|
PR LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC LUMBR
|
Professional
|
Both
|
$4,226.32
|
|
|
Service Code
|
HCPCS 63030
|
| Min. Negotiated Rate |
$787.72 |
| Max. Negotiated Rate |
$2,531.95 |
| Rate for Payer: Cash Price |
$1,132.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,125.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,012.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,012.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,069.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,125.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,069.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,125.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,125.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$843.98
|
| Rate for Payer: Healthfirst Commercial |
$1,125.31
|
| Rate for Payer: Healthfirst Essential Plan |
$2,531.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,069.04
|
| Rate for Payer: Healthfirst QHP |
$1,125.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$787.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,125.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$956.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$787.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,125.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$843.98
|
| Rate for Payer: SOMOS Essential |
$843.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,125.31
|
|
|
PR LAMNOTMY W/DCMPRSN NRV EACH ADDL CRVCL/LMBR
|
Professional
|
Both
|
$1,085.07
|
|
|
Service Code
|
HCPCS 63035
|
| Min. Negotiated Rate |
$196.69 |
| Max. Negotiated Rate |
$632.23 |
| Rate for Payer: Cash Price |
$285.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$280.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$252.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$252.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$266.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$280.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$266.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$280.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$280.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$210.74
|
| Rate for Payer: Healthfirst Commercial |
$280.99
|
| Rate for Payer: Healthfirst Essential Plan |
$632.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$266.94
|
| Rate for Payer: Healthfirst QHP |
$280.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$196.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$280.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$238.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$196.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$280.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$210.74
|
| Rate for Payer: SOMOS Essential |
$210.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$280.99
|
|
|
PR LAMOP CERVICAL W/DCMPRN SPI CORD 2/> VERT SEG
|
Professional
|
Both
|
$6,754.27
|
|
|
Service Code
|
HCPCS 63050
|
| Min. Negotiated Rate |
$1,268.20 |
| Max. Negotiated Rate |
$4,076.37 |
| Rate for Payer: Cash Price |
$1,792.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,811.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,630.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,630.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,721.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,811.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,721.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,811.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,811.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,358.79
|
| Rate for Payer: Healthfirst Commercial |
$1,811.72
|
| Rate for Payer: Healthfirst Essential Plan |
$4,076.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,721.13
|
| Rate for Payer: Healthfirst QHP |
$1,811.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,268.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,811.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,539.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,268.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,811.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,358.79
|
| Rate for Payer: SOMOS Essential |
$1,358.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,811.72
|
|
|
PR LAMOPLASTY CERVICAL DCMPRN CORD 2/> SEG RCNSTJ
|
Professional
|
Both
|
$7,797.30
|
|
|
Service Code
|
HCPCS 63051
|
| Min. Negotiated Rate |
$1,438.66 |
| Max. Negotiated Rate |
$4,624.27 |
| Rate for Payer: Cash Price |
$2,074.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,055.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,849.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,849.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,952.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,055.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,952.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,055.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,055.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,541.42
|
| Rate for Payer: Healthfirst Commercial |
$2,055.23
|
| Rate for Payer: Healthfirst Essential Plan |
$4,624.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,952.47
|
| Rate for Payer: Healthfirst QHP |
$2,055.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,438.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,055.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,746.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,438.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,055.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,541.42
|
| Rate for Payer: SOMOS Essential |
$1,541.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,055.23
|
|
|
PR LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC CERVICAL
|
Professional
|
Both
|
$6,392.86
|
|
|
Service Code
|
HCPCS 63040
|
| Min. Negotiated Rate |
$1,175.41 |
| Max. Negotiated Rate |
$3,778.11 |
| Rate for Payer: Cash Price |
$1,694.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,679.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,511.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,511.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,595.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,679.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,595.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,679.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,679.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,259.37
|
| Rate for Payer: Healthfirst Commercial |
$1,679.16
|
| Rate for Payer: Healthfirst Essential Plan |
$3,778.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,595.20
|
| Rate for Payer: Healthfirst QHP |
$1,679.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,175.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,679.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,427.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,175.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,679.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,259.37
|
| Rate for Payer: SOMOS Essential |
$1,259.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,679.16
|
|
|
PR LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC LUMBAR
|
Professional
|
Both
|
$5,956.86
|
|
|
Service Code
|
HCPCS 63042
|
| Min. Negotiated Rate |
$1,103.05 |
| Max. Negotiated Rate |
$3,545.51 |
| Rate for Payer: Cash Price |
$1,591.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,575.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,418.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,418.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,496.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,575.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,496.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,575.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,575.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,181.84
|
| Rate for Payer: Healthfirst Commercial |
$1,575.78
|
| Rate for Payer: Healthfirst Essential Plan |
$3,545.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,496.99
|
| Rate for Payer: Healthfirst QHP |
$1,575.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,103.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,575.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,339.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,103.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,575.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,181.84
|
| Rate for Payer: SOMOS Essential |
$1,181.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,575.78
|
|
|
PR LAM W/CORDOTOMY SCTJ SPINOTHALAMIC TRC 1STG THRC
|
Professional
|
Both
|
$8,258.46
|
|
|
Service Code
|
HCPCS 63197
|
| Min. Negotiated Rate |
$1,513.12 |
| Max. Negotiated Rate |
$4,863.60 |
| Rate for Payer: Cash Price |
$2,180.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,161.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,945.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,945.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,053.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,161.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,053.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,161.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,161.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,621.20
|
| Rate for Payer: Healthfirst Commercial |
$2,161.60
|
| Rate for Payer: Healthfirst Essential Plan |
$4,863.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,053.52
|
| Rate for Payer: Healthfirst QHP |
$2,161.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,513.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,161.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,837.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,513.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,161.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,621.20
|
| Rate for Payer: SOMOS Essential |
$1,621.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,161.60
|
|
|
PR LAM W/DRG INTRMEDULLARY CYST/SYRINX SUBARACHNOID
|
Professional
|
Both
|
$6,821.54
|
|
|
Service Code
|
HCPCS 63172
|
| Min. Negotiated Rate |
$1,250.80 |
| Max. Negotiated Rate |
$4,020.41 |
| Rate for Payer: Cash Price |
$1,800.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,786.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,608.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,608.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,697.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,786.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,697.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,786.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,786.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,340.14
|
| Rate for Payer: Healthfirst Commercial |
$1,786.85
|
| Rate for Payer: Healthfirst Essential Plan |
$4,020.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,697.51
|
| Rate for Payer: Healthfirst QHP |
$1,786.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,250.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,786.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,518.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,250.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,786.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,340.14
|
| Rate for Payer: SOMOS Essential |
$1,340.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,786.85
|
|
|
PR LAM W/DRG INTRMEDULRY CYST/SYRINX PRTL/PLEURAL
|
Professional
|
Both
|
$8,327.69
|
|
|
Service Code
|
HCPCS 63173
|
| Min. Negotiated Rate |
$1,524.68 |
| Max. Negotiated Rate |
$4,900.77 |
| Rate for Payer: Cash Price |
$2,199.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,178.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,960.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,960.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,069.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,178.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,069.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,178.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,178.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,633.59
|
| Rate for Payer: Healthfirst Commercial |
$2,178.12
|
| Rate for Payer: Healthfirst Essential Plan |
$4,900.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,069.21
|
| Rate for Payer: Healthfirst QHP |
$2,178.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,524.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,178.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,851.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,524.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,178.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,633.59
|
| Rate for Payer: SOMOS Essential |
$1,633.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,178.12
|
|
|
PR LAM W/MYELOTOMY CERVICAL/THORACIC/THORACOLUMBAR
|
Professional
|
Both
|
$7,686.91
|
|
|
Service Code
|
HCPCS 63170
|
| Min. Negotiated Rate |
$1,409.11 |
| Max. Negotiated Rate |
$4,529.30 |
| Rate for Payer: Cash Price |
$2,030.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,013.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,811.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,811.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,912.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,013.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,912.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,013.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,013.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,509.77
|
| Rate for Payer: Healthfirst Commercial |
$2,013.02
|
| Rate for Payer: Healthfirst Essential Plan |
$4,529.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,912.37
|
| Rate for Payer: Healthfirst QHP |
$2,013.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,409.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,013.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,711.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,409.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,013.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,509.77
|
| Rate for Payer: SOMOS Essential |
$1,509.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,013.02
|
|
|
PR LAM W/O FACETEC FORAMOT/DSKC 1/2 VRT SEG CRV
|
Professional
|
Both
|
$5,845.18
|
|
|
Service Code
|
HCPCS 63001
|
| Min. Negotiated Rate |
$1,075.40 |
| Max. Negotiated Rate |
$3,456.63 |
| Rate for Payer: Cash Price |
$1,542.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,536.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,382.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,382.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,459.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,536.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,459.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,536.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,536.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,152.21
|
| Rate for Payer: Healthfirst Commercial |
$1,536.28
|
| Rate for Payer: Healthfirst Essential Plan |
$3,456.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,459.47
|
| Rate for Payer: Healthfirst QHP |
$1,536.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,075.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,536.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,305.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,075.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,536.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,152.21
|
| Rate for Payer: SOMOS Essential |
$1,152.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,536.28
|
|
|
PR LAPAROSCOPIC APPENDECTOMY
|
Professional
|
Both
|
$2,718.66
|
|
|
Service Code
|
HCPCS 44970
|
| Min. Negotiated Rate |
$505.26 |
| Max. Negotiated Rate |
$1,624.05 |
| Rate for Payer: Cash Price |
$727.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$721.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$649.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$649.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$685.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$721.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$685.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$721.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$721.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$541.35
|
| Rate for Payer: Healthfirst Commercial |
$721.80
|
| Rate for Payer: Healthfirst Essential Plan |
$1,624.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$685.71
|
| Rate for Payer: Healthfirst QHP |
$721.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$505.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$721.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$613.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$505.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$721.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$541.35
|
| Rate for Payer: SOMOS Essential |
$541.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$721.80
|
|
|
PR LAPAROSCOPIC SURGICAL SPLENECTOMY
|
Professional
|
Both
|
$4,771.10
|
|
|
Service Code
|
HCPCS 38120
|
| Min. Negotiated Rate |
$886.37 |
| Max. Negotiated Rate |
$2,849.04 |
| Rate for Payer: Cash Price |
$1,275.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,266.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,139.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,139.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,202.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,266.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,202.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,266.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,266.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$949.68
|
| Rate for Payer: Healthfirst Commercial |
$1,266.24
|
| Rate for Payer: Healthfirst Essential Plan |
$2,849.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,202.93
|
| Rate for Payer: Healthfirst QHP |
$1,266.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$886.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,266.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,076.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$886.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,266.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$949.68
|
| Rate for Payer: SOMOS Essential |
$949.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,266.24
|
|
|
PR LAPAROSCOPY ADRENALECTOMY PRTL/COMPL TABDL
|
Professional
|
Both
|
$5,263.48
|
|
|
Service Code
|
HCPCS 60650
|
| Min. Negotiated Rate |
$985.67 |
| Max. Negotiated Rate |
$3,168.22 |
| Rate for Payer: Cash Price |
$1,414.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,408.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,267.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,267.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,337.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,408.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,337.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,408.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,408.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,056.08
|
| Rate for Payer: Healthfirst Commercial |
$1,408.10
|
| Rate for Payer: Healthfirst Essential Plan |
$3,168.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,337.69
|
| Rate for Payer: Healthfirst QHP |
$1,408.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$985.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,408.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,196.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$985.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,408.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,056.08
|
| Rate for Payer: SOMOS Essential |
$1,056.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,408.10
|
|
|
PR LAPAROSCOPY COLECTOMY PARTIAL W/ANASTOMOSIS
|
Professional
|
Both
|
$6,797.60
|
|
|
Service Code
|
HCPCS 44204
|
| Min. Negotiated Rate |
$1,260.07 |
| Max. Negotiated Rate |
$4,050.22 |
| Rate for Payer: Cash Price |
$1,816.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,800.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,620.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,620.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,710.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,800.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,710.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,800.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,800.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,350.08
|
| Rate for Payer: Healthfirst Commercial |
$1,800.10
|
| Rate for Payer: Healthfirst Essential Plan |
$4,050.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,710.10
|
| Rate for Payer: Healthfirst QHP |
$1,800.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,260.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,800.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,530.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,260.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,800.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,350.08
|
| Rate for Payer: SOMOS Essential |
$1,350.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,800.10
|
|
|
PR LAPAROSCOPY COLPOPEXY SUSPENSION VAGINAL APEX
|
Professional
|
Both
|
$4,206.97
|
|
|
Service Code
|
HCPCS 57425
|
| Min. Negotiated Rate |
$785.20 |
| Max. Negotiated Rate |
$2,523.85 |
| Rate for Payer: Cash Price |
$1,136.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,121.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,009.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,009.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,065.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,121.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,065.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,121.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,121.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$841.28
|
| Rate for Payer: Healthfirst Commercial |
$1,121.71
|
| Rate for Payer: Healthfirst Essential Plan |
$2,523.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,065.62
|
| Rate for Payer: Healthfirst QHP |
$1,121.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$785.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,121.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$953.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$785.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,121.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$841.28
|
| Rate for Payer: SOMOS Essential |
$841.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,121.71
|
|
|
PR LAPAROSCOPY DONOR NEPHRECTOMY LIVING DONOR
|
Professional
|
Both
|
$7,214.52
|
|
|
Service Code
|
HCPCS 50547
|
| Min. Negotiated Rate |
$1,355.48 |
| Max. Negotiated Rate |
$4,356.90 |
| Rate for Payer: Cash Price |
$1,938.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,936.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,742.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,742.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,839.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,936.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,839.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,936.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,936.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,452.30
|
| Rate for Payer: Healthfirst Commercial |
$1,936.40
|
| Rate for Payer: Healthfirst Essential Plan |
$4,356.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,839.58
|
| Rate for Payer: Healthfirst QHP |
$1,936.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,355.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,936.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,645.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,355.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,936.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,452.30
|
| Rate for Payer: SOMOS Essential |
$1,452.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,936.40
|
|
|
PR LAPAROSCOPY ENTEROLYSIS SEPARATE PROCEDURE
|
Professional
|
Both
|
$4,138.86
|
|
|
Service Code
|
HCPCS 44180
|
| Min. Negotiated Rate |
$768.40 |
| Max. Negotiated Rate |
$2,469.87 |
| Rate for Payer: Cash Price |
$1,104.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,097.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$987.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$987.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,042.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,097.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,042.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,097.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,097.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$823.29
|
| Rate for Payer: Healthfirst Commercial |
$1,097.72
|
| Rate for Payer: Healthfirst Essential Plan |
$2,469.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,042.83
|
| Rate for Payer: Healthfirst QHP |
$1,097.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$768.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,097.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$933.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$768.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,097.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$823.29
|
| Rate for Payer: SOMOS Essential |
$823.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,097.72
|
|
|
PR LAPAROSCOPY FIMBRIOPLASTY
|
Professional
|
Both
|
$3,188.75
|
|
|
Service Code
|
HCPCS 58672
|
| Min. Negotiated Rate |
$591.83 |
| Max. Negotiated Rate |
$1,902.31 |
| Rate for Payer: Cash Price |
$858.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$845.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$760.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$760.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$803.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$845.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$803.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$845.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$845.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$634.10
|
| Rate for Payer: Healthfirst Commercial |
$845.47
|
| Rate for Payer: Healthfirst Essential Plan |
$1,902.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$803.20
|
| Rate for Payer: Healthfirst QHP |
$845.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$591.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$845.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$718.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$591.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$845.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$634.10
|
| Rate for Payer: SOMOS Essential |
$634.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$845.47
|
|
|
PR LAPAROSCOPY FULGURATION OVIDUCTS
|
Professional
|
Both
|
$1,623.76
|
|
|
Service Code
|
HCPCS 58670
|
| Min. Negotiated Rate |
$302.89 |
| Max. Negotiated Rate |
$973.58 |
| Rate for Payer: Cash Price |
$439.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$432.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$389.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$389.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$411.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$432.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$411.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$432.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$432.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$324.52
|
| Rate for Payer: Healthfirst Commercial |
$432.70
|
| Rate for Payer: Healthfirst Essential Plan |
$973.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$411.06
|
| Rate for Payer: Healthfirst QHP |
$432.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$302.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$432.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$367.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$302.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$432.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$324.52
|
| Rate for Payer: SOMOS Essential |
$324.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$432.70
|
|
|
PR LAPAROSCOPY ISLET CELL TRANS
|
Professional
|
Both
|
$3,410.75
|
|
|
Service Code
|
HCPCS G0342
|
| Min. Negotiated Rate |
$632.66 |
| Max. Negotiated Rate |
$2,033.55 |
| Rate for Payer: Cash Price |
$910.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$903.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$813.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$813.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$858.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$903.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$858.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$903.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$903.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$677.85
|
| Rate for Payer: Healthfirst Commercial |
$903.80
|
| Rate for Payer: Healthfirst Essential Plan |
$2,033.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$858.61
|
| Rate for Payer: Healthfirst QHP |
$903.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$632.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$903.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$768.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$632.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$903.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$677.85
|
| Rate for Payer: SOMOS Essential |
$677.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$903.80
|
|
|
PR LAPAROSCOPY NEPHRECTOMY W/PARTIAL URETERECT
|
Professional
|
Both
|
$5,061.28
|
|
|
Service Code
|
HCPCS 50546
|
| Min. Negotiated Rate |
$958.92 |
| Max. Negotiated Rate |
$3,082.25 |
| Rate for Payer: Cash Price |
$1,378.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,369.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,232.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,232.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,301.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,369.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,301.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,369.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,369.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,027.42
|
| Rate for Payer: Healthfirst Commercial |
$1,369.89
|
| Rate for Payer: Healthfirst Essential Plan |
$3,082.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,301.40
|
| Rate for Payer: Healthfirst QHP |
$1,369.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$958.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,369.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,164.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$958.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,369.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,027.42
|
| Rate for Payer: SOMOS Essential |
$1,027.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,369.89
|
|
|
PR LAPAROSCOPY NEPHRECTOMY W/TOTAL URETERECTOMY
|
Professional
|
Both
|
$5,591.92
|
|
|
Service Code
|
HCPCS 50548
|
| Min. Negotiated Rate |
$1,060.48 |
| Max. Negotiated Rate |
$3,408.68 |
| Rate for Payer: Cash Price |
$1,525.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,514.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,363.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,363.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,439.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,514.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,439.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,514.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,514.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,136.23
|
| Rate for Payer: Healthfirst Commercial |
$1,514.97
|
| Rate for Payer: Healthfirst Essential Plan |
$3,408.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,439.22
|
| Rate for Payer: Healthfirst QHP |
$1,514.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,060.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,514.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,287.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,060.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,514.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,136.23
|
| Rate for Payer: SOMOS Essential |
$1,136.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,514.97
|
|
|
PR LAPAROSCOPY ORCHIOPEXY INTRA-ABDOMINAL TESTIS
|
Professional
|
Both
|
$3,160.22
|
|
|
Service Code
|
HCPCS 54692
|
| Min. Negotiated Rate |
$601.67 |
| Max. Negotiated Rate |
$1,933.94 |
| Rate for Payer: Cash Price |
$863.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$859.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$773.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$773.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$816.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$859.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$816.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$859.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$859.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$644.65
|
| Rate for Payer: Healthfirst Commercial |
$859.53
|
| Rate for Payer: Healthfirst Essential Plan |
$1,933.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$816.55
|
| Rate for Payer: Healthfirst QHP |
$859.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$601.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$859.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$730.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$601.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$859.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$644.65
|
| Rate for Payer: SOMOS Essential |
$644.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$859.53
|
|
|
PR LAPAROSCOPY PROCTOPEXY PROLAPSE
|
Professional
|
Both
|
$4,880.40
|
|
|
Service Code
|
HCPCS 45400
|
| Min. Negotiated Rate |
$913.40 |
| Max. Negotiated Rate |
$2,935.93 |
| Rate for Payer: Cash Price |
$1,317.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,304.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,174.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,174.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,239.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,304.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,239.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,304.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,304.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$978.64
|
| Rate for Payer: Healthfirst Commercial |
$1,304.86
|
| Rate for Payer: Healthfirst Essential Plan |
$2,935.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,239.62
|
| Rate for Payer: Healthfirst QHP |
$1,304.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$913.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,304.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,109.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$913.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,304.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$978.64
|
| Rate for Payer: SOMOS Essential |
$978.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,304.86
|
|
