|
PR RMVL FB/DACRYOLITH LACRIMAL PASSAGES
|
Professional
|
Both
|
$1,040.13
|
|
|
Service Code
|
HCPCS 68530
|
| Min. Negotiated Rate |
$198.50 |
| Max. Negotiated Rate |
$638.03 |
| Rate for Payer: Cash Price |
$286.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$255.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$255.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$269.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$269.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$283.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$212.68
|
| Rate for Payer: Healthfirst Commercial |
$283.57
|
| Rate for Payer: Healthfirst Essential Plan |
$638.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$269.39
|
| Rate for Payer: Healthfirst QHP |
$283.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$198.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$283.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$241.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$198.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$212.68
|
| Rate for Payer: SOMOS Essential |
$212.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.57
|
|
|
PR RMVL FB INTRAOCULAR ANT CHAMBER EYE/LENS
|
Professional
|
Both
|
$3,023.58
|
|
|
Service Code
|
HCPCS 65235
|
| Min. Negotiated Rate |
$570.95 |
| Max. Negotiated Rate |
$1,835.19 |
| Rate for Payer: Cash Price |
$833.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$815.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$734.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$734.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$774.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$815.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$774.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$815.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$815.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$611.73
|
| Rate for Payer: Healthfirst Commercial |
$815.64
|
| Rate for Payer: Healthfirst Essential Plan |
$1,835.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$774.86
|
| Rate for Payer: Healthfirst QHP |
$815.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$570.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$815.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$693.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$570.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$815.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$611.73
|
| Rate for Payer: SOMOS Essential |
$611.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$815.64
|
|
|
PR RMVL FB IO FROM POST SEG MAG XTRJ ANT/POST ROUTE
|
Professional
|
Both
|
$4,054.19
|
|
|
Service Code
|
HCPCS 65260
|
| Min. Negotiated Rate |
$766.22 |
| Max. Negotiated Rate |
$2,462.85 |
| Rate for Payer: Cash Price |
$1,113.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,094.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$985.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$985.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,039.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,094.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,039.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,094.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,094.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$820.95
|
| Rate for Payer: Healthfirst Commercial |
$1,094.60
|
| Rate for Payer: Healthfirst Essential Plan |
$2,462.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,039.87
|
| Rate for Payer: Healthfirst QHP |
$1,094.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$766.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,094.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$930.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$766.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,094.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$820.95
|
| Rate for Payer: SOMOS Essential |
$820.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,094.60
|
|
|
PR RMVL FB IO FROM POST SEG NONMAGNETIC XTRJ
|
Professional
|
Both
|
$4,562.18
|
|
|
Service Code
|
HCPCS 65265
|
| Min. Negotiated Rate |
$860.52 |
| Max. Negotiated Rate |
$2,765.95 |
| Rate for Payer: Cash Price |
$1,253.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,229.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,106.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,106.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,167.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,229.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,167.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,229.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,229.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$921.98
|
| Rate for Payer: Healthfirst Commercial |
$1,229.31
|
| Rate for Payer: Healthfirst Essential Plan |
$2,765.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,167.84
|
| Rate for Payer: Healthfirst QHP |
$1,229.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$860.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,229.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,044.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$860.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,229.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$921.98
|
| Rate for Payer: SOMOS Essential |
$921.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,229.31
|
|
|
PR RMVL FB XTRNL AUDITORY CANAL ANES
|
Professional
|
Both
|
$415.00
|
|
|
Service Code
|
HCPCS 69205
|
| Min. Negotiated Rate |
$76.86 |
| Max. Negotiated Rate |
$247.05 |
| Rate for Payer: Cash Price |
$111.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$109.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$98.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$98.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$104.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$109.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$104.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.35
|
| Rate for Payer: Healthfirst Commercial |
$109.80
|
| Rate for Payer: Healthfirst Essential Plan |
$247.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$104.31
|
| Rate for Payer: Healthfirst QHP |
$109.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$76.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$109.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$93.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$76.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$109.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.35
|
| Rate for Payer: SOMOS Essential |
$82.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$109.80
|
|
|
PR RMVL FB XTRNL AUDITORY CANAL W/O ANES
|
Professional
|
Both
|
$202.72
|
|
|
Service Code
|
HCPCS 69200
|
| Min. Negotiated Rate |
$38.70 |
| Max. Negotiated Rate |
$124.40 |
| Rate for Payer: Cash Price |
$54.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$55.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$52.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.47
|
| Rate for Payer: Healthfirst Commercial |
$55.29
|
| Rate for Payer: Healthfirst Essential Plan |
$124.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.53
|
| Rate for Payer: Healthfirst QHP |
$55.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$55.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.47
|
| Rate for Payer: SOMOS Essential |
$41.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.29
|
|
|
PR RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP
|
Professional
|
Both
|
$176.65
|
|
|
Service Code
|
HCPCS 65220
|
| Min. Negotiated Rate |
$32.26 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Cash Price |
$47.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.57
|
| Rate for Payer: Healthfirst Commercial |
$46.09
|
| Rate for Payer: Healthfirst Essential Plan |
$103.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.79
|
| Rate for Payer: Healthfirst QHP |
$46.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.57
|
| Rate for Payer: SOMOS Essential |
$34.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.09
|
|
|
PR RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP
|
Professional
|
Both
|
$200.97
|
|
|
Service Code
|
HCPCS 65222
|
| Min. Negotiated Rate |
$38.29 |
| Max. Negotiated Rate |
$123.08 |
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.02
|
| Rate for Payer: Healthfirst Commercial |
$54.70
|
| Rate for Payer: Healthfirst Essential Plan |
$123.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.97
|
| Rate for Payer: Healthfirst QHP |
$54.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$54.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$46.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.02
|
| Rate for Payer: SOMOS Essential |
$41.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.70
|
|
|
PR RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR
|
Professional
|
Both
|
$146.30
|
|
|
Service Code
|
HCPCS 65210
|
| Min. Negotiated Rate |
$27.69 |
| Max. Negotiated Rate |
$89.01 |
| Rate for Payer: Cash Price |
$39.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.67
|
| Rate for Payer: Healthfirst Commercial |
$39.56
|
| Rate for Payer: Healthfirst Essential Plan |
$89.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.58
|
| Rate for Payer: Healthfirst QHP |
$39.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.67
|
| Rate for Payer: SOMOS Essential |
$29.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.56
|
|
|
PR RMVL FECAL IMPACTION/FB SPX UNDER ANES
|
Professional
|
Both
|
$1,002.44
|
|
|
Service Code
|
HCPCS 45915
|
| Min. Negotiated Rate |
$189.29 |
| Max. Negotiated Rate |
$608.45 |
| Rate for Payer: Cash Price |
$270.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$270.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$243.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$243.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$256.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$270.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$256.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$270.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$270.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$202.81
|
| Rate for Payer: Healthfirst Commercial |
$270.42
|
| Rate for Payer: Healthfirst Essential Plan |
$608.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$256.90
|
| Rate for Payer: Healthfirst QHP |
$270.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$189.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$270.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$229.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$189.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$270.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$202.81
|
| Rate for Payer: SOMOS Essential |
$202.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$270.42
|
|
|
PR RMVL FOREIGN BODY INTRANASAL LATERAL RHINOTOMY
|
Professional
|
Both
|
$2,133.11
|
|
|
Service Code
|
HCPCS 30320
|
| Min. Negotiated Rate |
$395.31 |
| Max. Negotiated Rate |
$1,270.64 |
| Rate for Payer: Cash Price |
$576.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$564.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$508.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$508.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$536.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$564.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$536.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$564.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$564.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$423.55
|
| Rate for Payer: Healthfirst Commercial |
$564.73
|
| Rate for Payer: Healthfirst Essential Plan |
$1,270.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$536.49
|
| Rate for Payer: Healthfirst QHP |
$564.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$395.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$564.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$480.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$395.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$564.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$423.55
|
| Rate for Payer: SOMOS Essential |
$423.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$564.73
|
|
|
PR RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Professional
|
Both
|
$1,081.22
|
|
|
Service Code
|
HCPCS 20525
|
| Min. Negotiated Rate |
$205.06 |
| Max. Negotiated Rate |
$659.12 |
| Rate for Payer: Cash Price |
$292.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$292.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$263.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$263.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$278.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$292.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$278.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$292.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$292.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$219.71
|
| Rate for Payer: Healthfirst Commercial |
$292.94
|
| Rate for Payer: Healthfirst Essential Plan |
$659.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$278.29
|
| Rate for Payer: Healthfirst QHP |
$292.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$205.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$292.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$249.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$205.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$292.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$219.71
|
| Rate for Payer: SOMOS Essential |
$219.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.94
|
|
|
PR RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS
|
Professional
|
Both
|
$742.63
|
|
|
Service Code
|
HCPCS 27086
|
| Min. Negotiated Rate |
$141.43 |
| Max. Negotiated Rate |
$454.59 |
| Rate for Payer: Cash Price |
$203.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$202.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$181.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$181.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$191.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$202.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$191.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$202.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$151.53
|
| Rate for Payer: Healthfirst Commercial |
$202.04
|
| Rate for Payer: Healthfirst Essential Plan |
$454.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$191.94
|
| Rate for Payer: Healthfirst QHP |
$202.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$141.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$202.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$171.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$141.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$202.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$151.53
|
| Rate for Payer: SOMOS Essential |
$151.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$202.04
|
|
|
PR RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS
|
Professional
|
Both
|
$609.07
|
|
|
Service Code
|
HCPCS 24200
|
| Min. Negotiated Rate |
$119.06 |
| Max. Negotiated Rate |
$382.70 |
| Rate for Payer: Cash Price |
$168.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$170.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$153.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$161.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$170.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$161.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$170.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$127.57
|
| Rate for Payer: Healthfirst Commercial |
$170.09
|
| Rate for Payer: Healthfirst Essential Plan |
$382.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$161.59
|
| Rate for Payer: Healthfirst QHP |
$170.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$119.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$170.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$144.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$119.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$170.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$127.57
|
| Rate for Payer: SOMOS Essential |
$127.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$170.09
|
|
|
PR RMVL HIP PROSTH COMP W/TOT HIP PROSTH MMA
|
Professional
|
Both
|
$7,022.72
|
|
|
Service Code
|
HCPCS 27091
|
| Min. Negotiated Rate |
$1,316.04 |
| Max. Negotiated Rate |
$4,230.14 |
| Rate for Payer: Cash Price |
$1,888.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,880.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,692.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,692.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,786.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,880.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,786.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,880.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,880.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,410.05
|
| Rate for Payer: Healthfirst Commercial |
$1,880.06
|
| Rate for Payer: Healthfirst Essential Plan |
$4,230.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,786.06
|
| Rate for Payer: Healthfirst QHP |
$1,880.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,316.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,880.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,598.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,316.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,880.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,410.05
|
| Rate for Payer: SOMOS Essential |
$1,410.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,880.06
|
|
|
PR RMVL I-AORT BALO ASST DEV W/RPR FEM ART W/WO GRF
|
Professional
|
Both
|
$3,126.73
|
|
|
Service Code
|
HCPCS 33971
|
| Min. Negotiated Rate |
$578.21 |
| Max. Negotiated Rate |
$1,858.52 |
| Rate for Payer: Cash Price |
$834.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$826.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$743.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$743.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$784.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$826.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$784.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$826.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$826.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$619.51
|
| Rate for Payer: Healthfirst Commercial |
$826.01
|
| Rate for Payer: Healthfirst Essential Plan |
$1,858.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$784.71
|
| Rate for Payer: Healthfirst QHP |
$826.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$578.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$826.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$702.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$578.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$826.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$619.51
|
| Rate for Payer: SOMOS Essential |
$619.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$826.01
|
|
|
PR RMVL IMPLANTED MATERIAL ANTERIO SEGMENT EYE
|
Professional
|
Both
|
$3,268.83
|
|
|
Service Code
|
HCPCS 65920
|
| Min. Negotiated Rate |
$620.43 |
| Max. Negotiated Rate |
$1,994.24 |
| Rate for Payer: Cash Price |
$899.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$886.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$797.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$797.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$842.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$886.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$842.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$886.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$886.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$664.75
|
| Rate for Payer: Healthfirst Commercial |
$886.33
|
| Rate for Payer: Healthfirst Essential Plan |
$1,994.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$842.01
|
| Rate for Payer: Healthfirst QHP |
$886.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$620.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$886.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$753.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$620.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$886.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$664.75
|
| Rate for Payer: SOMOS Essential |
$664.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$886.33
|
|
|
PR RMVL IMPLNT MATL POSTERIOR SEGMENT EXTRAOCULAR
|
Professional
|
Both
|
$2,284.63
|
|
|
Service Code
|
HCPCS 67120
|
| Min. Negotiated Rate |
$434.38 |
| Max. Negotiated Rate |
$1,396.24 |
| Rate for Payer: Cash Price |
$629.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$620.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$558.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$558.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$589.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$620.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$589.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$620.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$620.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$465.41
|
| Rate for Payer: Healthfirst Commercial |
$620.55
|
| Rate for Payer: Healthfirst Essential Plan |
$1,396.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$589.52
|
| Rate for Payer: Healthfirst QHP |
$620.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$434.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$620.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$527.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$434.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$620.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$465.41
|
| Rate for Payer: SOMOS Essential |
$465.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$620.55
|
|
|
PR RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD
|
Professional
|
Both
|
$1,647.03
|
|
|
Service Code
|
HCPCS 33262
|
| Min. Negotiated Rate |
$302.60 |
| Max. Negotiated Rate |
$972.63 |
| Rate for Payer: Cash Price |
$436.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$432.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$389.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$389.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$432.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$432.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$432.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$324.21
|
| Rate for Payer: Healthfirst Commercial |
$432.28
|
| Rate for Payer: Healthfirst Essential Plan |
$972.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$410.67
|
| Rate for Payer: Healthfirst QHP |
$432.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$302.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$432.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$367.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$302.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$432.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$324.21
|
| Rate for Payer: SOMOS Essential |
$324.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$432.28
|
|
|
PR RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD
|
Professional
|
Both
|
$1,708.91
|
|
|
Service Code
|
HCPCS 33263
|
| Min. Negotiated Rate |
$315.01 |
| Max. Negotiated Rate |
$1,012.54 |
| Rate for Payer: Cash Price |
$454.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$450.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$405.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$405.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$427.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$450.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$427.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$450.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$450.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$337.51
|
| Rate for Payer: Healthfirst Commercial |
$450.02
|
| Rate for Payer: Healthfirst Essential Plan |
$1,012.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$427.52
|
| Rate for Payer: Healthfirst QHP |
$450.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$315.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$450.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$382.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$315.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$450.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$337.51
|
| Rate for Payer: SOMOS Essential |
$337.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$450.02
|
|
|
PR RMVL IMPLTBL DFB PLS GEN W/RPLCMT PLS GEN MLT LD
|
Professional
|
Both
|
$1,780.84
|
|
|
Service Code
|
HCPCS 33264
|
| Min. Negotiated Rate |
$328.36 |
| Max. Negotiated Rate |
$1,055.43 |
| Rate for Payer: Cash Price |
$473.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$469.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$422.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$422.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$445.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$469.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$445.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$469.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$469.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$351.81
|
| Rate for Payer: Healthfirst Commercial |
$469.08
|
| Rate for Payer: Healthfirst Essential Plan |
$1,055.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$445.63
|
| Rate for Payer: Healthfirst QHP |
$469.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$328.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$469.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$398.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$328.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$469.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$351.81
|
| Rate for Payer: SOMOS Essential |
$351.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$469.08
|
|
|
PR RMVL IMPLTBL GLUCOSE SENSOR SUBQ POCKET VIA INC
|
Professional
|
Both
|
$265.90
|
|
|
Service Code
|
HCPCS 0447T
|
| Min. Negotiated Rate |
$50.29 |
| Max. Negotiated Rate |
$161.64 |
| Rate for Payer: Cash Price |
$73.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$71.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$64.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$68.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$71.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$68.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.88
|
| Rate for Payer: Healthfirst Commercial |
$71.84
|
| Rate for Payer: Healthfirst Essential Plan |
$161.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.25
|
| Rate for Payer: Healthfirst QHP |
$71.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$50.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$71.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$61.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$71.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$53.88
|
| Rate for Payer: SOMOS Essential |
$53.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.84
|
|
|
PR RMVL IMPLT MATRL POSTERIOR SEGMENT INTRAOCULAR
|
Professional
|
Both
|
$3,703.63
|
|
|
Service Code
|
HCPCS 67121
|
| Min. Negotiated Rate |
$704.68 |
| Max. Negotiated Rate |
$2,265.03 |
| Rate for Payer: Cash Price |
$1,021.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,006.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$906.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$906.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$956.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,006.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$956.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,006.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,006.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$755.01
|
| Rate for Payer: Healthfirst Commercial |
$1,006.68
|
| Rate for Payer: Healthfirst Essential Plan |
$2,265.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$956.35
|
| Rate for Payer: Healthfirst QHP |
$1,006.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$704.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,006.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$855.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$704.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,006.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$755.01
|
| Rate for Payer: SOMOS Essential |
$755.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,006.68
|
|
|
PR RMVL INFLATABLE PENILE PROSTH W/O RPLCMT PROSTH
|
Professional
|
Both
|
$3,066.49
|
|
|
Service Code
|
HCPCS 54406
|
| Min. Negotiated Rate |
$584.29 |
| Max. Negotiated Rate |
$1,878.08 |
| Rate for Payer: Cash Price |
$839.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$834.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$751.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$751.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$792.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$834.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$792.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$834.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$834.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$626.02
|
| Rate for Payer: Healthfirst Commercial |
$834.70
|
| Rate for Payer: Healthfirst Essential Plan |
$1,878.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$792.97
|
| Rate for Payer: Healthfirst QHP |
$834.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$584.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$834.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$709.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$584.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$834.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$626.02
|
| Rate for Payer: SOMOS Essential |
$626.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$834.70
|
|
|
PR RMVL INSJ IMPLTBL GLUC SENSOR DIF ANATOMIC SITE
|
Professional
|
Both
|
$378.56
|
|
|
Service Code
|
HCPCS 0448T
|
| Min. Negotiated Rate |
$72.44 |
| Max. Negotiated Rate |
$232.85 |
| Rate for Payer: Cash Price |
$104.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$103.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$93.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$93.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$98.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$98.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.62
|
| Rate for Payer: Healthfirst Commercial |
$103.49
|
| Rate for Payer: Healthfirst Essential Plan |
$232.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$98.32
|
| Rate for Payer: Healthfirst QHP |
$103.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$103.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$87.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.62
|
| Rate for Payer: SOMOS Essential |
$77.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.49
|
|
