|
PR LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM
|
Professional
|
Both
|
$7,858.55
|
|
|
Service Code
|
HCPCS 43644
|
| Min. Negotiated Rate |
$1,452.31 |
| Max. Negotiated Rate |
$4,668.14 |
| Rate for Payer: Cash Price |
$2,092.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,074.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,867.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,867.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,970.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,074.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,970.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,074.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,074.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,556.05
|
| Rate for Payer: Healthfirst Commercial |
$2,074.73
|
| Rate for Payer: Healthfirst Essential Plan |
$4,668.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,970.99
|
| Rate for Payer: Healthfirst QHP |
$2,074.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,452.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,074.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,763.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,452.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,074.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,556.05
|
| Rate for Payer: SOMOS Essential |
$1,556.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,074.73
|
|
|
PR LAPS GSTR RSTCV PX W/BYP&SM INT RCNSTJ
|
Professional
|
Both
|
$8,334.10
|
|
|
Service Code
|
HCPCS 43645
|
| Min. Negotiated Rate |
$1,548.51 |
| Max. Negotiated Rate |
$4,977.34 |
| Rate for Payer: Cash Price |
$2,219.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,212.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,990.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,990.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,101.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,212.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,101.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,212.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,212.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,659.11
|
| Rate for Payer: Healthfirst Commercial |
$2,212.15
|
| Rate for Payer: Healthfirst Essential Plan |
$4,977.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,101.54
|
| Rate for Payer: Healthfirst QHP |
$2,212.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,548.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,212.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,880.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,548.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,212.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,659.11
|
| Rate for Payer: SOMOS Essential |
$1,659.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,212.15
|
|
|
PR LAPS INSERTION TUNNELED INTRAPERITONEAL CATHETER
|
Professional
|
Both
|
$1,750.28
|
|
|
Service Code
|
HCPCS 49324
|
| Min. Negotiated Rate |
$322.77 |
| Max. Negotiated Rate |
$1,037.47 |
| Rate for Payer: Cash Price |
$466.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$414.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$414.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$438.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$438.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$461.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$345.82
|
| Rate for Payer: Healthfirst Commercial |
$461.10
|
| Rate for Payer: Healthfirst Essential Plan |
$1,037.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$438.05
|
| Rate for Payer: Healthfirst QHP |
$461.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$322.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$391.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$322.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$345.82
|
| Rate for Payer: SOMOS Essential |
$345.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.10
|
|
|
PR LAPS LIGATION SPERMATIC VEINS VARICOCELE
|
Professional
|
Both
|
$1,807.12
|
|
|
Service Code
|
HCPCS 55550
|
| Min. Negotiated Rate |
$345.33 |
| Max. Negotiated Rate |
$1,109.99 |
| Rate for Payer: Cash Price |
$496.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$493.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$444.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$444.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$468.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$493.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$468.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$493.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$493.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$370.00
|
| Rate for Payer: Healthfirst Commercial |
$493.33
|
| Rate for Payer: Healthfirst Essential Plan |
$1,109.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$468.66
|
| Rate for Payer: Healthfirst QHP |
$493.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$345.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$493.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$419.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$345.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$493.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$370.00
|
| Rate for Payer: SOMOS Essential |
$370.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$493.33
|
|
|
PR LAPS MOBLJ SPLENIC FLXR PFRMD W/PRTL COLECTOMY
|
Professional
|
Both
|
$814.03
|
|
|
Service Code
|
HCPCS 44213
|
| Min. Negotiated Rate |
$151.26 |
| Max. Negotiated Rate |
$486.18 |
| Rate for Payer: Cash Price |
$217.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$216.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$194.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$194.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$205.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$216.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$205.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$216.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$216.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$162.06
|
| Rate for Payer: Healthfirst Commercial |
$216.08
|
| Rate for Payer: Healthfirst Essential Plan |
$486.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$205.28
|
| Rate for Payer: Healthfirst QHP |
$216.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$151.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$216.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$183.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$151.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$216.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$162.06
|
| Rate for Payer: SOMOS Essential |
$162.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$216.08
|
|
|
PR LAPS MYOMECTOMY EXC 1-4 MYOMAS 250 GM/<
|
Professional
|
Both
|
$3,937.96
|
|
|
Service Code
|
HCPCS 58545
|
| Min. Negotiated Rate |
$732.82 |
| Max. Negotiated Rate |
$2,355.50 |
| Rate for Payer: Cash Price |
$1,062.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,046.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$942.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$942.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$994.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,046.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$994.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,046.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,046.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$785.17
|
| Rate for Payer: Healthfirst Commercial |
$1,046.89
|
| Rate for Payer: Healthfirst Essential Plan |
$2,355.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$994.55
|
| Rate for Payer: Healthfirst QHP |
$1,046.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$732.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,046.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$889.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$732.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,046.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$785.17
|
| Rate for Payer: SOMOS Essential |
$785.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,046.89
|
|
|
PR LAPS MYOMECTOMY EXC 5/> MYOMAS >250 GRAMS
|
Professional
|
Both
|
$4,856.71
|
|
|
Service Code
|
HCPCS 58546
|
| Min. Negotiated Rate |
$901.80 |
| Max. Negotiated Rate |
$2,898.65 |
| Rate for Payer: Cash Price |
$1,306.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,288.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,159.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,159.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,223.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,288.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,223.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,288.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,288.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$966.22
|
| Rate for Payer: Healthfirst Commercial |
$1,288.29
|
| Rate for Payer: Healthfirst Essential Plan |
$2,898.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,223.88
|
| Rate for Payer: Healthfirst QHP |
$1,288.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$901.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,288.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,095.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$901.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,288.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$966.22
|
| Rate for Payer: SOMOS Essential |
$966.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,288.29
|
|
|
PR LAPS PROCTECTOMY ABDOMINOPERINEAL W/COLOSTOMY
|
Professional
|
Both
|
$8,481.59
|
|
|
Service Code
|
HCPCS 45395
|
| Min. Negotiated Rate |
$1,577.54 |
| Max. Negotiated Rate |
$5,070.67 |
| Rate for Payer: Cash Price |
$2,279.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,253.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,028.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,028.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,140.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,253.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,140.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,253.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,253.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,690.22
|
| Rate for Payer: Healthfirst Commercial |
$2,253.63
|
| Rate for Payer: Healthfirst Essential Plan |
$5,070.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,140.95
|
| Rate for Payer: Healthfirst QHP |
$2,253.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,577.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,253.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,915.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,577.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,253.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,690.22
|
| Rate for Payer: SOMOS Essential |
$1,690.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,253.63
|
|
|
PR LAPS PROCTECTOMY COMBINED PULL-THRU W/RESERVOIR
|
Professional
|
Both
|
$9,139.10
|
|
|
Service Code
|
HCPCS 45397
|
| Min. Negotiated Rate |
$1,703.20 |
| Max. Negotiated Rate |
$5,474.56 |
| Rate for Payer: Cash Price |
$2,453.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,433.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,189.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,189.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,311.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,433.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,311.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,433.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,433.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,824.86
|
| Rate for Payer: Healthfirst Commercial |
$2,433.14
|
| Rate for Payer: Healthfirst Essential Plan |
$5,474.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,311.48
|
| Rate for Payer: Healthfirst QHP |
$2,433.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,703.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,433.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,068.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,703.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,433.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,824.86
|
| Rate for Payer: SOMOS Essential |
$1,824.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,433.14
|
|
|
PR LAPS PROSTECT RETROPUBIC RAD W/NRV SPARING ROBOT
|
Professional
|
Both
|
$4,989.60
|
|
|
Service Code
|
HCPCS 55866
|
| Min. Negotiated Rate |
$947.09 |
| Max. Negotiated Rate |
$3,044.23 |
| Rate for Payer: Cash Price |
$1,360.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,352.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,217.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,217.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,285.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,352.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,285.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,352.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,352.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,014.74
|
| Rate for Payer: Healthfirst Commercial |
$1,352.99
|
| Rate for Payer: Healthfirst Essential Plan |
$3,044.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,285.34
|
| Rate for Payer: Healthfirst QHP |
$1,352.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$947.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,352.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,150.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$947.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,352.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,014.74
|
| Rate for Payer: SOMOS Essential |
$1,014.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,352.99
|
|
|
PR LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/MESH
|
Professional
|
Both
|
$7,809.97
|
|
|
Service Code
|
HCPCS 43282
|
| Min. Negotiated Rate |
$1,441.03 |
| Max. Negotiated Rate |
$4,631.87 |
| Rate for Payer: Cash Price |
$2,077.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,058.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,852.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,852.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,955.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,058.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,955.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,058.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,058.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,543.96
|
| Rate for Payer: Healthfirst Commercial |
$2,058.61
|
| Rate for Payer: Healthfirst Essential Plan |
$4,631.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,955.68
|
| Rate for Payer: Healthfirst QHP |
$2,058.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,441.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,058.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,749.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,441.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,058.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,543.96
|
| Rate for Payer: SOMOS Essential |
$1,543.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,058.61
|
|
|
PR LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/O MESH
|
Professional
|
Both
|
$6,943.55
|
|
|
Service Code
|
HCPCS 43281
|
| Min. Negotiated Rate |
$1,278.17 |
| Max. Negotiated Rate |
$4,108.41 |
| Rate for Payer: Cash Price |
$1,843.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,825.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,643.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,643.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,734.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,825.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,734.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,825.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,825.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,369.47
|
| Rate for Payer: Healthfirst Commercial |
$1,825.96
|
| Rate for Payer: Healthfirst Essential Plan |
$4,108.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,734.66
|
| Rate for Payer: Healthfirst QHP |
$1,825.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,278.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,825.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,552.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,278.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,825.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,369.47
|
| Rate for Payer: SOMOS Essential |
$1,369.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,825.96
|
|
|
PR LAPS SUPRACERVICAL HYSTERECTOMY >250
|
Professional
|
Both
|
$3,682.60
|
|
|
Service Code
|
HCPCS 58543
|
| Min. Negotiated Rate |
$683.44 |
| Max. Negotiated Rate |
$2,196.76 |
| Rate for Payer: Cash Price |
$991.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$976.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$878.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$878.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$927.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$976.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$927.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$976.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$976.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$732.25
|
| Rate for Payer: Healthfirst Commercial |
$976.34
|
| Rate for Payer: Healthfirst Essential Plan |
$2,196.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$927.52
|
| Rate for Payer: Healthfirst QHP |
$976.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$683.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$976.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$829.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$683.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$976.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$732.25
|
| Rate for Payer: SOMOS Essential |
$732.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$976.34
|
|
|
PR LAPS SUPRACRV HYSTEREC >250 G RMVL TUBE/OVARY
|
Professional
|
Both
|
$3,958.29
|
|
|
Service Code
|
HCPCS 58544
|
| Min. Negotiated Rate |
$735.13 |
| Max. Negotiated Rate |
$2,362.91 |
| Rate for Payer: Cash Price |
$1,065.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,050.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$945.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$945.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$997.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,050.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$997.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,050.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,050.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$787.63
|
| Rate for Payer: Healthfirst Commercial |
$1,050.18
|
| Rate for Payer: Healthfirst Essential Plan |
$2,362.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$997.67
|
| Rate for Payer: Healthfirst QHP |
$1,050.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$735.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,050.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$892.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$735.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,050.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$787.63
|
| Rate for Payer: SOMOS Essential |
$787.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,050.18
|
|
|
PR LAPS SUPRACRV HYSTERECT 250 GM/< RMVL TUBE/OVAR
|
Professional
|
Both
|
$3,617.78
|
|
|
Service Code
|
HCPCS 58542
|
| Min. Negotiated Rate |
$672.48 |
| Max. Negotiated Rate |
$2,161.53 |
| Rate for Payer: Cash Price |
$974.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$960.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$864.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$864.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$912.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$960.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$912.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$960.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$960.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$720.51
|
| Rate for Payer: Healthfirst Commercial |
$960.68
|
| Rate for Payer: Healthfirst Essential Plan |
$2,161.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$912.65
|
| Rate for Payer: Healthfirst QHP |
$960.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$672.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$960.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$816.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$672.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$960.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$720.51
|
| Rate for Payer: SOMOS Essential |
$720.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$960.68
|
|
|
PR LAPS SURG ABLTJ 1 > LVR TUM CRYOSURG
|
Professional
|
Both
|
$5,702.38
|
|
|
Service Code
|
HCPCS 47371
|
| Min. Negotiated Rate |
$1,055.06 |
| Max. Negotiated Rate |
$3,391.27 |
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,507.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,356.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,356.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,431.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,507.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,431.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,507.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,507.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,130.42
|
| Rate for Payer: Healthfirst Commercial |
$1,507.23
|
| Rate for Payer: Healthfirst Essential Plan |
$3,391.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,431.87
|
| Rate for Payer: Healthfirst QHP |
$1,507.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,055.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,507.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,281.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,055.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,507.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,130.42
|
| Rate for Payer: SOMOS Essential |
$1,130.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,507.23
|
|
|
PR LAPS SURG ABLTJ 1/> LVR TUM RF
|
Professional
|
Both
|
$5,663.81
|
|
|
Service Code
|
HCPCS 47370
|
| Min. Negotiated Rate |
$1,049.59 |
| Max. Negotiated Rate |
$3,373.70 |
| Rate for Payer: Cash Price |
$1,509.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,499.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,349.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,349.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,424.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,499.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,424.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,499.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,499.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,124.57
|
| Rate for Payer: Healthfirst Commercial |
$1,499.42
|
| Rate for Payer: Healthfirst Essential Plan |
$3,373.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,424.45
|
| Rate for Payer: Healthfirst QHP |
$1,499.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,049.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,499.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,274.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,049.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,499.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,124.57
|
| Rate for Payer: SOMOS Essential |
$1,124.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,499.42
|
|
|
PR LAPS SURG BILATERAL TOTAL PELVIC LMPHADECTOMY
|
Professional
|
Both
|
$2,792.58
|
|
|
Service Code
|
HCPCS 38571
|
| Min. Negotiated Rate |
$528.86 |
| Max. Negotiated Rate |
$1,699.92 |
| Rate for Payer: Cash Price |
$760.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$755.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$679.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$679.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$717.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$755.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$717.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$755.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$755.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$566.64
|
| Rate for Payer: Healthfirst Commercial |
$755.52
|
| Rate for Payer: Healthfirst Essential Plan |
$1,699.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$717.74
|
| Rate for Payer: Healthfirst QHP |
$755.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$528.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$755.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$642.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$528.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$755.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$566.64
|
| Rate for Payer: SOMOS Essential |
$566.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$755.52
|
|
|
PR LAPS SURG CHOLECSTC W/EXPL COMMON DUCT
|
Professional
|
Both
|
$5,047.84
|
|
|
Service Code
|
HCPCS 47564
|
| Min. Negotiated Rate |
$938.03 |
| Max. Negotiated Rate |
$3,015.09 |
| Rate for Payer: Cash Price |
$1,348.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,340.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,206.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,206.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,273.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,340.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,273.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,340.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,340.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,005.03
|
| Rate for Payer: Healthfirst Commercial |
$1,340.04
|
| Rate for Payer: Healthfirst Essential Plan |
$3,015.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,273.04
|
| Rate for Payer: Healthfirst QHP |
$1,340.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$938.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,340.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,139.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$938.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,340.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,005.03
|
| Rate for Payer: SOMOS Essential |
$1,005.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,340.04
|
|
|
PR LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY
|
Professional
|
Both
|
$3,251.68
|
|
|
Service Code
|
HCPCS 47563
|
| Min. Negotiated Rate |
$604.07 |
| Max. Negotiated Rate |
$1,941.64 |
| Rate for Payer: Cash Price |
$867.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$862.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$776.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$776.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$819.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$862.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$819.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$862.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$862.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$647.21
|
| Rate for Payer: Healthfirst Commercial |
$862.95
|
| Rate for Payer: Healthfirst Essential Plan |
$1,941.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$819.80
|
| Rate for Payer: Healthfirst QHP |
$862.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$604.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$862.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$733.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$604.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$862.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$647.21
|
| Rate for Payer: SOMOS Essential |
$647.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$862.95
|
|
|
PR LAPS SURG ESOPG/GSTR FUNDOPLASTY
|
Professional
|
Both
|
$4,863.43
|
|
|
Service Code
|
HCPCS 43280
|
| Min. Negotiated Rate |
$899.91 |
| Max. Negotiated Rate |
$2,892.55 |
| Rate for Payer: Cash Price |
$1,295.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,285.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,157.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,157.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,221.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,285.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,221.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,285.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,285.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$964.18
|
| Rate for Payer: Healthfirst Commercial |
$1,285.58
|
| Rate for Payer: Healthfirst Essential Plan |
$2,892.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,221.30
|
| Rate for Payer: Healthfirst QHP |
$1,285.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$899.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,285.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,092.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$899.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,285.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$964.18
|
| Rate for Payer: SOMOS Essential |
$964.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,285.58
|
|
|
PR LAPS SURG GASTROSTOMY W/O CONSTJ GSTR TUBE SPX
|
Professional
|
Both
|
$2,607.29
|
|
|
Service Code
|
HCPCS 43653
|
| Min. Negotiated Rate |
$486.58 |
| Max. Negotiated Rate |
$1,564.00 |
| Rate for Payer: Cash Price |
$699.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$695.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$625.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$625.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$660.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$695.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$660.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$695.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$695.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$521.33
|
| Rate for Payer: Healthfirst Commercial |
$695.11
|
| Rate for Payer: Healthfirst Essential Plan |
$1,564.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$660.35
|
| Rate for Payer: Healthfirst QHP |
$695.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$486.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$695.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$590.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$486.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$695.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$521.33
|
| Rate for Payer: SOMOS Essential |
$521.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$695.11
|
|
|
PR LAPS SURG PRST8ECT SMPL STOT ROBOTIC ASSISTANCE
|
Professional
|
Both
|
$4,381.69
|
|
|
Service Code
|
HCPCS 55867
|
| Min. Negotiated Rate |
$832.17 |
| Max. Negotiated Rate |
$2,674.84 |
| Rate for Payer: Cash Price |
$1,195.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,188.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,069.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,069.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,129.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,188.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,129.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,188.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,188.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$891.62
|
| Rate for Payer: Healthfirst Commercial |
$1,188.82
|
| Rate for Payer: Healthfirst Essential Plan |
$2,674.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,129.38
|
| Rate for Payer: Healthfirst QHP |
$1,188.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$832.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,188.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,010.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$832.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,188.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$891.62
|
| Rate for Payer: SOMOS Essential |
$891.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,188.82
|
|
|
PR LAPS SURG RETROPERITONEAL LYMPH NODE BX 1/MLT
|
Professional
|
Both
|
$2,237.80
|
|
|
Service Code
|
HCPCS 38570
|
| Min. Negotiated Rate |
$421.31 |
| Max. Negotiated Rate |
$1,354.21 |
| Rate for Payer: Cash Price |
$607.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$601.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$541.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$541.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$571.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$601.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$571.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$601.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$601.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$451.40
|
| Rate for Payer: Healthfirst Commercial |
$601.87
|
| Rate for Payer: Healthfirst Essential Plan |
$1,354.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$571.78
|
| Rate for Payer: Healthfirst QHP |
$601.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$421.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$601.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$511.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$421.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$601.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$451.40
|
| Rate for Payer: SOMOS Essential |
$451.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$601.87
|
|
|
PR LAPS SURG RPR RECURRENT INGUINAL HERNIA
|
Professional
|
Both
|
$2,555.95
|
|
|
Service Code
|
HCPCS 49651
|
| Min. Negotiated Rate |
$476.94 |
| Max. Negotiated Rate |
$1,533.04 |
| Rate for Payer: Cash Price |
$685.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$681.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$613.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$613.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$647.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$681.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$647.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$681.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$681.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$511.01
|
| Rate for Payer: Healthfirst Commercial |
$681.35
|
| Rate for Payer: Healthfirst Essential Plan |
$1,533.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$647.28
|
| Rate for Payer: Healthfirst QHP |
$681.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$476.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$681.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$579.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$476.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$681.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$511.01
|
| Rate for Payer: SOMOS Essential |
$511.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$681.35
|
|
