|
PR LAPS SURG TRNSXJ VAGUS NRV SLCTV/HILY SLCTV
|
Professional
|
Both
|
$3,469.45
|
|
|
Service Code
|
HCPCS 43652
|
| Min. Negotiated Rate |
$644.39 |
| Max. Negotiated Rate |
$2,071.26 |
| Rate for Payer: Cash Price |
$927.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$920.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$828.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$828.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$874.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$920.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$874.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$920.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$920.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$690.42
|
| Rate for Payer: Healthfirst Commercial |
$920.56
|
| Rate for Payer: Healthfirst Essential Plan |
$2,071.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$874.53
|
| Rate for Payer: Healthfirst QHP |
$920.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$644.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$920.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$782.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$644.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$920.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$690.42
|
| Rate for Payer: SOMOS Essential |
$690.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$920.56
|
|
|
PR LAPS SURG TRNSXJ VAGUS NRV TRUNCAL
|
Professional
|
Both
|
$2,971.57
|
|
|
Service Code
|
HCPCS 43651
|
| Min. Negotiated Rate |
$554.15 |
| Max. Negotiated Rate |
$1,781.21 |
| Rate for Payer: Cash Price |
$796.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$791.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$712.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$712.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$752.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$791.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$752.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$791.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$791.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$593.74
|
| Rate for Payer: Healthfirst Commercial |
$791.65
|
| Rate for Payer: Healthfirst Essential Plan |
$1,781.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$752.07
|
| Rate for Payer: Healthfirst QHP |
$791.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$554.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$791.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$672.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$554.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$791.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$593.74
|
| Rate for Payer: SOMOS Essential |
$593.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$791.65
|
|
|
PR LAPS SURG W/ASPIR CAVITY/CYST SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,679.72
|
|
|
Service Code
|
HCPCS 49322
|
| Min. Negotiated Rate |
$312.24 |
| Max. Negotiated Rate |
$1,003.61 |
| Rate for Payer: Cash Price |
$449.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$446.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$401.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$401.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$423.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$446.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$423.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$446.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$446.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$334.54
|
| Rate for Payer: Healthfirst Commercial |
$446.05
|
| Rate for Payer: Healthfirst Essential Plan |
$1,003.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$423.75
|
| Rate for Payer: Healthfirst QHP |
$446.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$312.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$446.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$379.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$312.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$446.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$334.54
|
| Rate for Payer: SOMOS Essential |
$334.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$446.05
|
|
|
PR LAPS SURG W/DRG LYMPHOCELE PRTL CAVITY
|
Professional
|
Both
|
$2,845.26
|
|
|
Service Code
|
HCPCS 49323
|
| Min. Negotiated Rate |
$533.36 |
| Max. Negotiated Rate |
$1,714.37 |
| Rate for Payer: Cash Price |
$765.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$761.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$685.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$685.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$723.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$761.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$723.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$761.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$761.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$571.46
|
| Rate for Payer: Healthfirst Commercial |
$761.94
|
| Rate for Payer: Healthfirst Essential Plan |
$1,714.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$723.84
|
| Rate for Payer: Healthfirst QHP |
$761.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$533.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$761.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$647.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$533.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$761.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$571.46
|
| Rate for Payer: SOMOS Essential |
$571.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$761.94
|
|
|
PR LAPS TOTAL HYSTERECT 250 GM/< W/RMVL TUBE/OVARY
|
Professional
|
Both
|
$3,953.25
|
|
|
Service Code
|
HCPCS 58571
|
| Min. Negotiated Rate |
$738.18 |
| Max. Negotiated Rate |
$2,372.72 |
| Rate for Payer: Cash Price |
$1,070.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,054.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$949.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$949.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,001.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,054.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,001.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,054.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,054.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$790.90
|
| Rate for Payer: Healthfirst Commercial |
$1,054.54
|
| Rate for Payer: Healthfirst Essential Plan |
$2,372.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,001.81
|
| Rate for Payer: Healthfirst QHP |
$1,054.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$738.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,054.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$896.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$738.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,054.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$790.90
|
| Rate for Payer: SOMOS Essential |
$790.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,054.54
|
|
|
PR LAPS TOT HYSTERECTOMY RESJ MALIGNANCY W/OMNTC
|
Professional
|
Both
|
$8,387.44
|
|
|
Service Code
|
HCPCS 58575
|
| Min. Negotiated Rate |
$1,571.28 |
| Max. Negotiated Rate |
$5,050.55 |
| Rate for Payer: Cash Price |
$2,271.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,244.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,020.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,020.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,132.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,244.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,132.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,244.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,244.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,683.52
|
| Rate for Payer: Healthfirst Commercial |
$2,244.69
|
| Rate for Payer: Healthfirst Essential Plan |
$5,050.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,132.46
|
| Rate for Payer: Healthfirst QHP |
$2,244.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,571.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,244.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,907.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,571.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,244.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,683.52
|
| Rate for Payer: SOMOS Essential |
$1,683.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,244.69
|
|
|
PR LAPS TX ECTOPIC PREG W/O SALPING&/OOPHORECTOMY
|
Professional
|
Both
|
$3,682.11
|
|
|
Service Code
|
HCPCS 59150
|
| Min. Negotiated Rate |
$673.23 |
| Max. Negotiated Rate |
$2,163.94 |
| Rate for Payer: Cash Price |
$977.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$961.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$865.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$913.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$961.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$913.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$961.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$961.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$721.31
|
| Rate for Payer: Healthfirst Commercial |
$961.75
|
| Rate for Payer: Healthfirst Essential Plan |
$2,163.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$913.66
|
| Rate for Payer: Healthfirst QHP |
$961.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$673.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$961.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$817.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$673.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$961.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$721.31
|
| Rate for Payer: SOMOS Essential |
$721.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$961.75
|
|
|
PR LAPS TX ECTOPIC PREG W/SALPING&/OOPHORECTOMY
|
Professional
|
Both
|
$3,600.31
|
|
|
Service Code
|
HCPCS 59151
|
| Min. Negotiated Rate |
$658.14 |
| Max. Negotiated Rate |
$2,115.45 |
| Rate for Payer: Cash Price |
$956.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$940.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$846.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$846.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$893.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$940.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$893.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$940.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$940.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$705.15
|
| Rate for Payer: Healthfirst Commercial |
$940.20
|
| Rate for Payer: Healthfirst Essential Plan |
$2,115.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$893.19
|
| Rate for Payer: Healthfirst QHP |
$940.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$658.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$940.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$799.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$658.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$940.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$705.15
|
| Rate for Payer: SOMOS Essential |
$705.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$940.20
|
|
|
PR LAPS URTRONEOCSTOST W/CSTSC&URTRL STENT PLMT
|
Professional
|
Both
|
$5,768.88
|
|
|
Service Code
|
HCPCS 50947
|
| Min. Negotiated Rate |
$1,093.37 |
| Max. Negotiated Rate |
$3,514.41 |
| Rate for Payer: Cash Price |
$1,575.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,561.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,405.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,405.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,483.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,561.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,483.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,561.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,561.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,171.47
|
| Rate for Payer: Healthfirst Commercial |
$1,561.96
|
| Rate for Payer: Healthfirst Essential Plan |
$3,514.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,483.86
|
| Rate for Payer: Healthfirst QHP |
$1,561.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,093.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,561.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,327.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,093.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,561.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,171.47
|
| Rate for Payer: SOMOS Essential |
$1,171.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,561.96
|
|
|
PR LAPS URTRONEOCSTOST W/O CSTSC&URTRL STENT PLMT
|
Professional
|
Both
|
$5,312.27
|
|
|
Service Code
|
HCPCS 50948
|
| Min. Negotiated Rate |
$1,012.38 |
| Max. Negotiated Rate |
$3,254.09 |
| Rate for Payer: Cash Price |
$1,442.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,446.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,301.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,301.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,373.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,446.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,373.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,446.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,446.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,084.69
|
| Rate for Payer: Healthfirst Commercial |
$1,446.26
|
| Rate for Payer: Healthfirst Essential Plan |
$3,254.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,373.95
|
| Rate for Payer: Healthfirst QHP |
$1,446.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,012.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,446.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,229.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,012.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,446.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,084.69
|
| Rate for Payer: SOMOS Essential |
$1,084.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,446.26
|
|
|
PR LAPS VAGINAL HYSTERECT > 250 GM RMVL TUBE&/OVAR
|
Professional
|
Both
|
$5,672.45
|
|
|
Service Code
|
HCPCS 58554
|
| Min. Negotiated Rate |
$1,055.53 |
| Max. Negotiated Rate |
$3,392.78 |
| Rate for Payer: Cash Price |
$1,531.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,507.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,357.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,357.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,432.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,507.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,432.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,507.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,507.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,130.92
|
| Rate for Payer: Healthfirst Commercial |
$1,507.90
|
| Rate for Payer: Healthfirst Essential Plan |
$3,392.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,432.51
|
| Rate for Payer: Healthfirst QHP |
$1,507.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,055.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,507.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,281.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,055.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,507.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,130.92
|
| Rate for Payer: SOMOS Essential |
$1,130.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,507.90
|
|
|
PR LAPS VAGINAL HYSTERECTOMY UTERUS 250 GM/<
|
Professional
|
Both
|
$3,844.86
|
|
|
Service Code
|
HCPCS 58550
|
| Min. Negotiated Rate |
$716.84 |
| Max. Negotiated Rate |
$2,304.14 |
| Rate for Payer: Cash Price |
$1,037.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,024.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$921.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$921.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$972.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,024.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$972.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,024.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,024.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$768.04
|
| Rate for Payer: Healthfirst Commercial |
$1,024.06
|
| Rate for Payer: Healthfirst Essential Plan |
$2,304.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$972.86
|
| Rate for Payer: Healthfirst QHP |
$1,024.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$716.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,024.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$870.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$716.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,024.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$768.04
|
| Rate for Payer: SOMOS Essential |
$768.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,024.06
|
|
|
PR LAPS W/BI TOT PEL LMPHADEC & OMNTC LYMPH BX
|
Professional
|
Both
|
$5,093.38
|
|
|
Service Code
|
HCPCS 38573
|
| Min. Negotiated Rate |
$958.38 |
| Max. Negotiated Rate |
$3,080.52 |
| Rate for Payer: Cash Price |
$1,378.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,369.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,232.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,232.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,300.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,369.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,300.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,369.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,369.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,026.84
|
| Rate for Payer: Healthfirst Commercial |
$1,369.12
|
| Rate for Payer: Healthfirst Essential Plan |
$3,080.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,300.66
|
| Rate for Payer: Healthfirst QHP |
$1,369.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$958.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,369.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,163.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$958.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,369.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,026.84
|
| Rate for Payer: SOMOS Essential |
$1,026.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,369.12
|
|
|
PR LAPS W/INSERTION NTRSTL DEV W/IMG GUID 1/MLT
|
Professional
|
Both
|
$586.04
|
|
|
Service Code
|
HCPCS 49327
|
| Min. Negotiated Rate |
$108.24 |
| Max. Negotiated Rate |
$347.92 |
| Rate for Payer: Cash Price |
$155.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$154.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$139.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$139.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$146.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$154.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$146.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$115.97
|
| Rate for Payer: Healthfirst Commercial |
$154.63
|
| Rate for Payer: Healthfirst Essential Plan |
$347.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$146.90
|
| Rate for Payer: Healthfirst QHP |
$154.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$108.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$154.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$131.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$108.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$154.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$115.97
|
| Rate for Payer: SOMOS Essential |
$115.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$154.63
|
|
|
PR LAPS W/RAD HYST W/BILAT LMPHADEC RMVL TUBE/OVARY
|
Professional
|
Both
|
$8,171.70
|
|
|
Service Code
|
HCPCS 58548
|
| Min. Negotiated Rate |
$1,529.24 |
| Max. Negotiated Rate |
$4,915.42 |
| Rate for Payer: Cash Price |
$2,213.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,184.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,966.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,966.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,075.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,184.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,075.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,184.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,184.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,638.47
|
| Rate for Payer: Healthfirst Commercial |
$2,184.63
|
| Rate for Payer: Healthfirst Essential Plan |
$4,915.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,075.40
|
| Rate for Payer: Healthfirst QHP |
$2,184.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,529.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,184.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,856.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,529.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,184.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,638.47
|
| Rate for Payer: SOMOS Essential |
$1,638.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,184.63
|
|
|
PR LAPS W/REVISION INTRAPERITONEAL CATHETER
|
Professional
|
Both
|
$1,865.99
|
|
|
Service Code
|
HCPCS 49325
|
| Min. Negotiated Rate |
$344.96 |
| Max. Negotiated Rate |
$1,108.80 |
| Rate for Payer: Cash Price |
$497.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$492.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$443.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$443.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$468.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$492.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$468.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$492.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$492.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$369.60
|
| Rate for Payer: Healthfirst Commercial |
$492.80
|
| Rate for Payer: Healthfirst Essential Plan |
$1,108.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$468.16
|
| Rate for Payer: Healthfirst QHP |
$492.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$344.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$492.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$418.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$344.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$492.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$369.60
|
| Rate for Payer: SOMOS Essential |
$369.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$492.80
|
|
|
PR LAPS W/VAG HYSTERECT 250 GM/&RMVL TUBE&/OVARIES
|
Professional
|
Both
|
$4,278.58
|
|
|
Service Code
|
HCPCS 58552
|
| Min. Negotiated Rate |
$796.84 |
| Max. Negotiated Rate |
$2,561.26 |
| Rate for Payer: Cash Price |
$1,151.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,138.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,024.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,024.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,081.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,138.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,081.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,138.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,138.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$853.75
|
| Rate for Payer: Healthfirst Commercial |
$1,138.34
|
| Rate for Payer: Healthfirst Essential Plan |
$2,561.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,081.42
|
| Rate for Payer: Healthfirst QHP |
$1,138.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$796.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,138.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$967.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$796.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,138.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$853.75
|
| Rate for Payer: SOMOS Essential |
$853.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,138.34
|
|
|
PR LAPS W/VAGINAL HYSTERECTOMY > 250 GRAMS
|
Professional
|
Both
|
$4,882.96
|
|
|
Service Code
|
HCPCS 58553
|
| Min. Negotiated Rate |
$907.08 |
| Max. Negotiated Rate |
$2,915.62 |
| Rate for Payer: Cash Price |
$1,314.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,295.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,166.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,166.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,231.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,295.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,231.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,295.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,295.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$971.87
|
| Rate for Payer: Healthfirst Commercial |
$1,295.83
|
| Rate for Payer: Healthfirst Essential Plan |
$2,915.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,231.04
|
| Rate for Payer: Healthfirst QHP |
$1,295.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$907.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,295.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,101.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$907.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,295.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$971.87
|
| Rate for Payer: SOMOS Essential |
$971.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,295.83
|
|
|
PR LAPT RPR PARAESOPH HIATAL HERNIA W/MESH
|
Professional
|
Both
|
$5,659.57
|
|
|
Service Code
|
HCPCS 43333
|
| Min. Negotiated Rate |
$1,048.80 |
| Max. Negotiated Rate |
$3,371.15 |
| Rate for Payer: Cash Price |
$1,508.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,498.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,348.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,348.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,423.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,498.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,423.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,498.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,498.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,123.72
|
| Rate for Payer: Healthfirst Commercial |
$1,498.29
|
| Rate for Payer: Healthfirst Essential Plan |
$3,371.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,423.38
|
| Rate for Payer: Healthfirst QHP |
$1,498.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,048.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,498.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,273.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,048.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,498.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,123.72
|
| Rate for Payer: SOMOS Essential |
$1,123.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,498.29
|
|
|
PR LAPT STG/RESTG OVARIAN TUBAL/PRIM MAL 2ND LOOK
|
Professional
|
Both
|
$4,331.85
|
|
|
Service Code
|
HCPCS 58960
|
| Min. Negotiated Rate |
$813.60 |
| Max. Negotiated Rate |
$2,615.15 |
| Rate for Payer: Cash Price |
$1,175.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,162.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,046.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,046.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,104.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,162.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,104.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,162.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,162.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$871.72
|
| Rate for Payer: Healthfirst Commercial |
$1,162.29
|
| Rate for Payer: Healthfirst Essential Plan |
$2,615.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,104.18
|
| Rate for Payer: Healthfirst QHP |
$1,162.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$813.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,162.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$987.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$813.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,162.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$871.72
|
| Rate for Payer: SOMOS Essential |
$871.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,162.29
|
|
|
PR LAPT W/ASPIR &/NJX HEPATC PARASITIC CYST/ABSCESS
|
Professional
|
Both
|
$5,268.69
|
|
|
Service Code
|
HCPCS 47015
|
| Min. Negotiated Rate |
$976.18 |
| Max. Negotiated Rate |
$3,137.72 |
| Rate for Payer: Cash Price |
$1,403.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,394.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,255.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,255.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,324.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,394.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,324.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,394.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,394.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,045.90
|
| Rate for Payer: Healthfirst Commercial |
$1,394.54
|
| Rate for Payer: Healthfirst Essential Plan |
$3,137.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,324.81
|
| Rate for Payer: Healthfirst QHP |
$1,394.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$976.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,394.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,185.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$976.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,394.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,045.90
|
| Rate for Payer: SOMOS Essential |
$1,045.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,394.54
|
|
|
PR LARGSC ARYTENOIDECTOMY MICROSCOPE/TELESCOPE
|
Professional
|
Both
|
$1,454.32
|
|
|
Service Code
|
HCPCS 31561
|
| Min. Negotiated Rate |
$271.87 |
| Max. Negotiated Rate |
$873.86 |
| Rate for Payer: Cash Price |
$392.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$388.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$349.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$349.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$368.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$388.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$368.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$388.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$388.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$291.29
|
| Rate for Payer: Healthfirst Commercial |
$388.38
|
| Rate for Payer: Healthfirst Essential Plan |
$873.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$368.96
|
| Rate for Payer: Healthfirst QHP |
$388.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$271.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$388.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$330.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$271.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$388.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$291.29
|
| Rate for Payer: SOMOS Essential |
$291.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$388.38
|
|
|
PR LARGSC EXC TUM&/STRPG CORDS/EPIGL MCRSCP/TLSCP
|
Professional
|
Both
|
$1,124.90
|
|
|
Service Code
|
HCPCS 31541
|
| Min. Negotiated Rate |
$210.21 |
| Max. Negotiated Rate |
$675.67 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$300.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$270.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$270.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$285.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$300.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$285.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$300.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$225.22
|
| Rate for Payer: Healthfirst Commercial |
$300.30
|
| Rate for Payer: Healthfirst Essential Plan |
$675.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$285.29
|
| Rate for Payer: Healthfirst QHP |
$300.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$210.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$300.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$255.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$210.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$300.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$225.22
|
| Rate for Payer: SOMOS Essential |
$225.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$300.30
|
|
|
PR LARGSC MICRO/TELESCOPE RMVL LES VOCAL CORD FLAP
|
Professional
|
Both
|
$1,541.33
|
|
|
Service Code
|
HCPCS 31545
|
| Min. Negotiated Rate |
$288.13 |
| Max. Negotiated Rate |
$926.14 |
| Rate for Payer: Cash Price |
$416.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$411.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$370.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$370.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$391.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$411.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$391.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$411.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$411.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$308.71
|
| Rate for Payer: Healthfirst Commercial |
$411.62
|
| Rate for Payer: Healthfirst Essential Plan |
$926.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.04
|
| Rate for Payer: Healthfirst QHP |
$411.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$288.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$411.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$349.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$288.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$411.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$308.71
|
| Rate for Payer: SOMOS Essential |
$308.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$411.62
|
|
|
PR LARGSC MICRO/TELESCOPE RMVL LES VOCAL CORD GRAFT
|
Professional
|
Both
|
$2,332.40
|
|
|
Service Code
|
HCPCS 31546
|
| Min. Negotiated Rate |
$436.93 |
| Max. Negotiated Rate |
$1,404.43 |
| Rate for Payer: Cash Price |
$630.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$624.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$561.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$561.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$592.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$624.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$592.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$624.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$624.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$468.14
|
| Rate for Payer: Healthfirst Commercial |
$624.19
|
| Rate for Payer: Healthfirst Essential Plan |
$1,404.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$592.98
|
| Rate for Payer: Healthfirst QHP |
$624.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$436.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$624.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$530.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$436.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$624.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$468.14
|
| Rate for Payer: SOMOS Essential |
$468.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$624.19
|
|
