|
PR POST-D/C H VST EXT PT 75 M
|
Professional
|
Both
|
$846.62
|
|
|
Service Code
|
HCPCS G2013
|
| Min. Negotiated Rate |
$159.99 |
| Max. Negotiated Rate |
$514.24 |
| Rate for Payer: Cash Price |
$232.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$228.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$205.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$205.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$217.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$228.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$217.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$228.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$228.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$171.41
|
| Rate for Payer: Healthfirst Commercial |
$228.55
|
| Rate for Payer: Healthfirst Essential Plan |
$514.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$217.12
|
| Rate for Payer: Healthfirst QHP |
$228.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$159.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$228.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$194.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$159.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$228.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$171.41
|
| Rate for Payer: SOMOS Essential |
$171.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$228.55
|
|
|
PR POST D/C H VST NEW PT 20 M
|
Professional
|
Both
|
$194.95
|
|
|
Service Code
|
HCPCS G2001
|
| Min. Negotiated Rate |
$37.77 |
| Max. Negotiated Rate |
$121.41 |
| Rate for Payer: Cash Price |
$54.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.47
|
| Rate for Payer: Healthfirst Commercial |
$53.96
|
| Rate for Payer: Healthfirst Essential Plan |
$121.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.26
|
| Rate for Payer: Healthfirst QHP |
$53.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.47
|
| Rate for Payer: SOMOS Essential |
$40.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.96
|
|
|
PR POST-D/C H VST NEW PT 30 M
|
Professional
|
Both
|
$294.21
|
|
|
Service Code
|
HCPCS G2002
|
| Min. Negotiated Rate |
$56.53 |
| Max. Negotiated Rate |
$181.71 |
| Rate for Payer: Cash Price |
$81.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$80.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.57
|
| Rate for Payer: Healthfirst Commercial |
$80.76
|
| Rate for Payer: Healthfirst Essential Plan |
$181.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.72
|
| Rate for Payer: Healthfirst QHP |
$80.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.57
|
| Rate for Payer: SOMOS Essential |
$60.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.76
|
|
|
PR POST-D/C H VST NEW PT 45 M
|
Professional
|
Both
|
$486.26
|
|
|
Service Code
|
HCPCS G2003
|
| Min. Negotiated Rate |
$92.29 |
| Max. Negotiated Rate |
$296.64 |
| Rate for Payer: Cash Price |
$133.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$131.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$118.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$118.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$125.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$131.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$125.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$131.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$98.88
|
| Rate for Payer: Healthfirst Commercial |
$131.84
|
| Rate for Payer: Healthfirst Essential Plan |
$296.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.25
|
| Rate for Payer: Healthfirst QHP |
$131.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$131.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$112.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$92.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$131.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$98.88
|
| Rate for Payer: SOMOS Essential |
$98.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$131.84
|
|
|
PR POST-D/C H VST NEW PT 60 M
|
Professional
|
Both
|
$645.09
|
|
|
Service Code
|
HCPCS G2004
|
| Min. Negotiated Rate |
$121.04 |
| Max. Negotiated Rate |
$389.05 |
| Rate for Payer: Cash Price |
$175.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$172.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$155.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$155.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$164.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$172.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$172.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$172.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$129.68
|
| Rate for Payer: Healthfirst Commercial |
$172.91
|
| Rate for Payer: Healthfirst Essential Plan |
$389.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$164.26
|
| Rate for Payer: Healthfirst QHP |
$172.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$121.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$172.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$146.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$121.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$172.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$129.68
|
| Rate for Payer: SOMOS Essential |
$129.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$172.91
|
|
|
PR POST-D/C H VST NEW PT 75 M
|
Professional
|
Both
|
$846.62
|
|
|
Service Code
|
HCPCS G2005
|
| Min. Negotiated Rate |
$159.99 |
| Max. Negotiated Rate |
$514.24 |
| Rate for Payer: Cash Price |
$232.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$228.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$205.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$205.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$217.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$228.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$217.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$228.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$228.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$171.41
|
| Rate for Payer: Healthfirst Commercial |
$228.55
|
| Rate for Payer: Healthfirst Essential Plan |
$514.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$217.12
|
| Rate for Payer: Healthfirst QHP |
$228.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$159.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$228.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$194.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$159.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$228.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$171.41
|
| Rate for Payer: SOMOS Essential |
$171.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$228.55
|
|
|
PR POSTERIOR NON-SEGMENTAL INSTRUMENTATION
|
Professional
|
Both
|
$3,500.81
|
|
|
Service Code
|
HCPCS 22840
|
| Min. Negotiated Rate |
$637.41 |
| Max. Negotiated Rate |
$2,048.83 |
| Rate for Payer: Cash Price |
$922.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$910.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$819.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$819.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$865.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$910.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$865.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$910.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$910.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$682.94
|
| Rate for Payer: Healthfirst Commercial |
$910.59
|
| Rate for Payer: Healthfirst Essential Plan |
$2,048.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.06
|
| Rate for Payer: Healthfirst QHP |
$910.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$637.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$910.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$774.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$637.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$910.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$682.94
|
| Rate for Payer: SOMOS Essential |
$682.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$910.59
|
|
|
PR POSTERIOR SEGMENTAL INSTRUMENTATION 13/> VRT SE
|
Professional
|
Both
|
$4,504.15
|
|
|
Service Code
|
HCPCS 22844
|
| Min. Negotiated Rate |
$830.70 |
| Max. Negotiated Rate |
$2,670.12 |
| Rate for Payer: Cash Price |
$1,189.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,186.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,068.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,068.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,127.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,186.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,127.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,186.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,186.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$890.04
|
| Rate for Payer: Healthfirst Commercial |
$1,186.72
|
| Rate for Payer: Healthfirst Essential Plan |
$2,670.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,127.38
|
| Rate for Payer: Healthfirst QHP |
$1,186.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$830.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,186.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,008.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$830.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,186.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$890.04
|
| Rate for Payer: SOMOS Essential |
$890.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,186.72
|
|
|
PR POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG
|
Professional
|
Both
|
$3,540.11
|
|
|
Service Code
|
HCPCS 22842
|
| Min. Negotiated Rate |
$648.44 |
| Max. Negotiated Rate |
$2,084.26 |
| Rate for Payer: Cash Price |
$934.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$926.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$833.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$833.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$880.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$926.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$880.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$926.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$926.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$694.75
|
| Rate for Payer: Healthfirst Commercial |
$926.34
|
| Rate for Payer: Healthfirst Essential Plan |
$2,084.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$880.02
|
| Rate for Payer: Healthfirst QHP |
$926.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$648.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$926.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$787.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$648.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$926.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$694.75
|
| Rate for Payer: SOMOS Essential |
$694.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$926.34
|
|
|
PR POSTERIOR SEGMENTAL INSTRUMENTATION 7-12 VRT SEG
|
Professional
|
Both
|
$3,790.19
|
|
|
Service Code
|
HCPCS 22843
|
| Min. Negotiated Rate |
$695.30 |
| Max. Negotiated Rate |
$2,234.90 |
| Rate for Payer: Cash Price |
$1,000.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$993.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$893.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$893.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$943.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$993.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$943.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$993.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$993.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$744.97
|
| Rate for Payer: Healthfirst Commercial |
$993.29
|
| Rate for Payer: Healthfirst Essential Plan |
$2,234.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$943.63
|
| Rate for Payer: Healthfirst QHP |
$993.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$695.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$993.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$844.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$695.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$993.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$744.97
|
| Rate for Payer: SOMOS Essential |
$744.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$993.29
|
|
|
PR POSTPARTUM CARE ONLY SEPARATE PROCEDURE
|
Professional
|
Both
|
$829.40
|
|
|
Service Code
|
HCPCS 59430
|
| Min. Negotiated Rate |
$149.64 |
| Max. Negotiated Rate |
$480.98 |
| Rate for Payer: Cash Price |
$218.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$213.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$192.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$192.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$203.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$213.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$203.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$213.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$213.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$160.33
|
| Rate for Payer: Healthfirst Commercial |
$213.77
|
| Rate for Payer: Healthfirst Essential Plan |
$480.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$203.08
|
| Rate for Payer: Healthfirst QHP |
$213.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$149.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$213.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$181.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$149.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$213.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$160.33
|
| Rate for Payer: SOMOS Essential |
$160.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$213.77
|
|
|
PR POST TIB NEUROSTIMULATION PRQ NEEDLE ELECTRODE
|
Professional
|
Both
|
$127.23
|
|
|
Service Code
|
HCPCS 64566
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$75.47 |
| Rate for Payer: Cash Price |
$34.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.16
|
| Rate for Payer: Healthfirst Commercial |
$33.54
|
| Rate for Payer: Healthfirst Essential Plan |
$75.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.86
|
| Rate for Payer: Healthfirst QHP |
$33.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.16
|
| Rate for Payer: SOMOS Essential |
$25.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.54
|
|
|
PR PPPS, INITIAL VISIT
|
Professional
|
Both
|
$681.07
|
|
|
Service Code
|
HCPCS G0438
|
| Min. Negotiated Rate |
$129.40 |
| Max. Negotiated Rate |
$415.91 |
| Rate for Payer: Cash Price |
$187.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$166.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$166.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$184.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$138.64
|
| Rate for Payer: Healthfirst Commercial |
$184.85
|
| Rate for Payer: Healthfirst Essential Plan |
$415.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$175.61
|
| Rate for Payer: Healthfirst QHP |
$184.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$129.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$184.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$157.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$129.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.64
|
| Rate for Payer: SOMOS Essential |
$138.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.85
|
|
|
PR PPPS, SUBSEQ VISIT
|
Professional
|
Both
|
$532.07
|
|
|
Service Code
|
HCPCS G0439
|
| Min. Negotiated Rate |
$102.47 |
| Max. Negotiated Rate |
$329.36 |
| Rate for Payer: Cash Price |
$148.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$146.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$131.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$131.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$139.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$146.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$139.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$146.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$146.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$109.78
|
| Rate for Payer: Healthfirst Commercial |
$146.38
|
| Rate for Payer: Healthfirst Essential Plan |
$329.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$139.06
|
| Rate for Payer: Healthfirst QHP |
$146.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$102.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$146.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$124.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$102.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$146.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$109.78
|
| Rate for Payer: SOMOS Essential |
$109.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$146.38
|
|
|
PR PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE
|
Professional
|
Both
|
$397.49
|
|
|
Service Code
|
HCPCS 90732
|
| Min. Negotiated Rate |
$93.43 |
| Max. Negotiated Rate |
$300.31 |
| Rate for Payer: Cash Price |
$133.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$133.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$120.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$120.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$126.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$133.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$126.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$133.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$100.10
|
| Rate for Payer: Healthfirst Commercial |
$133.47
|
| Rate for Payer: Healthfirst Essential Plan |
$300.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$126.80
|
| Rate for Payer: Healthfirst QHP |
$133.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$93.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$133.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$113.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$93.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$133.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$100.10
|
| Rate for Payer: SOMOS Essential |
$100.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$133.47
|
|
|
PR PRCTECT CMBN ABDOMINOPRNL PULL-THRU PX
|
Professional
|
Both
|
$7,666.96
|
|
|
Service Code
|
HCPCS 45112
|
| Min. Negotiated Rate |
$1,439.14 |
| Max. Negotiated Rate |
$4,625.80 |
| Rate for Payer: Cash Price |
$2,073.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,055.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,850.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,850.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,953.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,055.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,953.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,055.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,055.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,541.93
|
| Rate for Payer: Healthfirst Commercial |
$2,055.91
|
| Rate for Payer: Healthfirst Essential Plan |
$4,625.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,953.11
|
| Rate for Payer: Healthfirst QHP |
$2,055.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,439.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,055.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,747.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,439.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,055.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,541.93
|
| Rate for Payer: SOMOS Essential |
$1,541.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,055.91
|
|
|
PR PRCTECT CMBN PULL-THRU W/RSVR W/NTRSTM
|
Professional
|
Both
|
$7,946.93
|
|
|
Service Code
|
HCPCS 45119
|
| Min. Negotiated Rate |
$1,488.42 |
| Max. Negotiated Rate |
$4,784.22 |
| Rate for Payer: Cash Price |
$2,148.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,126.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,913.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,913.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,020.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,126.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,020.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,126.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,126.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,594.74
|
| Rate for Payer: Healthfirst Commercial |
$2,126.32
|
| Rate for Payer: Healthfirst Essential Plan |
$4,784.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,020.00
|
| Rate for Payer: Healthfirst QHP |
$2,126.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,488.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,126.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,807.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,488.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,126.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,594.74
|
| Rate for Payer: SOMOS Essential |
$1,594.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,126.32
|
|
|
PR PRCTECT COMPL CMBN ABDOMINOPRNL W/CLST
|
Professional
|
Both
|
$7,913.12
|
|
|
Service Code
|
HCPCS 45110
|
| Min. Negotiated Rate |
$1,465.15 |
| Max. Negotiated Rate |
$4,709.41 |
| Rate for Payer: Cash Price |
$2,117.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,093.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,883.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,883.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,988.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,093.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,988.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,093.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,093.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,569.80
|
| Rate for Payer: Healthfirst Commercial |
$2,093.07
|
| Rate for Payer: Healthfirst Essential Plan |
$4,709.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,988.42
|
| Rate for Payer: Healthfirst QHP |
$2,093.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,465.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,093.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,779.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,465.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,093.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,569.80
|
| Rate for Payer: SOMOS Essential |
$1,569.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,093.07
|
|
|
PR PRCTECT COMPL W/PULL-THRU PX & ANASTOMOSIS
|
Professional
|
Both
|
$7,239.65
|
|
|
Service Code
|
HCPCS 45120
|
| Min. Negotiated Rate |
$1,339.03 |
| Max. Negotiated Rate |
$4,304.02 |
| Rate for Payer: Cash Price |
$1,927.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,912.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,721.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,721.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,817.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,912.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,817.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,912.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,912.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,434.67
|
| Rate for Payer: Healthfirst Commercial |
$1,912.90
|
| Rate for Payer: Healthfirst Essential Plan |
$4,304.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,817.26
|
| Rate for Payer: Healthfirst QHP |
$1,912.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,339.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,912.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,625.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,339.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,912.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,434.67
|
| Rate for Payer: SOMOS Essential |
$1,434.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,912.90
|
|
|
PR PRCTECT COMPL W/STOT/TOT COLCT W/MLT BXS
|
Professional
|
Both
|
$7,902.37
|
|
|
Service Code
|
HCPCS 45121
|
| Min. Negotiated Rate |
$1,459.82 |
| Max. Negotiated Rate |
$4,692.28 |
| Rate for Payer: Cash Price |
$2,104.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,085.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,876.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,876.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,981.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,085.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,981.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,085.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,085.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,564.10
|
| Rate for Payer: Healthfirst Commercial |
$2,085.46
|
| Rate for Payer: Healthfirst Essential Plan |
$4,692.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,981.19
|
| Rate for Payer: Healthfirst QHP |
$2,085.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,459.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,085.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,772.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,459.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,085.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,564.10
|
| Rate for Payer: SOMOS Essential |
$1,564.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,085.46
|
|
|
PR PRCTECT PRTL RESCJ RECTUM TABDL APPR
|
Professional
|
Both
|
$4,752.06
|
|
|
Service Code
|
HCPCS 45111
|
| Min. Negotiated Rate |
$887.28 |
| Max. Negotiated Rate |
$2,851.99 |
| Rate for Payer: Cash Price |
$1,283.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,267.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,140.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,140.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,204.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,267.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,204.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,267.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,267.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$950.66
|
| Rate for Payer: Healthfirst Commercial |
$1,267.55
|
| Rate for Payer: Healthfirst Essential Plan |
$2,851.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,204.17
|
| Rate for Payer: Healthfirst QHP |
$1,267.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$887.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,267.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,077.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$887.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,267.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$950.66
|
| Rate for Payer: SOMOS Essential |
$950.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,267.55
|
|
|
PR PRCTECT PRTL W/ANAST ABDL & TRANSSAC APPROACH
|
Professional
|
Both
|
$8,221.15
|
|
|
Service Code
|
HCPCS 45114
|
| Min. Negotiated Rate |
$1,518.24 |
| Max. Negotiated Rate |
$4,880.07 |
| Rate for Payer: Cash Price |
$2,186.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,168.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,952.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,952.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,060.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,168.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,060.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,168.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,168.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,626.69
|
| Rate for Payer: Healthfirst Commercial |
$2,168.92
|
| Rate for Payer: Healthfirst Essential Plan |
$4,880.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,060.47
|
| Rate for Payer: Healthfirst QHP |
$2,168.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,518.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,168.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,843.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,518.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,168.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,626.69
|
| Rate for Payer: SOMOS Essential |
$1,626.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,168.92
|
|
|
PR PRCTECT PRTL W/ANAST TRANSSAC APPR ONLY
|
Professional
|
Both
|
$6,531.81
|
|
|
Service Code
|
HCPCS 45116
|
| Min. Negotiated Rate |
$1,227.90 |
| Max. Negotiated Rate |
$3,946.84 |
| Rate for Payer: Cash Price |
$1,768.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,754.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,578.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,578.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,666.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,754.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,666.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,754.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,754.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,315.61
|
| Rate for Payer: Healthfirst Commercial |
$1,754.15
|
| Rate for Payer: Healthfirst Essential Plan |
$3,946.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,666.44
|
| Rate for Payer: Healthfirst QHP |
$1,754.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,227.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,754.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,491.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,227.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,754.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,315.61
|
| Rate for Payer: SOMOS Essential |
$1,315.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,754.15
|
|
|
PR PRCTECT PRTL W/MUCOSEC ILEOANAL ANAST RSVR
|
Professional
|
Both
|
$7,889.04
|
|
|
Service Code
|
HCPCS 45113
|
| Min. Negotiated Rate |
$1,478.58 |
| Max. Negotiated Rate |
$4,752.56 |
| Rate for Payer: Cash Price |
$2,132.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,112.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,901.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,901.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,006.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,112.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,006.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,112.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,112.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,584.19
|
| Rate for Payer: Healthfirst Commercial |
$2,112.25
|
| Rate for Payer: Healthfirst Essential Plan |
$4,752.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,006.64
|
| Rate for Payer: Healthfirst QHP |
$2,112.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,478.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,112.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,795.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,478.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,112.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,584.19
|
| Rate for Payer: SOMOS Essential |
$1,584.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,112.25
|
|
|
PR PRCTECT PRTL W/O ANAST PRNL APPR
|
Professional
|
Both
|
$4,854.57
|
|
|
Service Code
|
HCPCS 45123
|
| Min. Negotiated Rate |
$899.92 |
| Max. Negotiated Rate |
$2,892.60 |
| Rate for Payer: Cash Price |
$1,296.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,285.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,157.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,157.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,221.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,285.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,221.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,285.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,285.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$964.20
|
| Rate for Payer: Healthfirst Commercial |
$1,285.60
|
| Rate for Payer: Healthfirst Essential Plan |
$2,892.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,221.32
|
| Rate for Payer: Healthfirst QHP |
$1,285.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$899.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,285.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,092.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$899.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,285.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$964.20
|
| Rate for Payer: SOMOS Essential |
$964.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,285.60
|
|
