|
PR SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX
|
Professional
|
Both
|
$260.09
|
|
|
Service Code
|
HCPCS 92060
|
| Min. Negotiated Rate |
$42.01 |
| Max. Negotiated Rate |
$161.08 |
| Rate for Payer: Amida Care Medicaid |
$42.01
|
| Rate for Payer: Cash Price |
$72.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$71.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$64.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$68.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$71.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$68.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.69
|
| Rate for Payer: Healthfirst Commercial |
$71.59
|
| Rate for Payer: Healthfirst Essential Plan |
$161.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.01
|
| Rate for Payer: Healthfirst QHP |
$71.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$50.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$71.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$60.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$71.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$53.69
|
| Rate for Payer: SOMOS Essential |
$53.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.59
|
|
|
PR SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES
|
Professional
|
Both
|
$265.55
|
|
|
Service Code
|
HCPCS 97533
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$159.12 |
| Rate for Payer: Cash Price |
$71.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$63.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$63.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$67.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$67.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.04
|
| Rate for Payer: Healthfirst Commercial |
$70.72
|
| Rate for Payer: Healthfirst Essential Plan |
$159.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$67.18
|
| Rate for Payer: Healthfirst QHP |
$70.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$49.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$70.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$60.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$49.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$53.04
|
| Rate for Payer: SOMOS Essential |
$53.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.72
|
|
|
PR SEPTAL/OTHER INTRANASAL DERMATOPLASTY
|
Professional
|
Both
|
$2,952.92
|
|
|
Service Code
|
HCPCS 30620
|
| Min. Negotiated Rate |
$541.21 |
| Max. Negotiated Rate |
$1,739.59 |
| Rate for Payer: Cash Price |
$796.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$773.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$695.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$695.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$734.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$773.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$734.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$773.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$773.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$579.86
|
| Rate for Payer: Healthfirst Commercial |
$773.15
|
| Rate for Payer: Healthfirst Essential Plan |
$1,739.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$734.49
|
| Rate for Payer: Healthfirst QHP |
$773.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$541.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$773.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$657.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$541.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$773.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$579.86
|
| Rate for Payer: SOMOS Essential |
$579.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$773.15
|
|
|
PR SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF
|
Professional
|
Both
|
$2,941.30
|
|
|
Service Code
|
HCPCS 30520
|
| Min. Negotiated Rate |
$544.12 |
| Max. Negotiated Rate |
$1,748.95 |
| Rate for Payer: Cash Price |
$795.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$777.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$699.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$699.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$738.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$777.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$738.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$777.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$777.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$582.98
|
| Rate for Payer: Healthfirst Commercial |
$777.31
|
| Rate for Payer: Healthfirst Essential Plan |
$1,748.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$738.44
|
| Rate for Payer: Healthfirst QHP |
$777.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$544.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$777.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$660.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$544.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$777.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$582.98
|
| Rate for Payer: SOMOS Essential |
$582.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$777.31
|
|
|
PR SEQUESTRECTOMY CLAVICLE
|
Professional
|
Both
|
$2,511.60
|
|
|
Service Code
|
HCPCS 23170
|
| Min. Negotiated Rate |
$475.22 |
| Max. Negotiated Rate |
$1,527.48 |
| Rate for Payer: Cash Price |
$682.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$678.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$610.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$610.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$644.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$678.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$644.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$678.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$678.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$509.16
|
| Rate for Payer: Healthfirst Commercial |
$678.88
|
| Rate for Payer: Healthfirst Essential Plan |
$1,527.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$644.94
|
| Rate for Payer: Healthfirst QHP |
$678.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$475.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$678.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$577.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$475.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$678.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$509.16
|
| Rate for Payer: SOMOS Essential |
$509.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$678.88
|
|
|
PR SEQUESTRECTOMY FOREARM &/WRIST
|
Professional
|
Both
|
$2,321.80
|
|
|
Service Code
|
HCPCS 25145
|
| Min. Negotiated Rate |
$440.29 |
| Max. Negotiated Rate |
$1,415.20 |
| Rate for Payer: Cash Price |
$630.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$628.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$566.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$566.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$597.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$628.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$597.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$628.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$628.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$471.74
|
| Rate for Payer: Healthfirst Commercial |
$628.98
|
| Rate for Payer: Healthfirst Essential Plan |
$1,415.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$597.53
|
| Rate for Payer: Healthfirst QHP |
$628.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$440.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$628.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$534.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$440.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$628.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$471.74
|
| Rate for Payer: SOMOS Essential |
$471.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$628.98
|
|
|
PR SEQUESTRECTOMY HUMERAL HEAD SURGERY NECK
|
Professional
|
Both
|
$3,391.26
|
|
|
Service Code
|
HCPCS 23174
|
| Min. Negotiated Rate |
$641.24 |
| Max. Negotiated Rate |
$2,061.11 |
| Rate for Payer: Cash Price |
$919.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$916.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$824.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$824.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$870.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$916.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$870.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$916.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$916.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$687.04
|
| Rate for Payer: Healthfirst Commercial |
$916.05
|
| Rate for Payer: Healthfirst Essential Plan |
$2,061.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$870.25
|
| Rate for Payer: Healthfirst QHP |
$916.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$641.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$916.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$778.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$641.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$916.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$687.04
|
| Rate for Payer: SOMOS Essential |
$687.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$916.05
|
|
|
PR SEQUESTRECTOMY OLECRANON PROCESS
|
Professional
|
Both
|
$3,056.24
|
|
|
Service Code
|
HCPCS 24138
|
| Min. Negotiated Rate |
$578.87 |
| Max. Negotiated Rate |
$1,860.66 |
| Rate for Payer: Cash Price |
$828.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$826.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$744.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$744.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$785.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$826.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$785.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$826.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$826.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$620.22
|
| Rate for Payer: Healthfirst Commercial |
$826.96
|
| Rate for Payer: Healthfirst Essential Plan |
$1,860.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$785.61
|
| Rate for Payer: Healthfirst QHP |
$826.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$578.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$826.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$702.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$578.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$826.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$620.22
|
| Rate for Payer: SOMOS Essential |
$620.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$826.96
|
|
|
PR SEQUESTRECTOMY RADIAL HEAD OR NECK
|
Professional
|
Both
|
$2,814.00
|
|
|
Service Code
|
HCPCS 24136
|
| Min. Negotiated Rate |
$531.85 |
| Max. Negotiated Rate |
$1,709.51 |
| Rate for Payer: Cash Price |
$761.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$759.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$683.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$683.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$721.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$759.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$721.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$759.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$759.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$569.84
|
| Rate for Payer: Healthfirst Commercial |
$759.78
|
| Rate for Payer: Healthfirst Essential Plan |
$1,709.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$721.79
|
| Rate for Payer: Healthfirst QHP |
$759.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$531.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$759.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$645.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$531.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$759.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$569.84
|
| Rate for Payer: SOMOS Essential |
$569.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$759.78
|
|
|
PR SEQUESTRECTOMY SCAPULA
|
Professional
|
Both
|
$2,540.97
|
|
|
Service Code
|
HCPCS 23172
|
| Min. Negotiated Rate |
$480.28 |
| Max. Negotiated Rate |
$1,543.77 |
| Rate for Payer: Cash Price |
$689.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$686.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$617.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$651.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$686.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$651.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$686.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$686.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$514.59
|
| Rate for Payer: Healthfirst Commercial |
$686.12
|
| Rate for Payer: Healthfirst Essential Plan |
$1,543.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$651.81
|
| Rate for Payer: Healthfirst QHP |
$686.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$480.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$686.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$583.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$480.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$686.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$514.59
|
| Rate for Payer: SOMOS Essential |
$514.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$686.12
|
|
|
PR SEQUESTRECTOMY SHAFT/DISTAL HUMERUS
|
Professional
|
Both
|
$3,318.70
|
|
|
Service Code
|
HCPCS 24134
|
| Min. Negotiated Rate |
$626.85 |
| Max. Negotiated Rate |
$2,014.88 |
| Rate for Payer: Cash Price |
$897.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$895.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$805.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$805.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$850.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$895.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$850.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$895.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$895.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$671.62
|
| Rate for Payer: Healthfirst Commercial |
$895.50
|
| Rate for Payer: Healthfirst Essential Plan |
$2,014.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$850.73
|
| Rate for Payer: Healthfirst QHP |
$895.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$626.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$895.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$761.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$626.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$895.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$671.62
|
| Rate for Payer: SOMOS Essential |
$671.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$895.50
|
|
|
PR SERIAL TONOMETRY SPX W/MLT MEAS INTRAOCULAR PRS
|
Professional
|
Both
|
$127.89
|
|
|
Service Code
|
HCPCS 92100
|
| Min. Negotiated Rate |
$22.81 |
| Max. Negotiated Rate |
$78.01 |
| Rate for Payer: Amida Care Medicaid |
$22.81
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.00
|
| Rate for Payer: Healthfirst Commercial |
$34.67
|
| Rate for Payer: Healthfirst Essential Plan |
$78.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.94
|
| Rate for Payer: Healthfirst QHP |
$34.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.00
|
| Rate for Payer: SOMOS Essential |
$26.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.67
|
|
|
PR SESAMOIDECTOMY FIRST TOE SPX
|
Professional
|
Both
|
$1,375.29
|
|
|
Service Code
|
HCPCS 28315
|
| Min. Negotiated Rate |
$264.10 |
| Max. Negotiated Rate |
$848.88 |
| Rate for Payer: Cash Price |
$377.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$377.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$339.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$339.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$358.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$377.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$358.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$377.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$377.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$282.96
|
| Rate for Payer: Healthfirst Commercial |
$377.28
|
| Rate for Payer: Healthfirst Essential Plan |
$848.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$358.42
|
| Rate for Payer: Healthfirst QHP |
$377.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$264.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$377.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$320.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$264.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$377.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$282.96
|
| Rate for Payer: SOMOS Essential |
$282.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$377.28
|
|
|
PR SESAMOIDECTOMY THUMB/FINGER SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,478.88
|
|
|
Service Code
|
HCPCS 26185
|
| Min. Negotiated Rate |
$472.68 |
| Max. Negotiated Rate |
$1,519.31 |
| Rate for Payer: Cash Price |
$675.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$675.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$607.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$607.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$641.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$675.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$641.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$675.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$675.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$506.44
|
| Rate for Payer: Healthfirst Commercial |
$675.25
|
| Rate for Payer: Healthfirst Essential Plan |
$1,519.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$641.49
|
| Rate for Payer: Healthfirst QHP |
$675.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$472.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$675.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$573.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$472.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$675.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$506.44
|
| Rate for Payer: SOMOS Essential |
$506.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$675.25
|
|
|
PR SET UP PORT XRAY EQUIPMENT
|
Professional
|
Both
|
$107.66
|
|
|
Service Code
|
HCPCS Q0092
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$70.38 |
| Rate for Payer: Cash Price |
$30.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.46
|
| Rate for Payer: Healthfirst Commercial |
$31.28
|
| Rate for Payer: Healthfirst Essential Plan |
$70.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.72
|
| Rate for Payer: Healthfirst QHP |
$31.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.46
|
| Rate for Payer: SOMOS Essential |
$23.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.28
|
|
|
PR SEVERING ADHESIONS ANTERIOR SEGMENT LASER SPX
|
Professional
|
Both
|
$1,016.58
|
|
|
Service Code
|
HCPCS 65860
|
| Min. Negotiated Rate |
$194.33 |
| Max. Negotiated Rate |
$624.62 |
| Rate for Payer: Cash Price |
$280.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$277.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$249.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$249.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$263.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$277.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$263.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$277.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$277.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$208.21
|
| Rate for Payer: Healthfirst Commercial |
$277.61
|
| Rate for Payer: Healthfirst Essential Plan |
$624.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$263.73
|
| Rate for Payer: Healthfirst QHP |
$277.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$194.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$277.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$235.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$194.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$277.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$208.21
|
| Rate for Payer: SOMOS Essential |
$208.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$277.61
|
|
|
PR SEVERING ADS ANT SEG INCAL SPX ANT SYNECHIAE
|
Professional
|
Both
|
$2,455.92
|
|
|
Service Code
|
HCPCS 65870
|
| Min. Negotiated Rate |
$466.75 |
| Max. Negotiated Rate |
$1,500.28 |
| Rate for Payer: Cash Price |
$675.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$666.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$600.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$600.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$633.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$666.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$633.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$666.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$666.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$500.09
|
| Rate for Payer: Healthfirst Commercial |
$666.79
|
| Rate for Payer: Healthfirst Essential Plan |
$1,500.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$633.45
|
| Rate for Payer: Healthfirst QHP |
$666.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$466.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$666.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$566.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$466.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$666.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$500.09
|
| Rate for Payer: SOMOS Essential |
$500.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$666.79
|
|
|
PR SEVERING ADS ANT SEG INCAL SPX CORNEOVITREAL
|
Professional
|
Both
|
$2,754.43
|
|
|
Service Code
|
HCPCS 65880
|
| Min. Negotiated Rate |
$521.37 |
| Max. Negotiated Rate |
$1,675.85 |
| Rate for Payer: Cash Price |
$757.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$744.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$670.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$670.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$707.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$744.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$707.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$744.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$744.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$558.62
|
| Rate for Payer: Healthfirst Commercial |
$744.82
|
| Rate for Payer: Healthfirst Essential Plan |
$1,675.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$707.58
|
| Rate for Payer: Healthfirst QHP |
$744.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$521.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$744.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$633.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$521.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$744.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$558.62
|
| Rate for Payer: SOMOS Essential |
$558.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$744.82
|
|
|
PR SEVERING ADS ANT SEG INCAL SPX POST SYNECHIAE
|
Professional
|
Both
|
$2,620.24
|
|
|
Service Code
|
HCPCS 65875
|
| Min. Negotiated Rate |
$497.04 |
| Max. Negotiated Rate |
$1,597.61 |
| Rate for Payer: Cash Price |
$721.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$710.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$639.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$639.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$674.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$710.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$674.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$710.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$710.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$532.54
|
| Rate for Payer: Healthfirst Commercial |
$710.05
|
| Rate for Payer: Healthfirst Essential Plan |
$1,597.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$674.55
|
| Rate for Payer: Healthfirst QHP |
$710.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$497.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$710.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$603.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$497.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$710.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$532.54
|
| Rate for Payer: SOMOS Essential |
$532.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$710.05
|
|
|
PR SEVERING ADS ANT SEG INCAL TQ SPX GONIOSYNECHIAE
|
Professional
|
Both
|
$1,978.69
|
|
|
Service Code
|
HCPCS 65865
|
| Min. Negotiated Rate |
$375.21 |
| Max. Negotiated Rate |
$1,206.05 |
| Rate for Payer: Cash Price |
$544.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$536.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$482.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$482.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$509.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$536.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$509.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$536.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$536.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$402.01
|
| Rate for Payer: Healthfirst Commercial |
$536.02
|
| Rate for Payer: Healthfirst Essential Plan |
$1,206.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$509.22
|
| Rate for Payer: Healthfirst QHP |
$536.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$375.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$536.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$455.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$375.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$536.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$402.01
|
| Rate for Payer: SOMOS Essential |
$402.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$536.02
|
|
|
PR SEVERING TARSORRHAPHY
|
Professional
|
Both
|
$410.06
|
|
|
Service Code
|
HCPCS 67710
|
| Min. Negotiated Rate |
$77.36 |
| Max. Negotiated Rate |
$248.65 |
| Rate for Payer: Cash Price |
$112.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$110.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$99.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$99.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$104.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$110.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$104.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.88
|
| Rate for Payer: Healthfirst Commercial |
$110.51
|
| Rate for Payer: Healthfirst Essential Plan |
$248.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$104.98
|
| Rate for Payer: Healthfirst QHP |
$110.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$77.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$110.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$93.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$77.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$110.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.88
|
| Rate for Payer: SOMOS Essential |
$82.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$110.51
|
|
|
PR SEVERING VITREOUS STRANS LASER 1/> STAGES
|
Professional
|
Both
|
$1,460.62
|
|
|
Service Code
|
HCPCS 67031
|
| Min. Negotiated Rate |
$277.27 |
| Max. Negotiated Rate |
$891.23 |
| Rate for Payer: Cash Price |
$401.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$396.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$356.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$356.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$376.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$396.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$376.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$396.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$297.07
|
| Rate for Payer: Healthfirst Commercial |
$396.10
|
| Rate for Payer: Healthfirst Essential Plan |
$891.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$376.30
|
| Rate for Payer: Healthfirst QHP |
$396.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$277.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$396.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$336.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$277.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$396.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$297.07
|
| Rate for Payer: SOMOS Essential |
$297.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$396.10
|
|
|
PR SGMDSC FLX DIRED SBMCSL NJX ANY SBST
|
Professional
|
Both
|
$282.14
|
|
|
Service Code
|
HCPCS 45335
|
| Min. Negotiated Rate |
$54.28 |
| Max. Negotiated Rate |
$174.49 |
| Rate for Payer: Cash Price |
$76.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$77.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$69.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$69.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$73.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$77.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$73.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.16
|
| Rate for Payer: Healthfirst Commercial |
$77.55
|
| Rate for Payer: Healthfirst Essential Plan |
$174.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.67
|
| Rate for Payer: Healthfirst QHP |
$77.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$54.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$77.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$65.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$54.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$77.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$58.16
|
| Rate for Payer: SOMOS Essential |
$58.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$77.55
|
|
|
PR SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ
|
Professional
|
Both
|
$503.27
|
|
|
Service Code
|
HCPCS 45338
|
| Min. Negotiated Rate |
$95.35 |
| Max. Negotiated Rate |
$306.50 |
| Rate for Payer: Cash Price |
$136.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$136.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$122.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$122.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$129.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$136.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$129.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.17
|
| Rate for Payer: Healthfirst Commercial |
$136.22
|
| Rate for Payer: Healthfirst Essential Plan |
$306.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$129.41
|
| Rate for Payer: Healthfirst QHP |
$136.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$95.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$136.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$115.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$95.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$136.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.17
|
| Rate for Payer: SOMOS Essential |
$102.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$136.22
|
|
|
PR SGMDSC FLX W/DCMPRN W/PLMT DCMPRN TUBE
|
Professional
|
Both
|
$479.22
|
|
|
Service Code
|
HCPCS 45337
|
| Min. Negotiated Rate |
$90.03 |
| Max. Negotiated Rate |
$289.39 |
| Rate for Payer: Cash Price |
$129.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$128.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$115.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$115.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$122.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$128.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$122.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$128.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.47
|
| Rate for Payer: Healthfirst Commercial |
$128.62
|
| Rate for Payer: Healthfirst Essential Plan |
$289.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$122.19
|
| Rate for Payer: Healthfirst QHP |
$128.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$90.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$128.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$109.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$90.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$128.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$96.47
|
| Rate for Payer: SOMOS Essential |
$96.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$128.62
|
|
