
| Rate for Payer: Healthfirst QHP |
$1,841.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,288.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,841.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,564.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,288.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,841.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,380.77
|
| Rate for Payer: SOMOS Essential |
$1,380.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,841.02
|
|
|
PR REMOVAL PANCREATIC CALCULUS
|
Professional
|
Both
|
$5,343.24
|
|
|
Service Code
|
HCPCS 48020
|
| Min. Negotiated Rate |
$988.97 |
| Max. Negotiated Rate |
$3,178.82 |
| Rate for Payer: Cash Price |
$1,423.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,412.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,271.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,271.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,342.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,412.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,342.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,412.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,412.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,059.61
|
| Rate for Payer: Healthfirst Commercial |
$1,412.81
|
| Rate for Payer: Healthfirst Essential Plan |
$3,178.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,342.17
|
| Rate for Payer: Healthfirst QHP |
$1,412.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$988.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,412.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,200.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$988.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,412.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,059.61
|
| Rate for Payer: SOMOS Essential |
$1,059.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,412.81
|
|
|
PR REMOVAL PERITONEAL FOREIGN BODY FROM CAVITY
|
Professional
|
Both
|
$3,840.27
|
|
|
Service Code
|
HCPCS 49402
|
| Min. Negotiated Rate |
$715.29 |
| Max. Negotiated Rate |
$2,299.14 |
| Rate for Payer: Cash Price |
$1,026.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,021.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$919.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$919.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$970.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,021.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$970.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,021.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,021.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$766.38
|
| Rate for Payer: Healthfirst Commercial |
$1,021.84
|
| Rate for Payer: Healthfirst Essential Plan |
$2,299.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$970.75
|
| Rate for Payer: Healthfirst QHP |
$1,021.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$715.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,021.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$868.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$715.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,021.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$766.38
|
| Rate for Payer: SOMOS Essential |
$766.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,021.84
|
|
|
PR REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY
|
Professional
|
Both
|
$1,031.73
|
|
|
Service Code
|
HCPCS 33233
|
| Min. Negotiated Rate |
$190.40 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Cash Price |
$274.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$272.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$244.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$244.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$258.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$272.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$258.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$272.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$272.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$204.00
|
| Rate for Payer: Healthfirst Commercial |
$272.00
|
| Rate for Payer: Healthfirst Essential Plan |
$612.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$258.40
|
| Rate for Payer: Healthfirst QHP |
$272.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$190.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$272.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$231.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$190.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$272.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$204.00
|
| Rate for Payer: SOMOS Essential |
$204.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$272.00
|
|
|
PR REMOVAL PERQ LEFT HRT VAD ARTL/ARTL&VEN SEP INSJ
|
Professional
|
Both
|
$823.24
|
|
|
Service Code
|
HCPCS 33992
|
| Min. Negotiated Rate |
$151.90 |
| Max. Negotiated Rate |
$488.25 |
| Rate for Payer: Cash Price |
$219.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$217.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$195.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$195.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$217.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$217.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$162.75
|
| Rate for Payer: Healthfirst Commercial |
$217.00
|
| Rate for Payer: Healthfirst Essential Plan |
$488.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$206.15
|
| Rate for Payer: Healthfirst QHP |
$217.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$151.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$217.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$184.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$151.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$217.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$162.75
|
| Rate for Payer: SOMOS Essential |
$162.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$217.00
|
|
|
PR REMOVAL PERQ R HEART VAD VENOUS CANNULA SEP INSJ
|
Professional
|
Both
|
$694.33
|
|
|
Service Code
|
HCPCS 33997
|
| Min. Negotiated Rate |
$130.46 |
| Max. Negotiated Rate |
$419.33 |
| Rate for Payer: Cash Price |
$188.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$186.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$167.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$177.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$186.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$177.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$186.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$186.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.78
|
| Rate for Payer: Healthfirst Commercial |
$186.37
|
| Rate for Payer: Healthfirst Essential Plan |
$419.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$177.05
|
| Rate for Payer: Healthfirst QHP |
$186.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$130.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$186.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$158.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$130.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$186.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$139.78
|
| Rate for Payer: SOMOS Essential |
$139.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$186.37
|
|
|
PR REMOVAL POSTERIOR NONSEGMENTAL INSTRUMENTATION
|
Professional
|
Both
|
$3,379.11
|
|
|
Service Code
|
HCPCS 22850
|
| Min. Negotiated Rate |
$632.18 |
| Max. Negotiated Rate |
$2,032.02 |
| Rate for Payer: Cash Price |
$905.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$903.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$812.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$812.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$857.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$903.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$857.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$903.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$903.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$677.34
|
| Rate for Payer: Healthfirst Commercial |
$903.12
|
| Rate for Payer: Healthfirst Essential Plan |
$2,032.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$857.96
|
| Rate for Payer: Healthfirst QHP |
$903.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$632.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$903.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$767.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$632.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$903.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$677.34
|
| Rate for Payer: SOMOS Essential |
$677.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$903.12
|
|
|
PR REMOVAL POSTERIOR SEGMENTAL INSTRUMENTATION
|
Professional
|
Both
|
$3,248.67
|
|
|
Service Code
|
HCPCS 22852
|
| Min. Negotiated Rate |
$607.73 |
| Max. Negotiated Rate |
$1,953.40 |
| Rate for Payer: Cash Price |
$872.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$868.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$781.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$781.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$824.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$868.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$824.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$868.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$868.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$651.13
|
| Rate for Payer: Healthfirst Commercial |
$868.18
|
| Rate for Payer: Healthfirst Essential Plan |
$1,953.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$824.77
|
| Rate for Payer: Healthfirst QHP |
$868.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$607.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$868.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$737.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$607.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$868.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$651.13
|
| Rate for Payer: SOMOS Essential |
$651.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$868.18
|
|
|
PR REMOVAL SHOULDER FOREIGN BODY DEEP SUBFASCIAL/IM
|
Professional
|
Both
|
$2,101.89
|
|
|
Service Code
|
HCPCS 23333
|
| Min. Negotiated Rate |
$400.23 |
| Max. Negotiated Rate |
$1,286.44 |
| Rate for Payer: Cash Price |
$571.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$571.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$514.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$514.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$543.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$571.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$543.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$571.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$571.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$428.81
|
| Rate for Payer: Healthfirst Commercial |
$571.75
|
| Rate for Payer: Healthfirst Essential Plan |
$1,286.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$543.16
|
| Rate for Payer: Healthfirst QHP |
$571.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$400.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$571.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$485.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$400.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$571.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$428.81
|
| Rate for Payer: SOMOS Essential |
$428.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$571.75
|
|
|
PR REMOVAL SUBCUTANEOUS CARDIAC RHYTHM MONITOR
|
Professional
|
Both
|
$382.97
|
|
|
Service Code
|
HCPCS 33286
|
| Min. Negotiated Rate |
$69.63 |
| Max. Negotiated Rate |
$223.81 |
| Rate for Payer: Cash Price |
$100.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$99.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$89.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$89.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$94.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$99.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$94.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.60
|
| Rate for Payer: Healthfirst Commercial |
$99.47
|
| Rate for Payer: Healthfirst Essential Plan |
$223.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$94.50
|
| Rate for Payer: Healthfirst QHP |
$99.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$69.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$99.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$84.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$69.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$99.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$74.60
|
| Rate for Payer: SOMOS Essential |
$74.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$99.47
|
|
|
PR REMOVAL SUBDELTOID CALCAREOUS DEPOSITS OPEN
|
Professional
|
Both
|
$1,558.38
|
|
|
Service Code
|
HCPCS 23000
|
| Min. Negotiated Rate |
$298.24 |
| Max. Negotiated Rate |
$958.61 |
| Rate for Payer: Cash Price |
$428.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$426.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$383.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$383.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$404.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$426.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$404.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$426.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$426.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$319.54
|
| Rate for Payer: Healthfirst Commercial |
$426.05
|
| Rate for Payer: Healthfirst Essential Plan |
$958.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$404.75
|
| Rate for Payer: Healthfirst QHP |
$426.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$298.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$426.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$362.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$298.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$426.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$319.54
|
| Rate for Payer: SOMOS Essential |
$319.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$426.05
|
|
|
PR REMOVAL SUTURES&STAPLES NOT REQUIRING ANESTHESIA
|
Professional
|
Both
|
$71.61
|
|
|
Service Code
|
HCPCS 15854
|
| Min. Negotiated Rate |
$11.84 |
| Max. Negotiated Rate |
$38.07 |
| Rate for Payer: Cash Price |
$19.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.69
|
| Rate for Payer: Healthfirst Commercial |
$16.92
|
| Rate for Payer: Healthfirst Essential Plan |
$38.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.07
|
| Rate for Payer: Healthfirst QHP |
$16.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.69
|
| Rate for Payer: SOMOS Essential |
$12.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.92
|
|
|
PR REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA
|
Professional
|
Both
|
$50.19
|
|
|
Service Code
|
HCPCS 15853
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$30.22 |
| Rate for Payer: Cash Price |
$13.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.07
|
| Rate for Payer: Healthfirst Commercial |
$13.43
|
| Rate for Payer: Healthfirst Essential Plan |
$30.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.76
|
| Rate for Payer: Healthfirst QHP |
$13.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.07
|
| Rate for Payer: SOMOS Essential |
$10.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.43
|
|
|
PR REMOVAL SUTURES/STAPLES REQUIRING ANESTHESIA
|
Professional
|
Both
|
$272.69
|
|
|
Service Code
|
HCPCS 15851
|
| Min. Negotiated Rate |
$52.26 |
| Max. Negotiated Rate |
$167.96 |
| Rate for Payer: Cash Price |
$74.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$74.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$74.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.99
|
| Rate for Payer: Healthfirst Commercial |
$74.65
|
| Rate for Payer: Healthfirst Essential Plan |
$167.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.92
|
| Rate for Payer: Healthfirst QHP |
$74.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$74.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$55.99
|
| Rate for Payer: SOMOS Essential |
$55.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.65
|
|
|
PR REMOVAL TISSUE EXPANDER W/O INSERTION IMPLANT
|
Professional
|
Both
|
$2,409.93
|
|
|
Service Code
|
HCPCS 11971
|
| Min. Negotiated Rate |
$457.42 |
| Max. Negotiated Rate |
$1,470.26 |
| Rate for Payer: Cash Price |
$655.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$653.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$588.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$588.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$620.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$653.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$620.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$653.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$653.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$490.09
|
| Rate for Payer: Healthfirst Commercial |
$653.45
|
| Rate for Payer: Healthfirst Essential Plan |
$1,470.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$620.78
|
| Rate for Payer: Healthfirst QHP |
$653.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$457.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$653.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$555.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$457.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$653.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$490.09
|
| Rate for Payer: SOMOS Essential |
$490.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$653.45
|
|
|
PR REMOVAL TONGS/HALO APPLIED BY ANOTHER INDIVIDUAL
|
Professional
|
Both
|
$407.44
|
|
|
Service Code
|
HCPCS 20665
|
| Min. Negotiated Rate |
$79.56 |
| Max. Negotiated Rate |
$255.74 |
| Rate for Payer: Cash Price |
$112.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$113.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$102.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$102.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$107.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$113.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$107.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.25
|
| Rate for Payer: Healthfirst Commercial |
$113.66
|
| Rate for Payer: Healthfirst Essential Plan |
$255.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$107.98
|
| Rate for Payer: Healthfirst QHP |
$113.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$79.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$113.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$96.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$79.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$113.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$85.25
|
| Rate for Payer: SOMOS Essential |
$85.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$113.66
|
|
