|
PR LAPAROSCOPY W TOTAL HYSTERECTOMY UTERUS 250 GM/<
|
Professional
|
Both
|
$3,525.48
|
|
|
Service Code
|
HCPCS 58570
|
| Min. Negotiated Rate |
$657.22 |
| Max. Negotiated Rate |
$2,112.50 |
| Rate for Payer: Cash Price |
$950.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$938.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$845.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$845.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$891.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$938.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$891.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$938.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$938.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$704.17
|
| Rate for Payer: Healthfirst Commercial |
$938.89
|
| Rate for Payer: Healthfirst Essential Plan |
$2,112.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.95
|
| Rate for Payer: Healthfirst QHP |
$938.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$657.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$938.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$798.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$657.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$938.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$704.17
|
| Rate for Payer: SOMOS Essential |
$704.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$938.89
|
|
|
PR LAPAROTOMY ISLET CELL TRANSP
|
Professional
|
Both
|
$5,591.04
|
|
|
Service Code
|
HCPCS G0343
|
| Min. Negotiated Rate |
$1,033.61 |
| Max. Negotiated Rate |
$3,322.33 |
| Rate for Payer: Cash Price |
$1,488.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,476.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,328.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,328.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,402.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,476.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,402.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,476.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,476.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,107.44
|
| Rate for Payer: Healthfirst Commercial |
$1,476.59
|
| Rate for Payer: Healthfirst Essential Plan |
$3,322.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,402.76
|
| Rate for Payer: Healthfirst QHP |
$1,476.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,033.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,476.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,255.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,033.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,476.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,107.44
|
| Rate for Payer: SOMOS Essential |
$1,107.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,476.59
|
|
|
PR LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX
|
Professional
|
Both
|
$1,472.63
|
|
|
Service Code
|
HCPCS 49320
|
| Min. Negotiated Rate |
$276.62 |
| Max. Negotiated Rate |
$889.13 |
| Rate for Payer: Cash Price |
$396.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$395.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$355.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$355.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$375.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$395.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$375.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$395.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$395.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$296.38
|
| Rate for Payer: Healthfirst Commercial |
$395.17
|
| Rate for Payer: Healthfirst Essential Plan |
$889.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$375.41
|
| Rate for Payer: Healthfirst QHP |
$395.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$276.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$395.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$335.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$276.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$395.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$296.38
|
| Rate for Payer: SOMOS Essential |
$296.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$395.17
|
|
|
PR LAPS ABLTJ RENAL MASS LESION W/INTRAOP US
|
Professional
|
Both
|
$4,881.56
|
|
|
Service Code
|
HCPCS 50542
|
| Min. Negotiated Rate |
$924.29 |
| Max. Negotiated Rate |
$2,970.95 |
| Rate for Payer: Cash Price |
$1,323.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,320.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,188.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,188.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,254.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,320.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,254.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,320.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,320.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$990.32
|
| Rate for Payer: Healthfirst Commercial |
$1,320.42
|
| Rate for Payer: Healthfirst Essential Plan |
$2,970.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,254.40
|
| Rate for Payer: Healthfirst QHP |
$1,320.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$924.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,320.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,122.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$924.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,320.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$990.32
|
| Rate for Payer: SOMOS Essential |
$990.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,320.42
|
|
|
PR LAPS ABLTJ UTERINE FIBROIDS W/INTRAOP US GDN
|
Professional
|
Both
|
$3,551.03
|
|
|
Service Code
|
HCPCS 58674
|
| Min. Negotiated Rate |
$659.83 |
| Max. Negotiated Rate |
$2,120.87 |
| Rate for Payer: Cash Price |
$955.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$942.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$848.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$848.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$895.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$942.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$895.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$942.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$942.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$706.96
|
| Rate for Payer: Healthfirst Commercial |
$942.61
|
| Rate for Payer: Healthfirst Essential Plan |
$2,120.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$895.48
|
| Rate for Payer: Healthfirst QHP |
$942.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$659.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$942.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$801.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$659.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$942.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$706.96
|
| Rate for Payer: SOMOS Essential |
$706.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$942.61
|
|
|
PR LAPS BI TOT PEL LMPHADEC & PRI-AORTIC LYMPH BX 1
|
Professional
|
Both
|
$3,900.72
|
|
|
Service Code
|
HCPCS 38572
|
| Min. Negotiated Rate |
$724.62 |
| Max. Negotiated Rate |
$2,329.13 |
| Rate for Payer: Cash Price |
$1,046.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,035.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$931.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$931.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$983.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,035.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$983.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,035.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,035.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$776.38
|
| Rate for Payer: Healthfirst Commercial |
$1,035.17
|
| Rate for Payer: Healthfirst Essential Plan |
$2,329.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$983.41
|
| Rate for Payer: Healthfirst QHP |
$1,035.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$724.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,035.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$879.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$724.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,035.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$776.38
|
| Rate for Payer: SOMOS Essential |
$776.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,035.17
|
|
|
PR LAPS CLSR NTRSTM LG/SM INT W/RESCJ & ANASTOMOSIS
|
Professional
|
Both
|
$7,343.25
|
|
|
Service Code
|
HCPCS 44227
|
| Min. Negotiated Rate |
$1,358.12 |
| Max. Negotiated Rate |
$4,365.38 |
| Rate for Payer: Cash Price |
$1,958.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,940.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,746.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,746.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,843.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,940.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,843.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,940.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,940.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,455.13
|
| Rate for Payer: Healthfirst Commercial |
$1,940.17
|
| Rate for Payer: Healthfirst Essential Plan |
$4,365.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,843.16
|
| Rate for Payer: Healthfirst QHP |
$1,940.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,358.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,940.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,649.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,358.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,940.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,455.13
|
| Rate for Payer: SOMOS Essential |
$1,455.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,940.17
|
|
|
PR LAPS COLCT TTL ABD W/PRCTECT ILEOANAL ANASTOMSIS
|
Professional
|
Both
|
$8,934.52
|
|
|
Service Code
|
HCPCS 44211
|
| Min. Negotiated Rate |
$1,675.94 |
| Max. Negotiated Rate |
$5,386.95 |
| Rate for Payer: Cash Price |
$2,417.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,394.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,154.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,154.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,274.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,394.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,274.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,394.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,394.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,795.65
|
| Rate for Payer: Healthfirst Commercial |
$2,394.20
|
| Rate for Payer: Healthfirst Essential Plan |
$5,386.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,274.49
|
| Rate for Payer: Healthfirst QHP |
$2,394.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,675.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,394.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,035.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,675.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,394.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,795.65
|
| Rate for Payer: SOMOS Essential |
$1,795.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,394.20
|
|
|
PR LAPS COLECTMY PRTL W/COLOPXTSTMY LW ANAST W/CLST
|
Professional
|
Both
|
$8,623.23
|
|
|
Service Code
|
HCPCS 44208
|
| Min. Negotiated Rate |
$1,598.59 |
| Max. Negotiated Rate |
$5,138.32 |
| Rate for Payer: Cash Price |
$2,311.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,283.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,055.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,055.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,169.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,283.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,169.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,283.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,283.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,712.78
|
| Rate for Payer: Healthfirst Commercial |
$2,283.70
|
| Rate for Payer: Healthfirst Essential Plan |
$5,138.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,169.51
|
| Rate for Payer: Healthfirst QHP |
$2,283.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,598.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,283.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,941.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,598.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,283.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,712.78
|
| Rate for Payer: SOMOS Essential |
$1,712.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,283.70
|
|
|
PR LAPS COLECTOMY ABDL W/PROCTECTOMY W/ILEOSTOMY
|
Professional
|
Both
|
$8,704.15
|
|
|
Service Code
|
HCPCS 44212
|
| Min. Negotiated Rate |
$1,634.64 |
| Max. Negotiated Rate |
$5,254.20 |
| Rate for Payer: Cash Price |
$2,346.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,335.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,101.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,101.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,218.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,335.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,218.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,335.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,335.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,751.40
|
| Rate for Payer: Healthfirst Commercial |
$2,335.20
|
| Rate for Payer: Healthfirst Essential Plan |
$5,254.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,218.44
|
| Rate for Payer: Healthfirst QHP |
$2,335.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,634.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,335.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,984.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,634.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,335.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,751.40
|
| Rate for Payer: SOMOS Essential |
$1,751.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,335.20
|
|
|
PR LAPS COLECTOMY PRTL W/COLOPXTSTMY LW ANAST
|
Professional
|
Both
|
$7,930.69
|
|
|
Service Code
|
HCPCS 44207
|
| Min. Negotiated Rate |
$1,471.26 |
| Max. Negotiated Rate |
$4,729.05 |
| Rate for Payer: Cash Price |
$2,122.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,101.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,891.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,891.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,996.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,101.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,996.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,101.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,101.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,576.35
|
| Rate for Payer: Healthfirst Commercial |
$2,101.80
|
| Rate for Payer: Healthfirst Essential Plan |
$4,729.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,996.71
|
| Rate for Payer: Healthfirst QHP |
$2,101.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,471.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,101.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,786.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,471.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,101.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,576.35
|
| Rate for Payer: SOMOS Essential |
$1,576.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,101.80
|
|
|
PR LAPS COLECTOMY PRTL W/END CLST & CLSR DSTL SGM
|
Professional
|
Both
|
$7,702.49
|
|
|
Service Code
|
HCPCS 44206
|
| Min. Negotiated Rate |
$1,424.60 |
| Max. Negotiated Rate |
$4,579.06 |
| Rate for Payer: Cash Price |
$2,059.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,035.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,831.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,831.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,933.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,035.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,933.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,035.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,035.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,526.36
|
| Rate for Payer: Healthfirst Commercial |
$2,035.14
|
| Rate for Payer: Healthfirst Essential Plan |
$4,579.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,933.38
|
| Rate for Payer: Healthfirst QHP |
$2,035.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,424.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,035.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,729.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,424.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,035.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,526.36
|
| Rate for Payer: SOMOS Essential |
$1,526.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,035.14
|
|
|
PR LAPS COLECTOMY PRTL W/RMVL TERMINAL ILEUM
|
Professional
|
Both
|
$5,882.42
|
|
|
Service Code
|
HCPCS 44205
|
| Min. Negotiated Rate |
$1,091.64 |
| Max. Negotiated Rate |
$3,508.85 |
| Rate for Payer: Cash Price |
$1,572.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,559.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,403.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,403.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,481.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,559.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,481.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,559.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,559.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,169.62
|
| Rate for Payer: Healthfirst Commercial |
$1,559.49
|
| Rate for Payer: Healthfirst Essential Plan |
$3,508.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,481.52
|
| Rate for Payer: Healthfirst QHP |
$1,559.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,091.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,559.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,325.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,091.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,559.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,169.62
|
| Rate for Payer: SOMOS Essential |
$1,169.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,559.49
|
|
|
PR LAPS COLECTOMY TOT W/O PRCTECT W/ILEOST/ILEOPXTS
|
Professional
|
Both
|
$7,691.01
|
|
|
Service Code
|
HCPCS 44210
|
| Min. Negotiated Rate |
$1,429.48 |
| Max. Negotiated Rate |
$4,594.75 |
| Rate for Payer: Cash Price |
$2,064.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,042.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,837.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,837.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,940.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,042.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,940.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,042.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,042.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,531.58
|
| Rate for Payer: Healthfirst Commercial |
$2,042.11
|
| Rate for Payer: Healthfirst Essential Plan |
$4,594.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,940.00
|
| Rate for Payer: Healthfirst QHP |
$2,042.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,429.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,042.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,735.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,429.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,042.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,531.58
|
| Rate for Payer: SOMOS Essential |
$1,531.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,042.11
|
|
|
PR LAPS ENTERECT RESCJ 1 SMALL INTEST RESCJ & ANA
|
Professional
|
Both
|
$6,213.62
|
|
|
Service Code
|
HCPCS 44202
|
| Min. Negotiated Rate |
$1,150.03 |
| Max. Negotiated Rate |
$3,696.53 |
| Rate for Payer: Cash Price |
$1,656.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,642.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,478.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,478.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,560.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,642.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,560.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,642.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,642.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,232.17
|
| Rate for Payer: Healthfirst Commercial |
$1,642.90
|
| Rate for Payer: Healthfirst Essential Plan |
$3,696.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,560.76
|
| Rate for Payer: Healthfirst QHP |
$1,642.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,150.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,642.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,396.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,150.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,642.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,232.17
|
| Rate for Payer: SOMOS Essential |
$1,232.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,642.90
|
|
|
PR LAPS ESOPHAGEAL LENGTHENING ADDL
|
Professional
|
Both
|
$707.35
|
|
|
Service Code
|
HCPCS 43283
|
| Min. Negotiated Rate |
$129.47 |
| Max. Negotiated Rate |
$416.14 |
| Rate for Payer: Cash Price |
$187.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$166.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$166.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$184.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$138.71
|
| Rate for Payer: Healthfirst Commercial |
$184.95
|
| Rate for Payer: Healthfirst Essential Plan |
$416.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$175.70
|
| Rate for Payer: Healthfirst QHP |
$184.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$129.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$184.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$157.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$129.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.71
|
| Rate for Payer: SOMOS Essential |
$138.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.95
|
|
|
PR LAPS ESOPHAGOMYOTOMY W/FUNDOPLASTY IF PERFORMED
|
Professional
|
Both
|
$5,779.62
|
|
|
Service Code
|
HCPCS 43279
|
| Min. Negotiated Rate |
$1,067.68 |
| Max. Negotiated Rate |
$3,431.84 |
| Rate for Payer: Cash Price |
$1,538.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,525.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,372.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,372.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,449.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,525.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,449.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,525.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,525.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,143.94
|
| Rate for Payer: Healthfirst Commercial |
$1,525.26
|
| Rate for Payer: Healthfirst Essential Plan |
$3,431.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,449.00
|
| Rate for Payer: Healthfirst QHP |
$1,525.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,067.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,525.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,296.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,067.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,525.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,143.94
|
| Rate for Payer: SOMOS Essential |
$1,143.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,525.26
|
|
|
PR LAPS ESOPHGL SPHNCTR AGMNTJ PLMT DEV CRRPL
|
Professional
|
Both
|
$2,948.58
|
|
|
Service Code
|
HCPCS 43284
|
| Min. Negotiated Rate |
$549.26 |
| Max. Negotiated Rate |
$1,765.48 |
| Rate for Payer: Cash Price |
$789.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$784.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$706.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$706.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$745.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$784.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$745.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$784.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$784.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$588.50
|
| Rate for Payer: Healthfirst Commercial |
$784.66
|
| Rate for Payer: Healthfirst Essential Plan |
$1,765.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$745.43
|
| Rate for Payer: Healthfirst QHP |
$784.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$549.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$784.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$666.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$549.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$784.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$588.50
|
| Rate for Payer: SOMOS Essential |
$588.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$784.66
|
|
|
PR LAPS FULG/EXC OVARY VISCERA/PERITONEAL SURFACE
|
Professional
|
Both
|
$3,107.90
|
|
|
Service Code
|
HCPCS 58662
|
| Min. Negotiated Rate |
$580.36 |
| Max. Negotiated Rate |
$1,865.45 |
| Rate for Payer: Cash Price |
$840.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$829.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$746.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$746.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$787.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$829.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$787.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$829.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$829.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$621.82
|
| Rate for Payer: Healthfirst Commercial |
$829.09
|
| Rate for Payer: Healthfirst Essential Plan |
$1,865.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$787.64
|
| Rate for Payer: Healthfirst QHP |
$829.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$580.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$829.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$704.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$580.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$829.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$621.82
|
| Rate for Payer: SOMOS Essential |
$621.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$829.09
|
|
|
PR LAPS GASTRIC RESTRICTIVE PROCEDURE PLACE DEVICE
|
Professional
|
Both
|
$5,095.62
|
|
|
Service Code
|
HCPCS 43770
|
| Min. Negotiated Rate |
$944.43 |
| Max. Negotiated Rate |
$3,035.66 |
| Rate for Payer: Cash Price |
$1,359.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,349.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,214.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,214.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,281.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,349.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,281.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,349.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,349.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,011.88
|
| Rate for Payer: Healthfirst Commercial |
$1,349.18
|
| Rate for Payer: Healthfirst Essential Plan |
$3,035.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,281.72
|
| Rate for Payer: Healthfirst QHP |
$1,349.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$944.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,349.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,146.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$944.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,349.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,011.88
|
| Rate for Payer: SOMOS Essential |
$1,011.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,349.18
|
|
|
PR LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE
|
Professional
|
Both
|
$4,283.65
|
|
|
Service Code
|
HCPCS 43772
|
| Min. Negotiated Rate |
$796.40 |
| Max. Negotiated Rate |
$2,559.85 |
| Rate for Payer: Cash Price |
$1,146.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,137.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,023.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,023.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,080.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,137.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,080.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,137.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,137.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$853.28
|
| Rate for Payer: Healthfirst Commercial |
$1,137.71
|
| Rate for Payer: Healthfirst Essential Plan |
$2,559.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,080.82
|
| Rate for Payer: Healthfirst QHP |
$1,137.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$796.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,137.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$967.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$796.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,137.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$853.28
|
| Rate for Payer: SOMOS Essential |
$853.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,137.71
|
|
|
PR LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE & PORT
|
Professional
|
Both
|
$4,351.59
|
|
|
Service Code
|
HCPCS 43774
|
| Min. Negotiated Rate |
$806.74 |
| Max. Negotiated Rate |
$2,593.08 |
| Rate for Payer: Cash Price |
$1,159.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,152.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,037.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,037.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,094.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,152.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,094.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,152.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,152.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$864.36
|
| Rate for Payer: Healthfirst Commercial |
$1,152.48
|
| Rate for Payer: Healthfirst Essential Plan |
$2,593.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,094.86
|
| Rate for Payer: Healthfirst QHP |
$1,152.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$806.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,152.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$979.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$806.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,152.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$864.36
|
| Rate for Payer: SOMOS Essential |
$864.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,152.48
|
|
|
PR LAPS GASTRIC RESTRICTIVE PX REMOVE&RPLCMT DEVICE
|
Professional
|
Both
|
$5,791.70
|
|
|
Service Code
|
HCPCS 43773
|
| Min. Negotiated Rate |
$1,071.39 |
| Max. Negotiated Rate |
$3,443.76 |
| Rate for Payer: Cash Price |
$1,542.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,530.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,377.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,377.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,454.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,530.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,454.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,530.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,530.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,147.92
|
| Rate for Payer: Healthfirst Commercial |
$1,530.56
|
| Rate for Payer: Healthfirst Essential Plan |
$3,443.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,454.03
|
| Rate for Payer: Healthfirst QHP |
$1,530.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,071.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,530.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,300.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,071.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,530.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,147.92
|
| Rate for Payer: SOMOS Essential |
$1,147.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,530.56
|
|
|
PR LAPS GASTRIC RESTRICTIVE PX REVISION DEVICE
|
Professional
|
Both
|
$5,791.70
|
|
|
Service Code
|
HCPCS 43771
|
| Min. Negotiated Rate |
$1,071.39 |
| Max. Negotiated Rate |
$3,443.76 |
| Rate for Payer: Cash Price |
$1,542.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,530.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,377.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,377.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,454.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,530.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,454.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,530.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,530.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,147.92
|
| Rate for Payer: Healthfirst Commercial |
$1,530.56
|
| Rate for Payer: Healthfirst Essential Plan |
$3,443.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,454.03
|
| Rate for Payer: Healthfirst QHP |
$1,530.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,071.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,530.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,300.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,071.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,530.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,147.92
|
| Rate for Payer: SOMOS Essential |
$1,147.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,530.56
|
|
|
PR LAPS GSTRC RSTRICTIV PX LONGITUDINAL GASTRECTOMY
|
Professional
|
Both
|
$5,023.55
|
|
|
Service Code
|
HCPCS 43775
|
| Min. Negotiated Rate |
$921.88 |
| Max. Negotiated Rate |
$2,963.18 |
| Rate for Payer: Cash Price |
$1,328.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,316.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,185.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,185.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,251.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,316.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,251.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,316.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,316.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$987.73
|
| Rate for Payer: Healthfirst Commercial |
$1,316.97
|
| Rate for Payer: Healthfirst Essential Plan |
$2,963.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,251.12
|
| Rate for Payer: Healthfirst QHP |
$1,316.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$921.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,316.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,119.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$921.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,316.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$987.73
|
| Rate for Payer: SOMOS Essential |
$987.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,316.97
|
|
