|
PR ENTERECTOMY RESCJ SMALL INTESTINE W/ENTEROSTOMY
|
Professional
|
Both
|
$5,231.66
|
|
|
Service Code
|
HCPCS 44125
|
| Min. Negotiated Rate |
$973.72 |
| Max. Negotiated Rate |
$3,129.82 |
| Rate for Payer: Cash Price |
$1,401.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,391.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,251.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,251.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,321.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,391.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,321.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,391.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,391.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,043.27
|
| Rate for Payer: Healthfirst Commercial |
$1,391.03
|
| Rate for Payer: Healthfirst Essential Plan |
$3,129.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,321.48
|
| Rate for Payer: Healthfirst QHP |
$1,391.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$973.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,391.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,182.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$973.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,391.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,043.27
|
| Rate for Payer: SOMOS Essential |
$1,043.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,391.03
|
|
|
PR ENTEROCYSTOPLASTY W/INTESTINAL ANASTOMOSIS
|
Professional
|
Both
|
$5,771.43
|
|
|
Service Code
|
HCPCS 51960
|
| Min. Negotiated Rate |
$1,096.07 |
| Max. Negotiated Rate |
$3,523.07 |
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,565.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,409.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,409.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,487.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,565.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,487.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,565.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,565.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,174.36
|
| Rate for Payer: Healthfirst Commercial |
$1,565.81
|
| Rate for Payer: Healthfirst Essential Plan |
$3,523.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,487.52
|
| Rate for Payer: Healthfirst QHP |
$1,565.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,096.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,565.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,330.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,096.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,565.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,174.36
|
| Rate for Payer: SOMOS Essential |
$1,174.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,565.81
|
|
|
PR ENTEROENTEROST ANAST INT W/WO CUTAN NTRSTM SPX
|
Professional
|
Both
|
$5,896.17
|
|
|
Service Code
|
HCPCS 44130
|
| Min. Negotiated Rate |
$1,094.60 |
| Max. Negotiated Rate |
$3,518.35 |
| Rate for Payer: Cash Price |
$1,573.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,563.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,407.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,407.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,485.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,563.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,485.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,563.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,563.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,172.78
|
| Rate for Payer: Healthfirst Commercial |
$1,563.71
|
| Rate for Payer: Healthfirst Essential Plan |
$3,518.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,485.52
|
| Rate for Payer: Healthfirst QHP |
$1,563.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,094.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,563.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,329.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,094.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,563.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,172.78
|
| Rate for Payer: SOMOS Essential |
$1,172.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,563.71
|
|
|
PR ENTEROLSS FRING INTSTINAL ADHESION SPX
|
Professional
|
Both
|
$4,901.02
|
|
|
Service Code
|
HCPCS 44005
|
| Min. Negotiated Rate |
$908.38 |
| Max. Negotiated Rate |
$2,919.80 |
| Rate for Payer: Cash Price |
$1,307.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,297.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,167.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,167.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,232.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,297.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,232.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,297.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,297.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$973.27
|
| Rate for Payer: Healthfirst Commercial |
$1,297.69
|
| Rate for Payer: Healthfirst Essential Plan |
$2,919.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,232.81
|
| Rate for Payer: Healthfirst QHP |
$1,297.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$908.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,297.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,103.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$908.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,297.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$973.27
|
| Rate for Payer: SOMOS Essential |
$973.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,297.69
|
|
|
PR ENTERORRHAPHY MULTIPLE PERFORATIONS
|
Professional
|
Both
|
$7,208.50
|
|
|
Service Code
|
HCPCS 44603
|
| Min. Negotiated Rate |
$1,336.74 |
| Max. Negotiated Rate |
$4,296.67 |
| Rate for Payer: Cash Price |
$1,923.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,909.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,718.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,718.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,814.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,909.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,814.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,909.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,909.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,432.22
|
| Rate for Payer: Healthfirst Commercial |
$1,909.63
|
| Rate for Payer: Healthfirst Essential Plan |
$4,296.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,814.15
|
| Rate for Payer: Healthfirst QHP |
$1,909.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,336.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,909.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,623.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,336.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,909.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,432.22
|
| Rate for Payer: SOMOS Essential |
$1,432.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,909.63
|
|
|
PR ENTERORRHAPHY SINGLE PERFORATION
|
Professional
|
Both
|
$6,315.96
|
|
|
Service Code
|
HCPCS 44602
|
| Min. Negotiated Rate |
$1,163.99 |
| Max. Negotiated Rate |
$3,741.39 |
| Rate for Payer: Cash Price |
$1,680.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,662.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,496.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,496.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,579.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,662.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,579.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,662.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,662.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,247.13
|
| Rate for Payer: Healthfirst Commercial |
$1,662.84
|
| Rate for Payer: Healthfirst Essential Plan |
$3,741.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,579.70
|
| Rate for Payer: Healthfirst QHP |
$1,662.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,163.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,662.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,413.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,163.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,662.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,247.13
|
| Rate for Payer: SOMOS Essential |
$1,247.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,662.84
|
|
|
PR ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,244.81
|
|
|
Service Code
|
HCPCS 44377
|
| Min. Negotiated Rate |
$232.68 |
| Max. Negotiated Rate |
$747.90 |
| Rate for Payer: Cash Price |
$337.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$332.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$299.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$299.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$315.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$332.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$315.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$332.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$332.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$249.30
|
| Rate for Payer: Healthfirst Commercial |
$332.40
|
| Rate for Payer: Healthfirst Essential Plan |
$747.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$315.78
|
| Rate for Payer: Healthfirst QHP |
$332.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$232.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$332.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$282.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$232.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$332.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$249.30
|
| Rate for Payer: SOMOS Essential |
$249.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$332.40
|
|
|
PR ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX
|
Professional
|
Both
|
$1,176.04
|
|
|
Service Code
|
HCPCS 44376
|
| Min. Negotiated Rate |
$221.88 |
| Max. Negotiated Rate |
$713.18 |
| Rate for Payer: Cash Price |
$318.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$316.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$285.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$285.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$301.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$316.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$301.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$316.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$316.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$237.73
|
| Rate for Payer: Healthfirst Commercial |
$316.97
|
| Rate for Payer: Healthfirst Essential Plan |
$713.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$301.12
|
| Rate for Payer: Healthfirst QHP |
$316.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$221.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$316.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$269.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$221.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$316.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$237.73
|
| Rate for Payer: SOMOS Essential |
$237.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$316.97
|
|
|
PR ENTEROSCOPY > 2ND PRTN ABLTJ LESION
|
Professional
|
Both
|
$1,016.89
|
|
|
Service Code
|
HCPCS 44369
|
| Min. Negotiated Rate |
$191.72 |
| Max. Negotiated Rate |
$616.25 |
| Rate for Payer: Cash Price |
$276.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$273.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$246.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$246.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$260.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$273.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$260.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$273.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$273.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$205.42
|
| Rate for Payer: Healthfirst Commercial |
$273.89
|
| Rate for Payer: Healthfirst Essential Plan |
$616.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$260.20
|
| Rate for Payer: Healthfirst QHP |
$273.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$191.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$273.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$232.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$191.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$273.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$205.42
|
| Rate for Payer: SOMOS Essential |
$205.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$273.89
|
|
|
PR ENTEROSCOPY > 2ND PRTN CONV GSTRST TUBE
|
Professional
|
Both
|
$802.31
|
|
|
Service Code
|
HCPCS 44373
|
| Min. Negotiated Rate |
$152.08 |
| Max. Negotiated Rate |
$488.83 |
| Rate for Payer: Cash Price |
$216.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$217.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$195.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$195.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$217.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$217.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$162.94
|
| Rate for Payer: Healthfirst Commercial |
$217.26
|
| Rate for Payer: Healthfirst Essential Plan |
$488.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$206.40
|
| Rate for Payer: Healthfirst QHP |
$217.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$152.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$217.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$184.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$152.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$217.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$162.94
|
| Rate for Payer: SOMOS Essential |
$162.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$217.26
|
|
|
PR ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING
|
Professional
|
Both
|
$1,591.21
|
|
|
Service Code
|
HCPCS 44378
|
| Min. Negotiated Rate |
$299.59 |
| Max. Negotiated Rate |
$962.98 |
| Rate for Payer: Cash Price |
$432.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$427.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$385.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$385.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$406.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$427.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$406.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$427.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$427.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$320.99
|
| Rate for Payer: Healthfirst Commercial |
$427.99
|
| Rate for Payer: Healthfirst Essential Plan |
$962.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$406.59
|
| Rate for Payer: Healthfirst QHP |
$427.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$299.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$427.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$363.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$299.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$427.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$320.99
|
| Rate for Payer: SOMOS Essential |
$320.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$427.99
|
|
|
PR ENTEROSCOPY > 2ND PRTN TNDSC STENT PLMT
|
Professional
|
Both
|
$1,108.77
|
|
|
Service Code
|
HCPCS 44370
|
| Min. Negotiated Rate |
$208.63 |
| Max. Negotiated Rate |
$670.59 |
| Rate for Payer: Cash Price |
$301.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$298.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$268.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$268.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$283.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$298.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$283.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$298.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$298.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$223.53
|
| Rate for Payer: Healthfirst Commercial |
$298.04
|
| Rate for Payer: Healthfirst Essential Plan |
$670.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$283.14
|
| Rate for Payer: Healthfirst QHP |
$298.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$208.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$298.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$253.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$208.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$298.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$223.53
|
| Rate for Payer: SOMOS Essential |
$223.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$298.04
|
|
|
PR ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING
|
Professional
|
Both
|
$994.63
|
|
|
Service Code
|
HCPCS 44366
|
| Min. Negotiated Rate |
$187.28 |
| Max. Negotiated Rate |
$601.97 |
| Rate for Payer: Cash Price |
$269.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$267.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$240.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$254.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$267.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$254.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$267.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$267.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$200.66
|
| Rate for Payer: Healthfirst Commercial |
$267.54
|
| Rate for Payer: Healthfirst Essential Plan |
$601.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$254.16
|
| Rate for Payer: Healthfirst QHP |
$267.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$187.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$267.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$227.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$187.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$267.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$200.66
|
| Rate for Payer: SOMOS Essential |
$200.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$267.54
|
|
|
PR ENTEROSCOPY > 2ND PRTN W/ILEUM W/STENT PLMT
|
Professional
|
Both
|
$1,694.91
|
|
|
Service Code
|
HCPCS 44379
|
| Min. Negotiated Rate |
$319.03 |
| Max. Negotiated Rate |
$1,025.46 |
| Rate for Payer: Cash Price |
$461.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$455.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$410.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$410.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$432.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$455.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$432.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$455.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$455.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$341.82
|
| Rate for Payer: Healthfirst Commercial |
$455.76
|
| Rate for Payer: Healthfirst Essential Plan |
$1,025.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$432.97
|
| Rate for Payer: Healthfirst QHP |
$455.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$319.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$455.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$387.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$319.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$455.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$341.82
|
| Rate for Payer: SOMOS Essential |
$341.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$455.76
|
|
|
PR ENTEROSCOPY > 2ND PRTN W/PLMT PRQ TUBE
|
Professional
|
Both
|
$1,002.30
|
|
|
Service Code
|
HCPCS 44372
|
| Min. Negotiated Rate |
$189.10 |
| Max. Negotiated Rate |
$607.84 |
| Rate for Payer: Cash Price |
$271.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$270.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$243.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$243.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$256.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$270.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$256.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$270.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$270.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$202.61
|
| Rate for Payer: Healthfirst Commercial |
$270.15
|
| Rate for Payer: Healthfirst Essential Plan |
$607.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$256.64
|
| Rate for Payer: Healthfirst QHP |
$270.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$189.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$270.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$229.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$189.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$270.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$202.61
|
| Rate for Payer: SOMOS Essential |
$202.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$270.15
|
|
|
PR ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY
|
Professional
|
Both
|
$797.09
|
|
|
Service Code
|
HCPCS 44363
|
| Min. Negotiated Rate |
$149.86 |
| Max. Negotiated Rate |
$481.70 |
| Rate for Payer: Cash Price |
$216.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$214.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$192.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$192.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$203.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$214.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$203.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$214.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$214.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$160.57
|
| Rate for Payer: Healthfirst Commercial |
$214.09
|
| Rate for Payer: Healthfirst Essential Plan |
$481.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$203.39
|
| Rate for Payer: Healthfirst QHP |
$214.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$149.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$214.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$181.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$149.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$214.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$160.57
|
| Rate for Payer: SOMOS Essential |
$160.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$214.09
|
|
|
PR ENTEROSCOPY > 2ND PRTN W/RMVL LESION CAUTERY
|
Professional
|
Both
|
$754.85
|
|
|
Service Code
|
HCPCS 44365
|
| Min. Negotiated Rate |
$142.92 |
| Max. Negotiated Rate |
$459.38 |
| Rate for Payer: Cash Price |
$206.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$204.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$183.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$183.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$193.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$204.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$193.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$204.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$204.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$153.13
|
| Rate for Payer: Healthfirst Commercial |
$204.17
|
| Rate for Payer: Healthfirst Essential Plan |
$459.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$193.96
|
| Rate for Payer: Healthfirst QHP |
$204.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$142.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$204.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$173.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$142.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$204.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$153.13
|
| Rate for Payer: SOMOS Essential |
$153.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$204.17
|
|
|
PR ENTEROSCOPY > 2ND PRTN W/RMVL LESION SNARE
|
Professional
|
Both
|
$848.44
|
|
|
Service Code
|
HCPCS 44364
|
| Min. Negotiated Rate |
$159.94 |
| Max. Negotiated Rate |
$514.10 |
| Rate for Payer: Cash Price |
$230.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$228.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$205.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$205.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$217.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$228.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$217.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$228.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$228.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$171.37
|
| Rate for Payer: Healthfirst Commercial |
$228.49
|
| Rate for Payer: Healthfirst Essential Plan |
$514.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$217.07
|
| Rate for Payer: Healthfirst QHP |
$228.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$159.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$228.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$194.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$159.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$228.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$171.37
|
| Rate for Payer: SOMOS Essential |
$171.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$228.49
|
|
|
PR ENTEROTOMY SM INT OTH/THN DUO DCMPRN
|
Professional
|
Both
|
$4,373.88
|
|
|
Service Code
|
HCPCS 44021
|
| Min. Negotiated Rate |
$813.32 |
| Max. Negotiated Rate |
$2,614.23 |
| Rate for Payer: Cash Price |
$1,164.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,161.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,045.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,045.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,103.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,161.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,103.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,161.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,161.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$871.41
|
| Rate for Payer: Healthfirst Commercial |
$1,161.88
|
| Rate for Payer: Healthfirst Essential Plan |
$2,614.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,103.79
|
| Rate for Payer: Healthfirst QHP |
$1,161.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$813.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,161.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$987.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$813.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,161.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$871.41
|
| Rate for Payer: SOMOS Essential |
$871.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,161.88
|
|
|
PR ENTEROTOMY SM INT OTH/THN DUO EXPL BX/FB RMVL
|
Professional
|
Both
|
$4,379.87
|
|
|
Service Code
|
HCPCS 44020
|
| Min. Negotiated Rate |
$814.41 |
| Max. Negotiated Rate |
$2,617.74 |
| Rate for Payer: Cash Price |
$1,168.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,163.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,047.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,047.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,105.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,163.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,105.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,163.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,163.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$872.58
|
| Rate for Payer: Healthfirst Commercial |
$1,163.44
|
| Rate for Payer: Healthfirst Essential Plan |
$2,617.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,105.27
|
| Rate for Payer: Healthfirst QHP |
$1,163.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$814.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,163.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$988.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$814.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,163.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$872.58
|
| Rate for Payer: SOMOS Essential |
$872.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,163.44
|
|
|
PR ENTRC RESCJ ATRESIA EA RESCJ & ANASTOMOSIS
|
Professional
|
Both
|
$1,098.30
|
|
|
Service Code
|
HCPCS 44128
|
| Min. Negotiated Rate |
$201.93 |
| Max. Negotiated Rate |
$649.06 |
| Rate for Payer: Cash Price |
$291.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$288.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$259.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$259.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$274.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$288.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$274.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$288.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$288.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$216.35
|
| Rate for Payer: Healthfirst Commercial |
$288.47
|
| Rate for Payer: Healthfirst Essential Plan |
$649.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$274.05
|
| Rate for Payer: Healthfirst QHP |
$288.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$201.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$288.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$245.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$201.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$288.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$216.35
|
| Rate for Payer: SOMOS Essential |
$216.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$288.47
|
|
|
PR ENTRC RESCJ ATRESIA RESCJ & ANAST SGM W/TAPRING
|
Professional
|
Both
|
$12,900.13
|
|
|
Service Code
|
HCPCS 44127
|
| Min. Negotiated Rate |
$2,378.43 |
| Max. Negotiated Rate |
$7,644.96 |
| Rate for Payer: Cash Price |
$3,428.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,397.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,057.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,057.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,227.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,397.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,227.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,397.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,397.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,548.32
|
| Rate for Payer: Healthfirst Commercial |
$3,397.76
|
| Rate for Payer: Healthfirst Essential Plan |
$7,644.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,227.87
|
| Rate for Payer: Healthfirst QHP |
$3,397.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,378.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,397.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,888.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,378.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,397.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,548.32
|
| Rate for Payer: SOMOS Essential |
$2,548.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,397.76
|
|
|
PR ENTRC RESCJ ATRESIA RESCJ & ANAST W/O TAPRING
|
Professional
|
Both
|
$11,166.79
|
|
|
Service Code
|
HCPCS 44126
|
| Min. Negotiated Rate |
$2,061.75 |
| Max. Negotiated Rate |
$6,627.06 |
| Rate for Payer: Cash Price |
$2,969.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,945.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,650.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,650.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,798.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,945.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,798.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,945.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,945.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,209.02
|
| Rate for Payer: Healthfirst Commercial |
$2,945.36
|
| Rate for Payer: Healthfirst Essential Plan |
$6,627.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,798.09
|
| Rate for Payer: Healthfirst QHP |
$2,945.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,061.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,945.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,503.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,061.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,945.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,209.02
|
| Rate for Payer: SOMOS Essential |
$2,209.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,945.36
|
|
|
PR ENTRC RESCJ SMALL INTESTINE 1 RESCJ & ANAST
|
Professional
|
Both
|
$5,483.49
|
|
|
Service Code
|
HCPCS 44120
|
| Min. Negotiated Rate |
$1,016.91 |
| Max. Negotiated Rate |
$3,268.64 |
| Rate for Payer: Cash Price |
$1,463.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,452.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,307.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,307.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,380.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,452.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,380.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,452.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,452.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,089.55
|
| Rate for Payer: Healthfirst Commercial |
$1,452.73
|
| Rate for Payer: Healthfirst Essential Plan |
$3,268.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,380.09
|
| Rate for Payer: Healthfirst QHP |
$1,452.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,016.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,452.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,234.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,016.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,452.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,089.55
|
| Rate for Payer: SOMOS Essential |
$1,089.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,452.73
|
|
|
PR ENUCLEATION EYE IMPLT MUSC ATTACHED IMPLT
|
Professional
|
Both
|
$4,013.14
|
|
|
Service Code
|
HCPCS 65105
|
| Min. Negotiated Rate |
$749.95 |
| Max. Negotiated Rate |
$2,410.54 |
| Rate for Payer: Cash Price |
$1,096.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,071.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$964.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$964.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,017.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,071.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,017.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,071.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,071.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$803.51
|
| Rate for Payer: Healthfirst Commercial |
$1,071.35
|
| Rate for Payer: Healthfirst Essential Plan |
$2,410.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,017.78
|
| Rate for Payer: Healthfirst QHP |
$1,071.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$749.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,071.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$910.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$749.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,071.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$803.51
|
| Rate for Payer: SOMOS Essential |
$803.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,071.35
|
|
