|
PR CORNEA SCRAPING DIAGNOSTIC SMEAR &/CULTURE
|
Professional
|
Both
|
$414.02
|
|
|
Service Code
|
HCPCS 65430
|
| Min. Negotiated Rate |
$79.49 |
| Max. Negotiated Rate |
$255.51 |
| Rate for Payer: Cash Price |
$113.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$113.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$102.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$102.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$107.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$113.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$107.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.17
|
| Rate for Payer: Healthfirst Commercial |
$113.56
|
| Rate for Payer: Healthfirst Essential Plan |
$255.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$107.88
|
| Rate for Payer: Healthfirst QHP |
$113.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$79.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$113.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$96.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$79.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$113.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$85.17
|
| Rate for Payer: SOMOS Essential |
$85.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$113.56
|
|
|
PR CORONARY ARTERY BYPASS 1 CORONARY VENOUS GRAFT
|
Professional
|
Both
|
$8,559.25
|
|
|
Service Code
|
HCPCS 33510
|
| Min. Negotiated Rate |
$1,577.41 |
| Max. Negotiated Rate |
$5,070.24 |
| Rate for Payer: Cash Price |
$2,274.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,253.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,028.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,028.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,140.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,253.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,140.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,253.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,253.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,690.08
|
| Rate for Payer: Healthfirst Commercial |
$2,253.44
|
| Rate for Payer: Healthfirst Essential Plan |
$5,070.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,140.77
|
| Rate for Payer: Healthfirst QHP |
$2,253.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,577.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,253.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,915.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,577.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,253.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,690.08
|
| Rate for Payer: SOMOS Essential |
$1,690.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,253.44
|
|
|
PR CORONARY ARTERY BYPASS 2 CORONARY VENOUS GRAFTS
|
Professional
|
Both
|
$9,392.57
|
|
|
Service Code
|
HCPCS 33511
|
| Min. Negotiated Rate |
$1,733.03 |
| Max. Negotiated Rate |
$5,570.44 |
| Rate for Payer: Cash Price |
$2,498.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,475.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,228.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,228.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,351.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,475.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,351.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,475.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,475.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,856.81
|
| Rate for Payer: Healthfirst Commercial |
$2,475.75
|
| Rate for Payer: Healthfirst Essential Plan |
$5,570.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,351.96
|
| Rate for Payer: Healthfirst QHP |
$2,475.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,733.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,475.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,104.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,733.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,475.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,856.81
|
| Rate for Payer: SOMOS Essential |
$1,856.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,475.75
|
|
|
PR CORONARY ARTERY BYPASS 3 CORONARY VENOUS GRAFTS
|
Professional
|
Both
|
$10,715.32
|
|
|
Service Code
|
HCPCS 33512
|
| Min. Negotiated Rate |
$1,971.97 |
| Max. Negotiated Rate |
$6,338.48 |
| Rate for Payer: Cash Price |
$2,847.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,817.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,535.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,535.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,676.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,817.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,676.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,817.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,817.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,112.82
|
| Rate for Payer: Healthfirst Commercial |
$2,817.10
|
| Rate for Payer: Healthfirst Essential Plan |
$6,338.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,676.24
|
| Rate for Payer: Healthfirst QHP |
$2,817.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,971.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,817.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,394.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,971.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,817.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,112.82
|
| Rate for Payer: SOMOS Essential |
$2,112.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,817.10
|
|
|
PR CORONARY ARTERY BYPASS 4 CORONARY VENOUS GRAFTS
|
Professional
|
Both
|
$10,968.09
|
|
|
Service Code
|
HCPCS 33513
|
| Min. Negotiated Rate |
$2,013.38 |
| Max. Negotiated Rate |
$6,471.56 |
| Rate for Payer: Cash Price |
$2,906.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,876.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,588.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,588.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,732.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,876.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,732.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,876.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,876.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,157.19
|
| Rate for Payer: Healthfirst Commercial |
$2,876.25
|
| Rate for Payer: Healthfirst Essential Plan |
$6,471.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,732.44
|
| Rate for Payer: Healthfirst QHP |
$2,876.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,013.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,876.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,444.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,013.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,876.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,157.19
|
| Rate for Payer: SOMOS Essential |
$2,157.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,876.25
|
|
|
PR CORONARY ARTERY BYPASS 5 CORONARY VENOUS GRAFTS
|
Professional
|
Both
|
$11,484.87
|
|
|
Service Code
|
HCPCS 33514
|
| Min. Negotiated Rate |
$2,114.14 |
| Max. Negotiated Rate |
$6,795.45 |
| Rate for Payer: Cash Price |
$3,048.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,020.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,718.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,718.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,869.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,020.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,869.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,020.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,020.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,265.15
|
| Rate for Payer: Healthfirst Commercial |
$3,020.20
|
| Rate for Payer: Healthfirst Essential Plan |
$6,795.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,869.19
|
| Rate for Payer: Healthfirst QHP |
$3,020.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,114.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,020.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,567.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,114.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,020.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,265.15
|
| Rate for Payer: SOMOS Essential |
$2,265.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,020.20
|
|
|
PR CORONARY ARTERY BYPASS 6/+ CORONARY VENOUS GRAFT
|
Professional
|
Both
|
$11,885.65
|
|
|
Service Code
|
HCPCS 33516
|
| Min. Negotiated Rate |
$2,188.54 |
| Max. Negotiated Rate |
$7,034.58 |
| Rate for Payer: Cash Price |
$3,154.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,126.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,813.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,813.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,970.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,126.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,970.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,126.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,126.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,344.86
|
| Rate for Payer: Healthfirst Commercial |
$3,126.48
|
| Rate for Payer: Healthfirst Essential Plan |
$7,034.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,970.16
|
| Rate for Payer: Healthfirst QHP |
$3,126.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,188.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,126.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,657.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,188.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,126.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,344.86
|
| Rate for Payer: SOMOS Essential |
$2,344.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,126.48
|
|
|
PR CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 1 VEIN
|
Professional
|
Both
|
$824.43
|
|
|
Service Code
|
HCPCS 33517
|
| Min. Negotiated Rate |
$151.55 |
| Max. Negotiated Rate |
$487.12 |
| Rate for Payer: Cash Price |
$219.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$216.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$194.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$194.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$205.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$216.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$205.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$216.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$216.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$162.38
|
| Rate for Payer: Healthfirst Commercial |
$216.50
|
| Rate for Payer: Healthfirst Essential Plan |
$487.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$205.68
|
| Rate for Payer: Healthfirst QHP |
$216.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$151.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$216.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$184.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$151.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$216.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$162.38
|
| Rate for Payer: SOMOS Essential |
$162.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$216.50
|
|
|
PR CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 2 VEIN
|
Professional
|
Both
|
$1,821.26
|
|
|
Service Code
|
HCPCS 33518
|
| Min. Negotiated Rate |
$334.03 |
| Max. Negotiated Rate |
$1,073.68 |
| Rate for Payer: Cash Price |
$480.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$477.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$429.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$429.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$453.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$477.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$453.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$477.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$477.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$357.89
|
| Rate for Payer: Healthfirst Commercial |
$477.19
|
| Rate for Payer: Healthfirst Essential Plan |
$1,073.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$453.33
|
| Rate for Payer: Healthfirst QHP |
$477.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$334.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$477.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$405.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$334.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$477.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$357.89
|
| Rate for Payer: SOMOS Essential |
$357.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$477.19
|
|
|
PR CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 3 VEIN
|
Professional
|
Both
|
$2,405.41
|
|
|
Service Code
|
HCPCS 33519
|
| Min. Negotiated Rate |
$440.15 |
| Max. Negotiated Rate |
$1,414.78 |
| Rate for Payer: Cash Price |
$636.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$628.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$565.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$565.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$597.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$628.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$597.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$628.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$628.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$471.59
|
| Rate for Payer: Healthfirst Commercial |
$628.79
|
| Rate for Payer: Healthfirst Essential Plan |
$1,414.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$597.35
|
| Rate for Payer: Healthfirst QHP |
$628.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$440.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$628.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$534.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$440.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$628.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$471.59
|
| Rate for Payer: SOMOS Essential |
$471.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$628.79
|
|
|
PR CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 4 VEIN
|
Professional
|
Both
|
$2,880.40
|
|
|
Service Code
|
HCPCS 33521
|
| Min. Negotiated Rate |
$528.62 |
| Max. Negotiated Rate |
$1,699.13 |
| Rate for Payer: Cash Price |
$761.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$755.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$679.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$679.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$717.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$755.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$717.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$755.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$755.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$566.38
|
| Rate for Payer: Healthfirst Commercial |
$755.17
|
| Rate for Payer: Healthfirst Essential Plan |
$1,699.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$717.41
|
| Rate for Payer: Healthfirst QHP |
$755.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$528.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$755.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$641.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$528.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$755.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$566.38
|
| Rate for Payer: SOMOS Essential |
$566.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$755.17
|
|
|
PR CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 5 VEIN
|
Professional
|
Both
|
$3,238.90
|
|
|
Service Code
|
HCPCS 33522
|
| Min. Negotiated Rate |
$593.69 |
| Max. Negotiated Rate |
$1,908.29 |
| Rate for Payer: Cash Price |
$856.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$848.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$763.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$763.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$805.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$848.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$805.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$848.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$848.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$636.10
|
| Rate for Payer: Healthfirst Commercial |
$848.13
|
| Rate for Payer: Healthfirst Essential Plan |
$1,908.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$805.72
|
| Rate for Payer: Healthfirst QHP |
$848.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$593.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$848.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$720.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$593.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$848.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$636.10
|
| Rate for Payer: SOMOS Essential |
$636.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$848.13
|
|
|
PR CORONARY ARTERY BYP W/VEIN &ARTERY GRAFT 6 VEIN
|
Professional
|
Both
|
$3,637.13
|
|
|
Service Code
|
HCPCS 33523
|
| Min. Negotiated Rate |
$666.11 |
| Max. Negotiated Rate |
$2,141.08 |
| Rate for Payer: Cash Price |
$961.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$951.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$856.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$856.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$904.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$951.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$904.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$951.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$951.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$713.69
|
| Rate for Payer: Healthfirst Commercial |
$951.59
|
| Rate for Payer: Healthfirst Essential Plan |
$2,141.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$904.01
|
| Rate for Payer: Healthfirst QHP |
$951.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$666.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$951.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$808.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$666.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$951.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$713.69
|
| Rate for Payer: SOMOS Essential |
$713.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$951.59
|
|
|
PR CORONARY ENDARTERCOMY OPEN ANY METHOD
|
Professional
|
Both
|
$1,024.38
|
|
|
Service Code
|
HCPCS 33572
|
| Min. Negotiated Rate |
$186.03 |
| Max. Negotiated Rate |
$597.96 |
| Rate for Payer: Cash Price |
$270.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$265.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$239.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$239.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$265.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$265.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$265.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$199.32
|
| Rate for Payer: Healthfirst Commercial |
$265.76
|
| Rate for Payer: Healthfirst Essential Plan |
$597.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$252.47
|
| Rate for Payer: Healthfirst QHP |
$265.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$186.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$265.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$225.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$186.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$265.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$199.32
|
| Rate for Payer: SOMOS Essential |
$199.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$265.76
|
|
|
PR CORONOIDECTOMY SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,635.47
|
|
|
Service Code
|
HCPCS 21070
|
| Min. Negotiated Rate |
$496.33 |
| Max. Negotiated Rate |
$1,595.34 |
| Rate for Payer: Cash Price |
$716.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$709.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$638.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$638.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$673.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$709.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$673.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$709.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$709.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$531.78
|
| Rate for Payer: Healthfirst Commercial |
$709.04
|
| Rate for Payer: Healthfirst Essential Plan |
$1,595.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$673.59
|
| Rate for Payer: Healthfirst QHP |
$709.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$496.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$709.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$602.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$496.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$709.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$531.78
|
| Rate for Payer: SOMOS Essential |
$531.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$709.04
|
|
|
PR CORPORA CAVERNOSA-CORPUS SPONGIOSUM SHUNT UNI/BI
|
Professional
|
Both
|
$2,679.50
|
|
|
Service Code
|
HCPCS 54430
|
| Min. Negotiated Rate |
$511.78 |
| Max. Negotiated Rate |
$1,645.02 |
| Rate for Payer: Cash Price |
$734.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$731.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$658.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$658.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$694.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$731.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$694.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$731.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$731.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$548.34
|
| Rate for Payer: Healthfirst Commercial |
$731.12
|
| Rate for Payer: Healthfirst Essential Plan |
$1,645.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$694.56
|
| Rate for Payer: Healthfirst QHP |
$731.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$511.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$731.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$621.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$511.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$731.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$548.34
|
| Rate for Payer: SOMOS Essential |
$548.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$731.12
|
|
|
PR CORPORA CAVERNOSA-GLANS PENIS FSTLJ PRIAPISM
|
Professional
|
Both
|
$1,743.14
|
|
|
Service Code
|
HCPCS 54435
|
| Min. Negotiated Rate |
$333.65 |
| Max. Negotiated Rate |
$1,072.46 |
| Rate for Payer: Cash Price |
$478.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$476.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$428.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$428.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$452.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$476.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$452.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$476.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$476.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$357.49
|
| Rate for Payer: Healthfirst Commercial |
$476.65
|
| Rate for Payer: Healthfirst Essential Plan |
$1,072.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$452.82
|
| Rate for Payer: Healthfirst QHP |
$476.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$333.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$476.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$405.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$333.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$476.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$357.49
|
| Rate for Payer: SOMOS Essential |
$357.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$476.65
|
|
|
PR CORPORA CAVERNOSA-SAPHENOUS VEIN SHUNT UNI/BI
|
Professional
|
Both
|
$2,945.78
|
|
|
Service Code
|
HCPCS 54420
|
| Min. Negotiated Rate |
$560.95 |
| Max. Negotiated Rate |
$1,803.04 |
| Rate for Payer: Cash Price |
$806.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$801.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$721.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$721.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$761.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$801.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$761.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$801.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$801.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$601.01
|
| Rate for Payer: Healthfirst Commercial |
$801.35
|
| Rate for Payer: Healthfirst Essential Plan |
$1,803.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$761.28
|
| Rate for Payer: Healthfirst QHP |
$801.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$560.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$801.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$681.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$560.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$801.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$601.01
|
| Rate for Payer: SOMOS Essential |
$601.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$801.35
|
|
|
PR CORRECTION CLAW FINGER OTHER METHODS
|
Professional
|
Both
|
$3,882.69
|
|
|
Service Code
|
HCPCS 26499
|
| Min. Negotiated Rate |
$720.80 |
| Max. Negotiated Rate |
$2,316.85 |
| Rate for Payer: Cash Price |
$1,043.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,029.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$926.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$926.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$978.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,029.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$978.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,029.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,029.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$772.28
|
| Rate for Payer: Healthfirst Commercial |
$1,029.71
|
| Rate for Payer: Healthfirst Essential Plan |
$2,316.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$978.22
|
| Rate for Payer: Healthfirst QHP |
$1,029.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$720.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,029.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$875.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$720.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,029.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$772.28
|
| Rate for Payer: SOMOS Essential |
$772.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,029.71
|
|
|
PR CORRECTION COCK-UP 5TH TOE W/PLASTIC CLOSURE
|
Professional
|
Both
|
$1,228.82
|
|
|
Service Code
|
HCPCS 28286
|
| Min. Negotiated Rate |
$236.99 |
| Max. Negotiated Rate |
$761.76 |
| Rate for Payer: Cash Price |
$342.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$338.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$304.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$304.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$321.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$338.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$321.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$338.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$338.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$253.92
|
| Rate for Payer: Healthfirst Commercial |
$338.56
|
| Rate for Payer: Healthfirst Essential Plan |
$761.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$321.63
|
| Rate for Payer: Healthfirst QHP |
$338.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$236.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$338.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$287.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$236.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$338.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$253.92
|
| Rate for Payer: SOMOS Essential |
$253.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$338.56
|
|
|
PR CORRECTION EVERTED PUNCTUM CAUTERY
|
Professional
|
Both
|
$685.83
|
|
|
Service Code
|
HCPCS 68705
|
| Min. Negotiated Rate |
$130.08 |
| Max. Negotiated Rate |
$418.12 |
| Rate for Payer: Cash Price |
$188.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$185.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$167.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$176.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$185.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$176.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$185.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.37
|
| Rate for Payer: Healthfirst Commercial |
$185.83
|
| Rate for Payer: Healthfirst Essential Plan |
$418.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$176.54
|
| Rate for Payer: Healthfirst QHP |
$185.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$130.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$185.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$157.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$130.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$185.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$139.37
|
| Rate for Payer: SOMOS Essential |
$139.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$185.83
|
|
|
PR CORRECTION HAMMERTOE
|
Professional
|
Both
|
$1,621.59
|
|
|
Service Code
|
HCPCS 28285
|
| Min. Negotiated Rate |
$315.27 |
| Max. Negotiated Rate |
$1,013.38 |
| Rate for Payer: Cash Price |
$449.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$450.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$405.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$405.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$427.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$450.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$427.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$450.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$450.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$337.79
|
| Rate for Payer: Healthfirst Commercial |
$450.39
|
| Rate for Payer: Healthfirst Essential Plan |
$1,013.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$427.87
|
| Rate for Payer: Healthfirst QHP |
$450.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$315.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$450.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$382.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$315.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$450.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$337.79
|
| Rate for Payer: SOMOS Essential |
$337.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$450.39
|
|
|
PR CORRECTION INVERTED NIPPLES
|
Professional
|
Both
|
$2,701.72
|
|
|
Service Code
|
HCPCS 19355
|
| Min. Negotiated Rate |
$509.34 |
| Max. Negotiated Rate |
$1,637.17 |
| Rate for Payer: Cash Price |
$729.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$727.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$654.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$654.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$691.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$727.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$691.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$727.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$727.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$545.72
|
| Rate for Payer: Healthfirst Commercial |
$727.63
|
| Rate for Payer: Healthfirst Essential Plan |
$1,637.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$691.25
|
| Rate for Payer: Healthfirst QHP |
$727.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$509.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$727.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$618.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$509.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$727.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$545.72
|
| Rate for Payer: SOMOS Essential |
$545.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$727.63
|
|
|
PR CORRECTION LID RETRACTION
|
Professional
|
Both
|
$2,299.68
|
|
|
Service Code
|
HCPCS 67911
|
| Min. Negotiated Rate |
$439.02 |
| Max. Negotiated Rate |
$1,411.13 |
| Rate for Payer: Cash Price |
$634.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$627.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$564.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$564.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$595.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$627.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$595.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$627.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$627.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$470.38
|
| Rate for Payer: Healthfirst Commercial |
$627.17
|
| Rate for Payer: Healthfirst Essential Plan |
$1,411.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$595.81
|
| Rate for Payer: Healthfirst QHP |
$627.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$439.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$627.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$533.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$439.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$627.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$470.38
|
| Rate for Payer: SOMOS Essential |
$470.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$627.17
|
|
|
PR CORRECTION TRICHIASIS EPILATION FORCEPS ONLY
|
Professional
|
Both
|
$90.13
|
|
|
Service Code
|
HCPCS 67820
|
| Min. Negotiated Rate |
$17.28 |
| Max. Negotiated Rate |
$55.53 |
| Rate for Payer: Cash Price |
$24.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.51
|
| Rate for Payer: Healthfirst Commercial |
$24.68
|
| Rate for Payer: Healthfirst Essential Plan |
$55.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.45
|
| Rate for Payer: Healthfirst QHP |
$24.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.51
|
| Rate for Payer: SOMOS Essential |
$18.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.68
|
|
