|
PR LAPAROSCOPY PROCTOPEXY PROLAPSE SIGMOID RESCJ
|
Professional
|
Both
|
$6,598.62
|
|
|
Service Code
|
HCPCS 45402
|
| Min. Negotiated Rate |
$1,226.82 |
| Max. Negotiated Rate |
$3,943.35 |
| Rate for Payer: Cash Price |
$1,771.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,752.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,577.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,577.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,664.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,752.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,664.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,752.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,752.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,314.45
|
| Rate for Payer: Healthfirst Commercial |
$1,752.60
|
| Rate for Payer: Healthfirst Essential Plan |
$3,943.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,664.97
|
| Rate for Payer: Healthfirst QHP |
$1,752.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,226.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,752.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,489.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,226.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,752.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,314.45
|
| Rate for Payer: SOMOS Essential |
$1,314.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,752.60
|
|
|
PR LAPAROSCOPY RADICAL NEPHRECTOMY
|
Professional
|
Both
|
$5,563.39
|
|
|
Service Code
|
HCPCS 50545
|
| Min. Negotiated Rate |
$1,055.75 |
| Max. Negotiated Rate |
$3,393.47 |
| Rate for Payer: Cash Price |
$1,518.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,508.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,357.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,357.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,432.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,508.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,432.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,508.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,508.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,131.16
|
| Rate for Payer: Healthfirst Commercial |
$1,508.21
|
| Rate for Payer: Healthfirst Essential Plan |
$3,393.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,432.80
|
| Rate for Payer: Healthfirst QHP |
$1,508.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,055.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,508.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,281.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,055.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,508.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,131.16
|
| Rate for Payer: SOMOS Essential |
$1,131.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,508.21
|
|
|
PR LAPAROSCOPY SALPINGOSTOMY
|
Professional
|
Both
|
$3,461.33
|
|
|
Service Code
|
HCPCS 58673
|
| Min. Negotiated Rate |
$642.24 |
| Max. Negotiated Rate |
$2,064.35 |
| Rate for Payer: Cash Price |
$931.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$917.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$825.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$825.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$871.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$917.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$871.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$917.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$917.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$688.12
|
| Rate for Payer: Healthfirst Commercial |
$917.49
|
| Rate for Payer: Healthfirst Essential Plan |
$2,064.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$871.62
|
| Rate for Payer: Healthfirst QHP |
$917.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$642.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$917.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$779.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$642.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$917.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$688.12
|
| Rate for Payer: SOMOS Essential |
$688.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$917.49
|
|
|
PR LAPAROSCOPY SLING OPERATION STRESS INCONT
|
Professional
|
Both
|
$3,576.62
|
|
|
Service Code
|
HCPCS 51992
|
| Min. Negotiated Rate |
$673.46 |
| Max. Negotiated Rate |
$2,164.68 |
| Rate for Payer: Cash Price |
$973.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$962.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$865.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$913.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$962.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$913.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$962.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$962.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$721.56
|
| Rate for Payer: Healthfirst Commercial |
$962.08
|
| Rate for Payer: Healthfirst Essential Plan |
$2,164.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$913.98
|
| Rate for Payer: Healthfirst QHP |
$962.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$673.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$962.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$817.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$673.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$962.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$721.56
|
| Rate for Payer: SOMOS Essential |
$721.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$962.08
|
|
|
PR LAPAROSCOPY SMALL INTESTINE RESCJ & ANASTOMOSIS
|
Professional
|
Both
|
$1,084.76
|
|
|
Service Code
|
HCPCS 44203
|
| Min. Negotiated Rate |
$197.28 |
| Max. Negotiated Rate |
$634.12 |
| Rate for Payer: Cash Price |
$284.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$281.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$253.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$253.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$267.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$281.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$267.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$281.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$281.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$211.37
|
| Rate for Payer: Healthfirst Commercial |
$281.83
|
| Rate for Payer: Healthfirst Essential Plan |
$634.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$267.74
|
| Rate for Payer: Healthfirst QHP |
$281.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$197.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$281.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$239.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$197.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$281.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$211.37
|
| Rate for Payer: SOMOS Essential |
$211.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$281.83
|
|
|
PR LAPAROSCOPY SUPRACERVICAL HYSTERECTOMY 250 GM/<
|
Professional
|
Both
|
$3,166.31
|
|
|
Service Code
|
HCPCS 58541
|
| Min. Negotiated Rate |
$592.08 |
| Max. Negotiated Rate |
$1,903.12 |
| Rate for Payer: Cash Price |
$857.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$845.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$761.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$761.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$803.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$845.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$803.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$845.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$845.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$634.37
|
| Rate for Payer: Healthfirst Commercial |
$845.83
|
| Rate for Payer: Healthfirst Essential Plan |
$1,903.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$803.54
|
| Rate for Payer: Healthfirst QHP |
$845.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$592.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$845.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$718.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$592.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$845.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$634.37
|
| Rate for Payer: SOMOS Essential |
$634.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$845.83
|
|
|
PR LAPAROSCOPY SURG ABLATION RENAL CYSTS
|
Professional
|
Both
|
$3,839.57
|
|
|
Service Code
|
HCPCS 50541
|
| Min. Negotiated Rate |
$728.66 |
| Max. Negotiated Rate |
$2,342.11 |
| Rate for Payer: Cash Price |
$1,046.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,040.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$936.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$936.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$988.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,040.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$988.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,040.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,040.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$780.71
|
| Rate for Payer: Healthfirst Commercial |
$1,040.94
|
| Rate for Payer: Healthfirst Essential Plan |
$2,342.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$988.89
|
| Rate for Payer: Healthfirst QHP |
$1,040.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$728.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,040.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$884.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$728.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,040.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$780.71
|
| Rate for Payer: SOMOS Essential |
$780.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,040.94
|
|
|
PR LAPAROSCOPY SURG CHOLECYSTECTOMY
|
Professional
|
Both
|
$2,979.24
|
|
|
Service Code
|
HCPCS 47562
|
| Min. Negotiated Rate |
$555.23 |
| Max. Negotiated Rate |
$1,784.65 |
| Rate for Payer: Cash Price |
$797.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$793.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$713.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$713.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$753.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$793.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$753.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$793.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$793.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$594.88
|
| Rate for Payer: Healthfirst Commercial |
$793.18
|
| Rate for Payer: Healthfirst Essential Plan |
$1,784.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$753.52
|
| Rate for Payer: Healthfirst QHP |
$793.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$555.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$793.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$674.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$555.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$793.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$594.88
|
| Rate for Payer: SOMOS Essential |
$594.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$793.18
|
|
|
PR LAPAROSCOPY SURG CHOLECYSTOENETEROSTOMY
|
Professional
|
Both
|
$3,522.93
|
|
|
Service Code
|
HCPCS 47570
|
| Min. Negotiated Rate |
$651.92 |
| Max. Negotiated Rate |
$2,095.45 |
| Rate for Payer: Cash Price |
$937.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$931.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$838.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$838.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$884.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$931.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$884.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$931.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$931.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$698.48
|
| Rate for Payer: Healthfirst Commercial |
$931.31
|
| Rate for Payer: Healthfirst Essential Plan |
$2,095.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$884.74
|
| Rate for Payer: Healthfirst QHP |
$931.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$651.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$931.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$791.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$651.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$931.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$698.48
|
| Rate for Payer: SOMOS Essential |
$698.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$931.31
|
|
|
PR LAPAROSCOPY SURG COLOSTOMY/SKN LVL CECOSTOMY
|
Professional
|
Both
|
$5,379.22
|
|
|
Service Code
|
HCPCS 44188
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$3,202.76 |
| Rate for Payer: Cash Price |
$1,437.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,423.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,281.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,281.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,352.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,423.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,352.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,423.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,423.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,067.59
|
| Rate for Payer: Healthfirst Commercial |
$1,423.45
|
| Rate for Payer: Healthfirst Essential Plan |
$3,202.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,352.28
|
| Rate for Payer: Healthfirst QHP |
$1,423.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$996.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,423.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,209.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$996.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,423.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,067.59
|
| Rate for Payer: SOMOS Essential |
$1,067.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,423.45
|
|
|
PR LAPAROSCOPY SURGICAL JEJUNOSTOMY
|
Professional
|
Both
|
$2,935.45
|
|
|
Service Code
|
HCPCS 44186
|
| Min. Negotiated Rate |
$545.03 |
| Max. Negotiated Rate |
$1,751.87 |
| Rate for Payer: Cash Price |
$785.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$778.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$700.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$700.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$739.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$778.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$739.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$778.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$778.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$583.96
|
| Rate for Payer: Healthfirst Commercial |
$778.61
|
| Rate for Payer: Healthfirst Essential Plan |
$1,751.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$739.68
|
| Rate for Payer: Healthfirst QHP |
$778.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$545.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$778.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$661.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$545.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$778.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$583.96
|
| Rate for Payer: SOMOS Essential |
$583.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$778.61
|
|
|
PR LAPAROSCOPY SURGICAL ORCHIECTOMY
|
Professional
|
Both
|
$2,742.85
|
|
|
Service Code
|
HCPCS 54690
|
| Min. Negotiated Rate |
$523.18 |
| Max. Negotiated Rate |
$1,681.65 |
| Rate for Payer: Cash Price |
$751.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$747.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$672.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$672.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$710.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$747.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$710.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$747.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$747.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$560.55
|
| Rate for Payer: Healthfirst Commercial |
$747.40
|
| Rate for Payer: Healthfirst Essential Plan |
$1,681.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$710.03
|
| Rate for Payer: Healthfirst QHP |
$747.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$523.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$747.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$635.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$523.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$747.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$560.55
|
| Rate for Payer: SOMOS Essential |
$560.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$747.40
|
|
|
PR LAPAROSCOPY SURG ILEOSTOMY/JEJUNOSTOMY NON-TUBE
|
Professional
|
Both
|
$4,778.38
|
|
|
Service Code
|
HCPCS 44187
|
| Min. Negotiated Rate |
$888.37 |
| Max. Negotiated Rate |
$2,855.47 |
| Rate for Payer: Cash Price |
$1,281.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,269.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,142.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,142.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,205.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,269.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,205.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,269.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,269.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$951.83
|
| Rate for Payer: Healthfirst Commercial |
$1,269.10
|
| Rate for Payer: Healthfirst Essential Plan |
$2,855.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,205.64
|
| Rate for Payer: Healthfirst QHP |
$1,269.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$888.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,269.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,078.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$888.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,269.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$951.83
|
| Rate for Payer: SOMOS Essential |
$951.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,269.10
|
|
|
PR LAPAROSCOPY SURG PARTIAL NEPHRECTOMY
|
Professional
|
Both
|
$6,213.48
|
|
|
Service Code
|
HCPCS 50543
|
| Min. Negotiated Rate |
$1,179.32 |
| Max. Negotiated Rate |
$3,790.66 |
| Rate for Payer: Cash Price |
$1,697.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,684.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,516.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,516.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,600.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,684.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,600.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,684.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,684.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,263.56
|
| Rate for Payer: Healthfirst Commercial |
$1,684.74
|
| Rate for Payer: Healthfirst Essential Plan |
$3,790.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,600.50
|
| Rate for Payer: Healthfirst QHP |
$1,684.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,179.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,684.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,432.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,179.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,684.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,263.56
|
| Rate for Payer: SOMOS Essential |
$1,263.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,684.74
|
|
|
PR LAPAROSCOPY SURG PYELOPLASTY
|
Professional
|
Both
|
$5,173.77
|
|
|
Service Code
|
HCPCS 50544
|
| Min. Negotiated Rate |
$980.11 |
| Max. Negotiated Rate |
$3,150.34 |
| Rate for Payer: Cash Price |
$1,409.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,400.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,260.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,260.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,330.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,400.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,330.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,400.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,400.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,050.11
|
| Rate for Payer: Healthfirst Commercial |
$1,400.15
|
| Rate for Payer: Healthfirst Essential Plan |
$3,150.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,330.14
|
| Rate for Payer: Healthfirst QHP |
$1,400.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$980.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,400.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,190.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$980.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,400.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,050.11
|
| Rate for Payer: SOMOS Essential |
$1,050.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,400.15
|
|
|
PR LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA
|
Professional
|
Both
|
$1,953.67
|
|
|
Service Code
|
HCPCS 49650
|
| Min. Negotiated Rate |
$365.36 |
| Max. Negotiated Rate |
$1,174.37 |
| Rate for Payer: Cash Price |
$524.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$521.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$469.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$469.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$495.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$521.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$495.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$521.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$521.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$391.45
|
| Rate for Payer: Healthfirst Commercial |
$521.94
|
| Rate for Payer: Healthfirst Essential Plan |
$1,174.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$495.84
|
| Rate for Payer: Healthfirst QHP |
$521.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$365.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$521.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$443.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$365.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$521.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$391.45
|
| Rate for Payer: SOMOS Essential |
$391.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$521.94
|
|
|
PR LAPAROSCOPY SURG W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,537.24
|
|
|
Service Code
|
HCPCS 49321
|
| Min. Negotiated Rate |
$286.79 |
| Max. Negotiated Rate |
$921.83 |
| Rate for Payer: Cash Price |
$412.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$409.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$368.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$368.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$389.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$409.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$389.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$409.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$409.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$307.27
|
| Rate for Payer: Healthfirst Commercial |
$409.70
|
| Rate for Payer: Healthfirst Essential Plan |
$921.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$389.21
|
| Rate for Payer: Healthfirst QHP |
$409.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$286.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$409.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$348.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$286.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$409.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$307.27
|
| Rate for Payer: SOMOS Essential |
$307.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$409.70
|
|
|
PR LAPAROSCOPY TOTAL HYSTERECTOMY UTERUS >250 GM
|
Professional
|
Both
|
$4,524.77
|
|
|
Service Code
|
HCPCS 58572
|
| Min. Negotiated Rate |
$846.03 |
| Max. Negotiated Rate |
$2,719.39 |
| Rate for Payer: Cash Price |
$1,191.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,208.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,087.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,087.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,148.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,208.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,148.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,208.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,208.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$906.47
|
| Rate for Payer: Healthfirst Commercial |
$1,208.62
|
| Rate for Payer: Healthfirst Essential Plan |
$2,719.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,148.19
|
| Rate for Payer: Healthfirst QHP |
$1,208.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$846.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,208.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,027.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$846.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,208.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$906.47
|
| Rate for Payer: SOMOS Essential |
$906.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,208.62
|
|
|
PR LAPAROSCOPY TOT HYSTERECTOMY >250 G W/TUBE/OVAR
|
Professional
|
Both
|
$5,292.11
|
|
|
Service Code
|
HCPCS 58573
|
| Min. Negotiated Rate |
$989.11 |
| Max. Negotiated Rate |
$3,179.27 |
| Rate for Payer: Cash Price |
$1,433.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,413.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,271.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,271.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,342.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,413.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,342.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,413.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,413.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,059.76
|
| Rate for Payer: Healthfirst Commercial |
$1,413.01
|
| Rate for Payer: Healthfirst Essential Plan |
$3,179.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,342.36
|
| Rate for Payer: Healthfirst QHP |
$1,413.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$989.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,413.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,201.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$989.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,413.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,059.76
|
| Rate for Payer: SOMOS Essential |
$1,059.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,413.01
|
|
|
PR LAPAROSCOPY URETHRAL SUSPENSION STRESS INCONT
|
Professional
|
Both
|
$3,122.67
|
|
|
Service Code
|
HCPCS 51990
|
| Min. Negotiated Rate |
$593.87 |
| Max. Negotiated Rate |
$1,908.86 |
| Rate for Payer: Cash Price |
$853.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$848.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$763.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$763.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$805.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$848.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$805.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$848.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$848.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$636.28
|
| Rate for Payer: Healthfirst Commercial |
$848.38
|
| Rate for Payer: Healthfirst Essential Plan |
$1,908.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$805.96
|
| Rate for Payer: Healthfirst QHP |
$848.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$593.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$848.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$721.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$593.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$848.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$636.28
|
| Rate for Payer: SOMOS Essential |
$636.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$848.38
|
|
|
PR LAPAROSCOPY URTROLITHOTOMY
|
Professional
|
Both
|
$4,048.07
|
|
|
Service Code
|
HCPCS 50945
|
| Min. Negotiated Rate |
$768.35 |
| Max. Negotiated Rate |
$2,469.69 |
| Rate for Payer: Cash Price |
$1,105.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,097.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$987.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$987.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,042.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,097.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,042.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,097.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,097.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$823.23
|
| Rate for Payer: Healthfirst Commercial |
$1,097.64
|
| Rate for Payer: Healthfirst Essential Plan |
$2,469.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,042.76
|
| Rate for Payer: Healthfirst QHP |
$1,097.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$768.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,097.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$932.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$768.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,097.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$823.23
|
| Rate for Payer: SOMOS Essential |
$823.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,097.64
|
|
|
PR LAPAROSCOPY W/LYSIS OF ADHESIONS
|
Professional
|
Both
|
$3,005.77
|
|
|
Service Code
|
HCPCS 58660
|
| Min. Negotiated Rate |
$563.23 |
| Max. Negotiated Rate |
$1,810.39 |
| Rate for Payer: Cash Price |
$812.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$804.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$724.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$724.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$764.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$804.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$764.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$804.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$804.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$603.47
|
| Rate for Payer: Healthfirst Commercial |
$804.62
|
| Rate for Payer: Healthfirst Essential Plan |
$1,810.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$764.39
|
| Rate for Payer: Healthfirst QHP |
$804.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$563.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$804.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$683.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$563.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$804.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$603.47
|
| Rate for Payer: SOMOS Essential |
$603.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$804.62
|
|
|
PR LAPAROSCOPY W/OMENTOPEXY
|
Professional
|
Both
|
$847.63
|
|
|
Service Code
|
HCPCS 49326
|
| Min. Negotiated Rate |
$155.74 |
| Max. Negotiated Rate |
$500.58 |
| Rate for Payer: Cash Price |
$224.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$222.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$200.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$200.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$211.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$222.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$211.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$222.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$222.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$166.86
|
| Rate for Payer: Healthfirst Commercial |
$222.48
|
| Rate for Payer: Healthfirst Essential Plan |
$500.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$211.36
|
| Rate for Payer: Healthfirst QHP |
$222.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$155.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$222.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$189.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$155.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$222.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$166.86
|
| Rate for Payer: SOMOS Essential |
$166.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$222.48
|
|
|
PR LAPAROSCOPY W/PLMT OCCLUSION DEVICE OVIDUCTS
|
Professional
|
Both
|
$1,623.76
|
|
|
Service Code
|
HCPCS 58671
|
| 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 W/RMVL ADNEXAL STRUCTURES
|
Professional
|
Both
|
$2,848.51
|
|
|
Service Code
|
HCPCS 58661
|
| Min. Negotiated Rate |
$529.96 |
| Max. Negotiated Rate |
$1,703.45 |
| Rate for Payer: Cash Price |
$766.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$757.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$681.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$681.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$719.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$757.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$719.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$757.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$757.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$567.82
|
| Rate for Payer: Healthfirst Commercial |
$757.09
|
| Rate for Payer: Healthfirst Essential Plan |
$1,703.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$719.24
|
| Rate for Payer: Healthfirst QHP |
$757.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$529.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$757.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$643.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$529.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$757.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$567.82
|
| Rate for Payer: SOMOS Essential |
$567.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$757.09
|
|
