|
PR REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL
|
Professional
|
Both
|
$1,750.46
|
|
|
Service Code
|
HCPCS 37220
|
| Min. Negotiated Rate |
$320.79 |
| Max. Negotiated Rate |
$1,031.11 |
| Rate for Payer: Cash Price |
$462.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$458.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$412.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$412.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$435.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$458.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$435.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$458.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$458.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$343.70
|
| Rate for Payer: Healthfirst Commercial |
$458.27
|
| Rate for Payer: Healthfirst Essential Plan |
$1,031.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$435.36
|
| Rate for Payer: Healthfirst QHP |
$458.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$320.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$458.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$389.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$320.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$458.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$343.70
|
| Rate for Payer: SOMOS Essential |
$343.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$458.27
|
|
|
PR REVIS ELBOW ARTHRPLSTY HUMERAL&ULNA COMPNT
|
Professional
|
Both
|
$7,765.17
|
|
|
Service Code
|
HCPCS 24371
|
| Min. Negotiated Rate |
$1,454.03 |
| Max. Negotiated Rate |
$4,673.65 |
| Rate for Payer: Cash Price |
$2,090.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,077.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,869.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,869.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,973.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,077.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,973.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,077.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,077.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,557.88
|
| Rate for Payer: Healthfirst Commercial |
$2,077.18
|
| Rate for Payer: Healthfirst Essential Plan |
$4,673.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,973.32
|
| Rate for Payer: Healthfirst QHP |
$2,077.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,454.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,077.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,765.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,454.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,077.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,557.88
|
| Rate for Payer: SOMOS Essential |
$1,557.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,077.18
|
|
|
PR REVIS ELBOW ARTHRPLSTY HUMERAL/ULNA COMPNT
|
Professional
|
Both
|
$6,759.59
|
|
|
Service Code
|
HCPCS 24370
|
| Min. Negotiated Rate |
$1,266.95 |
| Max. Negotiated Rate |
$4,072.34 |
| Rate for Payer: Cash Price |
$1,817.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,809.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,628.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,628.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,719.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,809.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,719.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,809.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,809.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,357.45
|
| Rate for Payer: Healthfirst Commercial |
$1,809.93
|
| Rate for Payer: Healthfirst Essential Plan |
$4,072.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,719.43
|
| Rate for Payer: Healthfirst QHP |
$1,809.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,266.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,809.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,538.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,266.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,809.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,357.45
|
| Rate for Payer: SOMOS Essential |
$1,357.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,809.93
|
|
|
PR REVISION FEMORAL ANAST OPEN W/AUTOG GRAFT
|
Professional
|
Both
|
$5,514.22
|
|
|
Service Code
|
HCPCS 35884
|
| Min. Negotiated Rate |
$1,010.15 |
| Max. Negotiated Rate |
$3,246.91 |
| Rate for Payer: Cash Price |
$1,459.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,443.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,298.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,298.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,370.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,443.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,370.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,443.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,443.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,082.30
|
| Rate for Payer: Healthfirst Commercial |
$1,443.07
|
| Rate for Payer: Healthfirst Essential Plan |
$3,246.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,370.92
|
| Rate for Payer: Healthfirst QHP |
$1,443.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,010.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,443.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,226.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,010.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,443.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,082.30
|
| Rate for Payer: SOMOS Essential |
$1,082.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,443.07
|
|
|
PR REVISION OF RECONSTRUCTED BREAST
|
Professional
|
Both
|
$3,534.27
|
|
|
Service Code
|
HCPCS 19380
|
| Min. Negotiated Rate |
$666.23 |
| Max. Negotiated Rate |
$2,141.46 |
| Rate for Payer: Cash Price |
$954.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$951.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$856.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$856.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$904.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$951.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$904.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$951.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$951.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$713.82
|
| Rate for Payer: Healthfirst Commercial |
$951.76
|
| Rate for Payer: Healthfirst Essential Plan |
$2,141.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$904.17
|
| Rate for Payer: Healthfirst QHP |
$951.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$666.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$951.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$809.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$666.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$951.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$713.82
|
| Rate for Payer: SOMOS Essential |
$713.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$951.76
|
|
|
PR REVISION OPEN GASTRIC RESTRICTIVE PX NOT DEVICE
|
Professional
|
Both
|
$8,720.32
|
|
|
Service Code
|
HCPCS 43848
|
| Min. Negotiated Rate |
$1,612.42 |
| Max. Negotiated Rate |
$5,182.78 |
| Rate for Payer: Cash Price |
$2,331.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,303.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,073.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,073.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,188.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,303.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,188.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,303.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,303.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,727.60
|
| Rate for Payer: Healthfirst Commercial |
$2,303.46
|
| Rate for Payer: Healthfirst Essential Plan |
$5,182.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,188.29
|
| Rate for Payer: Healthfirst QHP |
$2,303.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,612.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,303.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,957.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,612.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,303.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,727.60
|
| Rate for Payer: SOMOS Essential |
$1,727.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,303.46
|
|
|
PR REVISION PERI-IMPLANT CAPSULE BREAST
|
Professional
|
Both
|
$2,939.48
|
|
|
Service Code
|
HCPCS 19370
|
| Min. Negotiated Rate |
$554.99 |
| Max. Negotiated Rate |
$1,783.89 |
| Rate for Payer: Cash Price |
$794.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$792.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$713.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$713.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$753.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$792.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$753.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$792.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$792.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$594.63
|
| Rate for Payer: Healthfirst Commercial |
$792.84
|
| Rate for Payer: Healthfirst Essential Plan |
$1,783.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$753.20
|
| Rate for Payer: Healthfirst QHP |
$792.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$554.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$792.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$673.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$554.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$792.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$594.63
|
| Rate for Payer: SOMOS Essential |
$594.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$792.84
|
|
|
PR REVISION PRIOR HYPOSPADIAS REPAIR DSJ&EXC RCNSTJ
|
Professional
|
Both
|
$5,894.67
|
|
|
Service Code
|
HCPCS 54352
|
| Min. Negotiated Rate |
$1,118.38 |
| Max. Negotiated Rate |
$3,594.80 |
| Rate for Payer: Cash Price |
$1,609.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,597.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,437.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,437.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,517.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,597.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,517.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,597.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,597.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,198.27
|
| Rate for Payer: Healthfirst Commercial |
$1,597.69
|
| Rate for Payer: Healthfirst Essential Plan |
$3,594.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,517.81
|
| Rate for Payer: Healthfirst QHP |
$1,597.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,118.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,597.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,358.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,118.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,597.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,198.27
|
| Rate for Payer: SOMOS Essential |
$1,198.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,597.69
|
|
|
PR REVISION PROSTHETIC VAGINAL GRAFT LAPAROSCOPIC
|
Professional
|
Both
|
$3,766.49
|
|
|
Service Code
|
HCPCS 57426
|
| Min. Negotiated Rate |
$706.68 |
| Max. Negotiated Rate |
$2,271.47 |
| Rate for Payer: Cash Price |
$1,023.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,009.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$908.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$908.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$959.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,009.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$959.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,009.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,009.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$757.15
|
| Rate for Payer: Healthfirst Commercial |
$1,009.54
|
| Rate for Payer: Healthfirst Essential Plan |
$2,271.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$959.06
|
| Rate for Payer: Healthfirst QHP |
$1,009.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$706.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,009.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$858.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$706.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,009.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$757.15
|
| Rate for Payer: SOMOS Essential |
$757.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,009.54
|
|
|
PR REVISION/REPLMT NEUROSTIMLATOR ELTRD CRANIAL NRV
|
Professional
|
Both
|
$3,580.40
|
|
|
Service Code
|
HCPCS 64569
|
| Min. Negotiated Rate |
$669.73 |
| Max. Negotiated Rate |
$2,152.69 |
| Rate for Payer: Cash Price |
$962.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$956.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$861.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$861.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$908.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$956.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$908.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$956.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$956.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$717.56
|
| Rate for Payer: Healthfirst Commercial |
$956.75
|
| Rate for Payer: Healthfirst Essential Plan |
$2,152.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$908.91
|
| Rate for Payer: Healthfirst QHP |
$956.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$669.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$956.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$813.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$669.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$956.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$717.56
|
| Rate for Payer: SOMOS Essential |
$717.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$956.75
|
|
|
PR REVISION STAPEDECTOMY/STAPEDOTOMY
|
Professional
|
Both
|
$5,024.04
|
|
|
Service Code
|
HCPCS 69662
|
| Min. Negotiated Rate |
$926.05 |
| Max. Negotiated Rate |
$2,976.59 |
| Rate for Payer: Cash Price |
$1,356.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,322.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,190.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,190.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,256.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,322.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,256.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,322.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,322.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$992.20
|
| Rate for Payer: Healthfirst Commercial |
$1,322.93
|
| Rate for Payer: Healthfirst Essential Plan |
$2,976.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,256.78
|
| Rate for Payer: Healthfirst QHP |
$1,322.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$926.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,322.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,124.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$926.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,322.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$992.20
|
| Rate for Payer: SOMOS Essential |
$992.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,322.93
|
|
|
PR REVISION TRACHEOSTOMY SCAR
|
Professional
|
Both
|
$1,594.43
|
|
|
Service Code
|
HCPCS 31830
|
| Min. Negotiated Rate |
$298.91 |
| Max. Negotiated Rate |
$960.79 |
| Rate for Payer: Cash Price |
$433.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$427.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$384.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$384.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$405.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$427.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$405.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$427.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$427.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$320.26
|
| Rate for Payer: Healthfirst Commercial |
$427.02
|
| Rate for Payer: Healthfirst Essential Plan |
$960.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$405.67
|
| Rate for Payer: Healthfirst QHP |
$427.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$298.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$427.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$362.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$298.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$427.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$320.26
|
| Rate for Payer: SOMOS Essential |
$320.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$427.02
|
|
|
PR REVIS PERITONEAL-VENOUS SHUNT
|
Professional
|
Both
|
$3,038.46
|
|
|
Service Code
|
HCPCS 49426
|
| Min. Negotiated Rate |
$563.77 |
| Max. Negotiated Rate |
$1,812.13 |
| Rate for Payer: Cash Price |
$811.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$805.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$724.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$724.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$765.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$805.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$765.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$805.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$805.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$604.04
|
| Rate for Payer: Healthfirst Commercial |
$805.39
|
| Rate for Payer: Healthfirst Essential Plan |
$1,812.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$765.12
|
| Rate for Payer: Healthfirst QHP |
$805.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$563.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$805.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$684.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$563.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$805.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$604.04
|
| Rate for Payer: SOMOS Essential |
$604.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$805.39
|
|
|
PR REVIS SHOULDER ARTHRPLSTY HUMERAL&GLENOID COMPNT
|
Professional
|
Both
|
$7,640.15
|
|
|
Service Code
|
HCPCS 23474
|
| Min. Negotiated Rate |
$1,428.14 |
| Max. Negotiated Rate |
$4,590.45 |
| Rate for Payer: Cash Price |
$2,052.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,040.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,836.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,836.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,938.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,040.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,938.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,040.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,040.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,530.15
|
| Rate for Payer: Healthfirst Commercial |
$2,040.20
|
| Rate for Payer: Healthfirst Essential Plan |
$4,590.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,938.19
|
| Rate for Payer: Healthfirst QHP |
$2,040.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,428.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,040.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,734.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,428.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,040.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,530.15
|
| Rate for Payer: SOMOS Essential |
$1,530.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,040.20
|
|
|
PR REVIS SHOULDER ARTHRPLSTY HUMERAL/GLENOID COMPNT
|
Professional
|
Both
|
$7,073.47
|
|
|
Service Code
|
HCPCS 23473
|
| Min. Negotiated Rate |
$1,323.04 |
| Max. Negotiated Rate |
$4,252.64 |
| Rate for Payer: Cash Price |
$1,901.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,890.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,701.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,701.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,795.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,890.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,795.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,890.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,890.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,417.55
|
| Rate for Payer: Healthfirst Commercial |
$1,890.06
|
| Rate for Payer: Healthfirst Essential Plan |
$4,252.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,795.56
|
| Rate for Payer: Healthfirst QHP |
$1,890.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,323.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,890.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,606.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,323.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,890.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,417.55
|
| Rate for Payer: SOMOS Essential |
$1,417.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,890.06
|
|
|
PR REVJ AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/GRAFT
|
Professional
|
Both
|
$3,511.66
|
|
|
Service Code
|
HCPCS 66185
|
| Min. Negotiated Rate |
$666.66 |
| Max. Negotiated Rate |
$2,142.83 |
| Rate for Payer: Cash Price |
$967.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$952.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$857.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$857.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$904.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$952.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$904.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$952.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$952.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$714.28
|
| Rate for Payer: Healthfirst Commercial |
$952.37
|
| Rate for Payer: Healthfirst Essential Plan |
$2,142.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$904.75
|
| Rate for Payer: Healthfirst QHP |
$952.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$666.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$952.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$809.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$666.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$952.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$714.28
|
| Rate for Payer: SOMOS Essential |
$714.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$952.37
|
|
|
PR REVJ ARTHRP W/REMOVAL IMPLANT WRIST JOINT
|
Professional
|
Both
|
$4,547.76
|
|
|
Service Code
|
HCPCS 25449
|
| Min. Negotiated Rate |
$856.16 |
| Max. Negotiated Rate |
$2,751.95 |
| Rate for Payer: Cash Price |
$1,226.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,223.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,100.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,100.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,161.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,223.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,161.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,223.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,223.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$917.32
|
| Rate for Payer: Healthfirst Commercial |
$1,223.09
|
| Rate for Payer: Healthfirst Essential Plan |
$2,751.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,161.94
|
| Rate for Payer: Healthfirst QHP |
$1,223.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$856.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,223.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,039.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$856.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,223.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$917.32
|
| Rate for Payer: SOMOS Essential |
$917.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,223.09
|
|
|
PR REVJ COLOSTOMY COMP RCNSTJ IN-DEPTH SPX
|
Professional
|
Both
|
$4,658.96
|
|
|
Service Code
|
HCPCS 44345
|
| Min. Negotiated Rate |
$867.11 |
| Max. Negotiated Rate |
$2,787.14 |
| Rate for Payer: Cash Price |
$1,246.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,238.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,114.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,114.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,176.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,238.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,176.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,238.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,238.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$929.05
|
| Rate for Payer: Healthfirst Commercial |
$1,238.73
|
| Rate for Payer: Healthfirst Essential Plan |
$2,787.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,176.79
|
| Rate for Payer: Healthfirst QHP |
$1,238.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$867.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,238.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,052.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$867.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,238.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$929.05
|
| Rate for Payer: SOMOS Essential |
$929.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,238.73
|
|
|
PR REVJ COLOSTOMY SMPL RLS SUPFC SCAR SPX
|
Professional
|
Both
|
$2,791.71
|
|
|
Service Code
|
HCPCS 44340
|
| Min. Negotiated Rate |
$520.19 |
| Max. Negotiated Rate |
$1,672.04 |
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$743.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$668.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$668.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$705.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$743.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$705.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$743.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$743.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$557.35
|
| Rate for Payer: Healthfirst Commercial |
$743.13
|
| Rate for Payer: Healthfirst Essential Plan |
$1,672.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$705.97
|
| Rate for Payer: Healthfirst QHP |
$743.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$520.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$743.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$631.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$520.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$743.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$557.35
|
| Rate for Payer: SOMOS Essential |
$557.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$743.13
|
|
|
PR REVJ COLOSTOMY W/RPR PARACLST HERNIA SPX
|
Professional
|
Both
|
$5,243.70
|
|
|
Service Code
|
HCPCS 44346
|
| Min. Negotiated Rate |
$976.30 |
| Max. Negotiated Rate |
$3,138.10 |
| Rate for Payer: Cash Price |
$1,404.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,394.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,255.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,255.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,324.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,394.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,324.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,394.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,394.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,046.03
|
| Rate for Payer: Healthfirst Commercial |
$1,394.71
|
| Rate for Payer: Healthfirst Essential Plan |
$3,138.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,324.97
|
| Rate for Payer: Healthfirst QHP |
$1,394.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$976.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,394.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,185.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$976.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,394.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,046.03
|
| Rate for Payer: SOMOS Essential |
$1,046.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,394.71
|
|
|
PR REVJ FEM ANAST BPG GRN OPN W/NONAUTOG PATCH GRF
|
Professional
|
Both
|
$5,321.58
|
|
|
Service Code
|
HCPCS 35883
|
| Min. Negotiated Rate |
$971.77 |
| Max. Negotiated Rate |
$3,123.54 |
| Rate for Payer: Cash Price |
$1,406.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,388.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,249.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,249.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,318.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,388.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,318.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,388.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,388.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,041.18
|
| Rate for Payer: Healthfirst Commercial |
$1,388.24
|
| Rate for Payer: Healthfirst Essential Plan |
$3,123.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,318.83
|
| Rate for Payer: Healthfirst QHP |
$1,388.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$971.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,388.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,180.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$971.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,388.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,041.18
|
| Rate for Payer: SOMOS Essential |
$1,041.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,388.24
|
|
|
PR REVJ GSTR/JJ ANAST W/RCNSTJ W/O VGTMY
|
Professional
|
Both
|
$7,373.14
|
|
|
Service Code
|
HCPCS 43860
|
| Min. Negotiated Rate |
$1,364.88 |
| Max. Negotiated Rate |
$4,387.12 |
| Rate for Payer: Cash Price |
$1,962.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,949.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,754.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,754.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,852.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,949.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,852.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,949.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,949.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,462.37
|
| Rate for Payer: Healthfirst Commercial |
$1,949.83
|
| Rate for Payer: Healthfirst Essential Plan |
$4,387.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,852.34
|
| Rate for Payer: Healthfirst QHP |
$1,949.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,364.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,949.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,657.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,364.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,949.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,462.37
|
| Rate for Payer: SOMOS Essential |
$1,462.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,949.83
|
|
|
PR REVJ GSTR/JJ ANAST W/RCNSTJ W/VGTMY
|
Professional
|
Both
|
$7,737.77
|
|
|
Service Code
|
HCPCS 43865
|
| Min. Negotiated Rate |
$1,428.50 |
| Max. Negotiated Rate |
$4,591.62 |
| Rate for Payer: Cash Price |
$2,059.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,040.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,836.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,836.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,938.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,040.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,938.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,040.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,040.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,530.54
|
| Rate for Payer: Healthfirst Commercial |
$2,040.72
|
| Rate for Payer: Healthfirst Essential Plan |
$4,591.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,938.68
|
| Rate for Payer: Healthfirst QHP |
$2,040.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,428.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,040.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,734.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,428.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,040.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,530.54
|
| Rate for Payer: SOMOS Essential |
$1,530.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,040.72
|
|
|
PR REVJ ILEOSTOMY COMPLIC RCNSTJ IN-DEPTH SPX
|
Professional
|
Both
|
$4,415.95
|
|
|
Service Code
|
HCPCS 44314
|
| Min. Negotiated Rate |
$820.74 |
| Max. Negotiated Rate |
$2,638.10 |
| Rate for Payer: Cash Price |
$1,184.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,172.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,055.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,055.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,113.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,172.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,113.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,172.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,172.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$879.37
|
| Rate for Payer: Healthfirst Commercial |
$1,172.49
|
| Rate for Payer: Healthfirst Essential Plan |
$2,638.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,113.87
|
| Rate for Payer: Healthfirst QHP |
$1,172.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$820.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,172.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$996.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$820.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,172.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$879.37
|
| Rate for Payer: SOMOS Essential |
$879.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,172.49
|
|
|
PR REVJ ILEOSTOMY SIMPLE RLS SUPERFICIAL SCAR SPX
|
Professional
|
Both
|
$2,633.75
|
|
|
Service Code
|
HCPCS 44312
|
| Min. Negotiated Rate |
$492.68 |
| Max. Negotiated Rate |
$1,583.62 |
| Rate for Payer: Cash Price |
$709.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$703.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$633.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$633.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$668.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$703.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$668.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$703.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$703.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$527.87
|
| Rate for Payer: Healthfirst Commercial |
$703.83
|
| Rate for Payer: Healthfirst Essential Plan |
$1,583.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$668.64
|
| Rate for Payer: Healthfirst QHP |
$703.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$492.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$703.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$598.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$492.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$703.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$527.87
|
| Rate for Payer: SOMOS Essential |
$527.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$703.83
|
|
