|
PR COMPUTERIZED CORNEAL TOPOGRAPHY UNI/BI W/I&R
|
Professional
|
Both
|
$151.38
|
|
|
Service Code
|
HCPCS 92025
|
| Min. Negotiated Rate |
$24.87 |
| Max. Negotiated Rate |
$92.79 |
| Rate for Payer: Amida Care Medicaid |
$24.87
|
| Rate for Payer: Cash Price |
$41.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.93
|
| Rate for Payer: Healthfirst Commercial |
$41.24
|
| Rate for Payer: Healthfirst Essential Plan |
$92.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.18
|
| Rate for Payer: Healthfirst QHP |
$41.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.93
|
| Rate for Payer: SOMOS Essential |
$30.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.24
|
|
|
PR COMPUTERIZED CORNEAL TOPOGRAPHY UNI/BI W/I&R
|
Professional
|
Both
|
$76.76
|
|
|
Service Code
|
HCPCS 92025 26
|
| Min. Negotiated Rate |
$14.58 |
| Max. Negotiated Rate |
$46.87 |
| Rate for Payer: Amida Care Medicaid |
$24.87
|
| Rate for Payer: Cash Price |
$21.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.62
|
| Rate for Payer: Healthfirst Commercial |
$20.83
|
| Rate for Payer: Healthfirst Essential Plan |
$46.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.79
|
| Rate for Payer: Healthfirst QHP |
$20.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.62
|
| Rate for Payer: SOMOS Essential |
$15.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.83
|
|
|
PR COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE
|
Professional
|
Both
|
$84.46
|
|
|
Service Code
|
HCPCS 92133 26
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Amida Care Medicaid |
$34.19
|
| Rate for Payer: Cash Price |
$23.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.43
|
| Rate for Payer: Healthfirst Commercial |
$17.90
|
| Rate for Payer: Healthfirst Essential Plan |
$40.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.00
|
| Rate for Payer: Healthfirst QHP |
$17.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$17.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.43
|
| Rate for Payer: SOMOS Essential |
$13.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.90
|
|
|
PR COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE
|
Professional
|
Both
|
$67.41
|
|
|
Service Code
|
HCPCS 92133 TC
|
| Min. Negotiated Rate |
$11.84 |
| Max. Negotiated Rate |
$38.07 |
| Rate for Payer: Amida Care Medicaid |
$34.19
|
| Rate for Payer: Cash Price |
$18.31
|
| 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 COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE
|
Professional
|
Both
|
$151.90
|
|
|
Service Code
|
HCPCS 92133
|
| Min. Negotiated Rate |
$24.37 |
| Max. Negotiated Rate |
$78.34 |
| Rate for Payer: Amida Care Medicaid |
$34.19
|
| Rate for Payer: Cash Price |
$41.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.11
|
| Rate for Payer: Healthfirst Commercial |
$34.82
|
| Rate for Payer: Healthfirst Essential Plan |
$78.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.08
|
| Rate for Payer: Healthfirst QHP |
$34.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.11
|
| Rate for Payer: SOMOS Essential |
$26.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.82
|
|
|
PR COMPUTERIZED OPHTHALMIC IMAGING RETINA
|
Professional
|
Both
|
$97.90
|
|
|
Service Code
|
HCPCS 92134 26
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$43.65 |
| Rate for Payer: Amida Care Medicaid |
$34.19
|
| Rate for Payer: Cash Price |
$26.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.55
|
| Rate for Payer: Healthfirst Commercial |
$19.40
|
| Rate for Payer: Healthfirst Essential Plan |
$43.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.43
|
| Rate for Payer: Healthfirst QHP |
$19.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.55
|
| Rate for Payer: SOMOS Essential |
$14.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.40
|
|
|
PR COMPUTERIZED OPHTHALMIC IMAGING RETINA
|
Professional
|
Both
|
$68.85
|
|
|
Service Code
|
HCPCS 92134 TC
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$38.95 |
| Rate for Payer: Amida Care Medicaid |
$34.19
|
| Rate for Payer: Cash Price |
$19.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.98
|
| Rate for Payer: Healthfirst Commercial |
$17.31
|
| Rate for Payer: Healthfirst Essential Plan |
$38.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.44
|
| Rate for Payer: Healthfirst QHP |
$17.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$17.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.98
|
| Rate for Payer: SOMOS Essential |
$12.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.31
|
|
|
PR COMPUTERIZED OPHTHALMIC IMAGING RETINA
|
Professional
|
Both
|
$166.78
|
|
|
Service Code
|
HCPCS 92134
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$82.60 |
| Rate for Payer: Amida Care Medicaid |
$34.19
|
| Rate for Payer: Cash Price |
$46.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.53
|
| Rate for Payer: Healthfirst Commercial |
$36.71
|
| Rate for Payer: Healthfirst Essential Plan |
$82.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.87
|
| Rate for Payer: Healthfirst QHP |
$36.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.53
|
| Rate for Payer: SOMOS Essential |
$27.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.71
|
|
|
PR CONDITIONING PLAY AUDIOMETRY
|
Professional
|
Both
|
$353.50
|
|
|
Service Code
|
HCPCS 92582
|
| Min. Negotiated Rate |
$72.98 |
| Max. Negotiated Rate |
$234.59 |
| Rate for Payer: Cash Price |
$102.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$104.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$93.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$93.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$99.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$104.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$99.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$78.19
|
| Rate for Payer: Healthfirst Commercial |
$104.26
|
| Rate for Payer: Healthfirst Essential Plan |
$234.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$99.05
|
| Rate for Payer: Healthfirst QHP |
$104.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$104.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$88.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$104.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$78.19
|
| Rate for Payer: SOMOS Essential |
$78.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$104.26
|
|
|
PR CONDYLECTOMY TEMPOROMANDIBULAR JOINT SPX
|
Professional
|
Both
|
$3,651.59
|
|
|
Service Code
|
HCPCS 21050
|
| Min. Negotiated Rate |
$691.07 |
| Max. Negotiated Rate |
$2,221.29 |
| Rate for Payer: Cash Price |
$992.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$987.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$888.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$888.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$937.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$987.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$937.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$987.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$987.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$740.43
|
| Rate for Payer: Healthfirst Commercial |
$987.24
|
| Rate for Payer: Healthfirst Essential Plan |
$2,221.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$937.88
|
| Rate for Payer: Healthfirst QHP |
$987.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$691.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$987.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$839.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$691.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$987.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$740.43
|
| Rate for Payer: SOMOS Essential |
$740.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$987.24
|
|
|
PR CONIZATION CERVIX W/WO D&C RPR ELTRD EXC
|
Professional
|
Both
|
$1,111.29
|
|
|
Service Code
|
HCPCS 57522
|
| Min. Negotiated Rate |
$208.63 |
| Max. Negotiated Rate |
$670.61 |
| Rate for Payer: Cash Price |
$302.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$298.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$268.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$268.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$283.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$298.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$283.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$298.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$298.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$223.54
|
| Rate for Payer: Healthfirst Commercial |
$298.05
|
| Rate for Payer: Healthfirst Essential Plan |
$670.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$283.15
|
| Rate for Payer: Healthfirst QHP |
$298.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$208.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$298.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$253.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$208.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$298.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$223.54
|
| Rate for Payer: SOMOS Essential |
$223.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$298.05
|
|
|
PR CONIZATION CERVIX W/WO D&C RPR KNIFE/LASER
|
Professional
|
Both
|
$1,293.22
|
|
|
Service Code
|
HCPCS 57520
|
| Min. Negotiated Rate |
$242.82 |
| Max. Negotiated Rate |
$780.48 |
| Rate for Payer: Cash Price |
$351.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$346.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$312.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$312.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$329.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$346.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$329.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$346.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$346.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$260.16
|
| Rate for Payer: Healthfirst Commercial |
$346.88
|
| Rate for Payer: Healthfirst Essential Plan |
$780.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$329.54
|
| Rate for Payer: Healthfirst QHP |
$346.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$242.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$346.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$294.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$242.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$346.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$260.16
|
| Rate for Payer: SOMOS Essential |
$260.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$346.88
|
|
|
PR CONJUNCTIVAL FLAP BRIDGE/PARTIAL SPX
|
Professional
|
Both
|
$1,689.91
|
|
|
Service Code
|
HCPCS 68360
|
| Min. Negotiated Rate |
$322.94 |
| Max. Negotiated Rate |
$1,038.02 |
| Rate for Payer: Cash Price |
$466.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$415.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$415.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$438.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$438.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$461.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$346.00
|
| Rate for Payer: Healthfirst Commercial |
$461.34
|
| Rate for Payer: Healthfirst Essential Plan |
$1,038.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$438.27
|
| Rate for Payer: Healthfirst QHP |
$461.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$322.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$392.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$322.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$346.00
|
| Rate for Payer: SOMOS Essential |
$346.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.34
|
|
|
PR CONJUNCTIVAL FLAP TOTAL
|
Professional
|
Both
|
$2,693.46
|
|
|
Service Code
|
HCPCS 68362
|
| Min. Negotiated Rate |
$512.78 |
| Max. Negotiated Rate |
$1,648.24 |
| Rate for Payer: Cash Price |
$742.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$732.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$659.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$659.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$695.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$732.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$695.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$732.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$732.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$549.41
|
| Rate for Payer: Healthfirst Commercial |
$732.55
|
| Rate for Payer: Healthfirst Essential Plan |
$1,648.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$695.92
|
| Rate for Payer: Healthfirst QHP |
$732.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$512.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$732.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$622.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$512.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$732.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$549.41
|
| Rate for Payer: SOMOS Essential |
$549.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$732.55
|
|
|
PR CONJUNCTIVOPLASTY W/BUCCAL MUC MEMB GRAFT
|
Professional
|
Both
|
$2,694.65
|
|
|
Service Code
|
HCPCS 68325
|
| Min. Negotiated Rate |
$513.81 |
| Max. Negotiated Rate |
$1,651.52 |
| Rate for Payer: Cash Price |
$743.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$734.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$660.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$660.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$697.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$734.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$697.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$734.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$734.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$550.51
|
| Rate for Payer: Healthfirst Commercial |
$734.01
|
| Rate for Payer: Healthfirst Essential Plan |
$1,651.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$697.31
|
| Rate for Payer: Healthfirst QHP |
$734.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$513.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$734.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$623.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$513.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$734.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$550.51
|
| Rate for Payer: SOMOS Essential |
$550.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$734.01
|
|
|
PR CONJUNCTIVOPLASTY W/GRF/XTNSV REARRANGEMENT
|
Professional
|
Both
|
$2,227.30
|
|
|
Service Code
|
HCPCS 68320
|
| Min. Negotiated Rate |
$425.14 |
| Max. Negotiated Rate |
$1,366.54 |
| Rate for Payer: Cash Price |
$614.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$607.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$546.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$546.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$576.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$607.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$576.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$607.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$607.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$455.51
|
| Rate for Payer: Healthfirst Commercial |
$607.35
|
| Rate for Payer: Healthfirst Essential Plan |
$1,366.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$576.98
|
| Rate for Payer: Healthfirst QHP |
$607.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$425.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$607.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$516.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$425.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$607.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$455.51
|
| Rate for Payer: SOMOS Essential |
$455.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$607.35
|
|
|
PR CONJUNCTIVORHINOSTOMY INSJ TUBE/STENT
|
Professional
|
Both
|
$3,580.78
|
|
|
Service Code
|
HCPCS 68750
|
| Min. Negotiated Rate |
$674.53 |
| Max. Negotiated Rate |
$2,168.14 |
| Rate for Payer: Cash Price |
$983.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$963.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$867.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$867.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$915.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$963.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$915.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$963.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$963.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$722.72
|
| Rate for Payer: Healthfirst Commercial |
$963.62
|
| Rate for Payer: Healthfirst Essential Plan |
$2,168.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$915.44
|
| Rate for Payer: Healthfirst QHP |
$963.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$674.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$963.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$819.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$674.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$963.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$722.72
|
| Rate for Payer: SOMOS Essential |
$722.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$963.62
|
|
|
PR CONJUNCTIVORHINOSTOMY W/O TUBE
|
Professional
|
Both
|
$3,380.02
|
|
|
Service Code
|
HCPCS 68745
|
| Min. Negotiated Rate |
$638.59 |
| Max. Negotiated Rate |
$2,052.61 |
| Rate for Payer: Cash Price |
$927.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$912.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$821.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$821.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$866.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$912.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$866.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$912.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$912.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$684.20
|
| Rate for Payer: Healthfirst Commercial |
$912.27
|
| Rate for Payer: Healthfirst Essential Plan |
$2,052.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$866.66
|
| Rate for Payer: Healthfirst QHP |
$912.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$638.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$912.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$775.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$638.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$912.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$684.20
|
| Rate for Payer: SOMOS Essential |
$684.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$912.27
|
|
|
PR CONJUNCTPL CUL-DE-SAC W/BUCCAL MUC MEMB GRAFT
|
Professional
|
Both
|
$2,906.23
|
|
|
Service Code
|
HCPCS 68328
|
| Min. Negotiated Rate |
$551.01 |
| Max. Negotiated Rate |
$1,771.11 |
| Rate for Payer: Cash Price |
$796.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$787.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$708.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$708.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$747.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$787.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$747.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$787.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$787.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$590.37
|
| Rate for Payer: Healthfirst Commercial |
$787.16
|
| Rate for Payer: Healthfirst Essential Plan |
$1,771.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$747.80
|
| Rate for Payer: Healthfirst QHP |
$787.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$551.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$787.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$669.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$551.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$787.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$590.37
|
| Rate for Payer: SOMOS Essential |
$590.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$787.16
|
|
|
PR CONSTJ INTERMARGIN ADHES/TARSOR/CANTHOR W/TRPOS
|
Professional
|
Both
|
$1,940.58
|
|
|
Service Code
|
HCPCS 67882
|
| Min. Negotiated Rate |
$371.40 |
| Max. Negotiated Rate |
$1,193.78 |
| Rate for Payer: Cash Price |
$534.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$530.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$477.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$477.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$504.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$530.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$504.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$530.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$530.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$397.93
|
| Rate for Payer: Healthfirst Commercial |
$530.57
|
| Rate for Payer: Healthfirst Essential Plan |
$1,193.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$504.04
|
| Rate for Payer: Healthfirst QHP |
$530.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$371.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$530.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$450.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$371.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$530.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$397.93
|
| Rate for Payer: SOMOS Essential |
$397.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$530.57
|
|
|
PR CONSTJ INTERMARGIN ADHES/TARSORRH/CANTHORRHAPY
|
Professional
|
Both
|
$1,519.74
|
|
|
Service Code
|
HCPCS 67880
|
| Min. Negotiated Rate |
$290.83 |
| Max. Negotiated Rate |
$934.81 |
| Rate for Payer: Cash Price |
$419.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$415.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$373.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$373.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$394.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$415.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$394.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$415.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$415.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$311.60
|
| Rate for Payer: Healthfirst Commercial |
$415.47
|
| Rate for Payer: Healthfirst Essential Plan |
$934.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$394.70
|
| Rate for Payer: Healthfirst QHP |
$415.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$290.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$415.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$353.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$290.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$415.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$311.60
|
| Rate for Payer: SOMOS Essential |
$311.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$415.47
|
|
|
PR CONSTJ TRACHEOESOPHGL FSTL&INSJ SP PROSTH
|
Professional
|
Both
|
$2,325.12
|
|
|
Service Code
|
HCPCS 31611
|
| Min. Negotiated Rate |
$434.75 |
| Max. Negotiated Rate |
$1,397.41 |
| Rate for Payer: Cash Price |
$631.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$621.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$558.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$558.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$590.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$621.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$590.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$621.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$621.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$465.80
|
| Rate for Payer: Healthfirst Commercial |
$621.07
|
| Rate for Payer: Healthfirst Essential Plan |
$1,397.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$590.02
|
| Rate for Payer: Healthfirst QHP |
$621.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$434.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$621.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$527.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$434.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$621.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$465.80
|
| Rate for Payer: SOMOS Essential |
$465.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$621.07
|
|
|
PR CONSTRUCTION APICAL-AORTIC CONDUIT
|
Professional
|
Both
|
$7,697.90
|
|
|
Service Code
|
HCPCS 33404
|
| Min. Negotiated Rate |
$1,421.02 |
| Max. Negotiated Rate |
$4,567.57 |
| Rate for Payer: Cash Price |
$2,047.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,030.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,827.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,827.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,928.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,030.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,928.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,030.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,030.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,522.52
|
| Rate for Payer: Healthfirst Commercial |
$2,030.03
|
| Rate for Payer: Healthfirst Essential Plan |
$4,567.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,928.53
|
| Rate for Payer: Healthfirst QHP |
$2,030.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,421.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,030.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,725.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,421.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,030.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,522.52
|
| Rate for Payer: SOMOS Essential |
$1,522.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,030.03
|
|
|
PR CONSTRUCTION ARTIFICIAL VAGINA W/GRAFT
|
Professional
|
Both
|
$3,620.02
|
|
|
Service Code
|
HCPCS 57292
|
| Min. Negotiated Rate |
$671.68 |
| Max. Negotiated Rate |
$2,158.97 |
| Rate for Payer: Cash Price |
$974.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$959.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$863.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$863.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$911.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$959.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$911.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$959.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$959.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$719.65
|
| Rate for Payer: Healthfirst Commercial |
$959.54
|
| Rate for Payer: Healthfirst Essential Plan |
$2,158.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$911.56
|
| Rate for Payer: Healthfirst QHP |
$959.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$671.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$959.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$815.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$671.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$959.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$719.65
|
| Rate for Payer: SOMOS Essential |
$719.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$959.54
|
|
|
PR CONSTRUCTION ARTIFICIAL VAGINA W/O GRAFT
|
Professional
|
Both
|
$2,398.13
|
|
|
Service Code
|
HCPCS 57291
|
| Min. Negotiated Rate |
$447.86 |
| Max. Negotiated Rate |
$1,439.55 |
| Rate for Payer: Cash Price |
$649.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$639.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$575.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$575.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$607.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$639.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$607.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$639.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$639.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$479.85
|
| Rate for Payer: Healthfirst Commercial |
$639.80
|
| Rate for Payer: Healthfirst Essential Plan |
$1,439.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$607.81
|
| Rate for Payer: Healthfirst QHP |
$639.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$447.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$639.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$543.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$447.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$639.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$479.85
|
| Rate for Payer: SOMOS Essential |
$479.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$639.80
|
|
