|
PR RPR 1ST INGUN HRNA FULL TERM INFT <6 MO RDC
|
Professional
|
Both
|
$1,856.02
|
|
|
Service Code
|
HCPCS 49495
|
| Min. Negotiated Rate |
$345.58 |
| Max. Negotiated Rate |
$1,110.78 |
| Rate for Payer: Cash Price |
$496.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$493.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$444.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$444.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$469.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$493.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$469.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$493.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$493.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$370.26
|
| Rate for Payer: Healthfirst Commercial |
$493.68
|
| Rate for Payer: Healthfirst Essential Plan |
$1,110.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$469.00
|
| Rate for Payer: Healthfirst QHP |
$493.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$345.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$493.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$419.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$345.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$493.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$370.26
|
| Rate for Payer: SOMOS Essential |
$370.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$493.68
|
|
|
PR RPR 1ST INGUN HRNA PRETERM INFT INCARCERATED
|
Professional
|
Both
|
$4,349.91
|
|
|
Service Code
|
HCPCS 49492
|
| Min. Negotiated Rate |
$806.35 |
| Max. Negotiated Rate |
$2,591.84 |
| Rate for Payer: Cash Price |
$1,160.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,151.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,036.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,036.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,094.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,151.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,094.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,151.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,151.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$863.95
|
| Rate for Payer: Healthfirst Commercial |
$1,151.93
|
| Rate for Payer: Healthfirst Essential Plan |
$2,591.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,094.33
|
| Rate for Payer: Healthfirst QHP |
$1,151.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$806.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,151.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$979.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$806.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,151.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$863.95
|
| Rate for Payer: SOMOS Essential |
$863.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,151.93
|
|
|
PR RPR 1ST INGUN HRNA PRETERM INFT RDC
|
Professional
|
Both
|
$3,621.49
|
|
|
Service Code
|
HCPCS 49491
|
| Min. Negotiated Rate |
$671.52 |
| Max. Negotiated Rate |
$2,158.45 |
| Rate for Payer: Cash Price |
$966.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$959.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$863.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$863.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$911.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$959.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$911.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$959.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$959.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$719.48
|
| Rate for Payer: Healthfirst Commercial |
$959.31
|
| Rate for Payer: Healthfirst Essential Plan |
$2,158.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$911.34
|
| Rate for Payer: Healthfirst QHP |
$959.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$671.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$959.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$815.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$671.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$959.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$719.48
|
| Rate for Payer: SOMOS Essential |
$719.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$959.31
|
|
|
PR RPR 1 TORN LIGM&/CAPSL KNE COLTRL&CRUCIATE
|
Professional
|
Both
|
$4,283.58
|
|
|
Service Code
|
HCPCS 27409
|
| Min. Negotiated Rate |
$805.10 |
| Max. Negotiated Rate |
$2,587.82 |
| Rate for Payer: Cash Price |
$1,155.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,150.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,035.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,035.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,092.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,150.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,092.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,150.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,150.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$862.61
|
| Rate for Payer: Healthfirst Commercial |
$1,150.14
|
| Rate for Payer: Healthfirst Essential Plan |
$2,587.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,092.63
|
| Rate for Payer: Healthfirst QHP |
$1,150.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$805.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,150.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$977.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$805.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,150.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$862.61
|
| Rate for Payer: SOMOS Essential |
$862.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,150.14
|
|
|
PR RPR 1 TRANSVNS ELTRD PRM PM/PACING IMPLNTBL DFB
|
Professional
|
Both
|
$1,721.72
|
|
|
Service Code
|
HCPCS 33218
|
| Min. Negotiated Rate |
$316.97 |
| Max. Negotiated Rate |
$1,018.82 |
| Rate for Payer: Cash Price |
$457.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$452.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$407.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$407.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$430.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$452.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$430.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$452.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$452.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$339.61
|
| Rate for Payer: Healthfirst Commercial |
$452.81
|
| Rate for Payer: Healthfirst Essential Plan |
$1,018.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$430.17
|
| Rate for Payer: Healthfirst QHP |
$452.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$316.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$452.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$384.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$316.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$452.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$339.61
|
| Rate for Payer: SOMOS Essential |
$339.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$452.81
|
|
|
PR RPR 1 VNTRC W/O/F OBSTRCJ&AORTIC ARCH HYPOPLAS
|
Professional
|
Both
|
$12,217.38
|
|
|
Service Code
|
HCPCS 33619
|
| Min. Negotiated Rate |
$2,249.14 |
| Max. Negotiated Rate |
$7,229.39 |
| Rate for Payer: Cash Price |
$3,249.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,213.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,891.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,891.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,052.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,213.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,052.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,213.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,213.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,409.80
|
| Rate for Payer: Healthfirst Commercial |
$3,213.06
|
| Rate for Payer: Healthfirst Essential Plan |
$7,229.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,052.41
|
| Rate for Payer: Healthfirst QHP |
$3,213.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,249.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,213.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,731.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,249.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,213.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,409.80
|
| Rate for Payer: SOMOS Essential |
$2,409.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,213.06
|
|
|
PR RPR 2 OUTLET R VNTRC RPR R VENTR O/F TRC OBSTRCJ
|
Professional
|
Both
|
$8,904.35
|
|
|
Service Code
|
HCPCS 33612
|
| Min. Negotiated Rate |
$1,637.13 |
| Max. Negotiated Rate |
$5,262.21 |
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,338.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,104.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,104.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,221.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,338.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,221.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,338.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,338.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,754.07
|
| Rate for Payer: Healthfirst Commercial |
$2,338.76
|
| Rate for Payer: Healthfirst Essential Plan |
$5,262.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,221.82
|
| Rate for Payer: Healthfirst QHP |
$2,338.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,637.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,338.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,987.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,637.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,338.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,754.07
|
| Rate for Payer: SOMOS Essential |
$1,754.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,338.76
|
|
|
PR RPR 2 OUTLET R VNTRC W/INTRAVENTR TUNNEL RPR
|
Professional
|
Both
|
$8,673.18
|
|
|
Service Code
|
HCPCS 33611
|
| Min. Negotiated Rate |
$1,594.59 |
| Max. Negotiated Rate |
$5,125.48 |
| Rate for Payer: Cash Price |
$2,303.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,277.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,050.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,050.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,164.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,277.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,164.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,277.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,277.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,708.49
|
| Rate for Payer: Healthfirst Commercial |
$2,277.99
|
| Rate for Payer: Healthfirst Essential Plan |
$5,125.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,164.09
|
| Rate for Payer: Healthfirst QHP |
$2,277.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,594.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,277.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,936.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,594.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,277.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,708.49
|
| Rate for Payer: SOMOS Essential |
$1,708.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,277.99
|
|
|
PR RPR 2 TRANSVNS ELECTRODES PRM PM/IMPLANTABLE DFB
|
Professional
|
Both
|
$1,663.62
|
|
|
Service Code
|
HCPCS 33220
|
| Min. Negotiated Rate |
$311.16 |
| Max. Negotiated Rate |
$1,000.17 |
| Rate for Payer: Cash Price |
$448.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$444.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$400.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$400.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$422.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$444.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$422.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$444.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$444.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$333.39
|
| Rate for Payer: Healthfirst Commercial |
$444.52
|
| Rate for Payer: Healthfirst Essential Plan |
$1,000.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$422.29
|
| Rate for Payer: Healthfirst QHP |
$444.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$311.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$444.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$377.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$311.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$444.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$333.39
|
| Rate for Payer: SOMOS Essential |
$333.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$444.52
|
|
|
PR RPR AA HERNIA 1ST > 10 CM NCRC8/STRANGULATED
|
Professional
|
Both
|
$4,611.67
|
|
|
Service Code
|
HCPCS 49596
|
| Min. Negotiated Rate |
$856.19 |
| Max. Negotiated Rate |
$2,752.04 |
| Rate for Payer: Cash Price |
$1,225.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,223.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,100.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,100.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,161.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,223.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,161.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,223.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,223.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$917.35
|
| Rate for Payer: Healthfirst Commercial |
$1,223.13
|
| Rate for Payer: Healthfirst Essential Plan |
$2,752.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,161.97
|
| Rate for Payer: Healthfirst QHP |
$1,223.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$856.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,223.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,039.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$856.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,223.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$917.35
|
| Rate for Payer: SOMOS Essential |
$917.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,223.13
|
|
|
PR RPR AA HERNIA 1ST > 10 CM REDUCIBLE
|
Professional
|
Both
|
$3,476.48
|
|
|
Service Code
|
HCPCS 49595
|
| Min. Negotiated Rate |
$644.45 |
| Max. Negotiated Rate |
$2,071.44 |
| Rate for Payer: Cash Price |
$925.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$920.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$828.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$828.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$874.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$920.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$874.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$920.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$920.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$690.48
|
| Rate for Payer: Healthfirst Commercial |
$920.64
|
| Rate for Payer: Healthfirst Essential Plan |
$2,071.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$874.61
|
| Rate for Payer: Healthfirst QHP |
$920.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$644.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$920.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$782.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$644.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$920.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$690.48
|
| Rate for Payer: SOMOS Essential |
$690.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$920.64
|
|
|
PR RPR AA HERNIA 1ST 3-10 CM NCRC8/STRANGULATED
|
Professional
|
Both
|
$3,376.66
|
|
|
Service Code
|
HCPCS 49594
|
| Min. Negotiated Rate |
$622.66 |
| Max. Negotiated Rate |
$2,001.42 |
| Rate for Payer: Cash Price |
$896.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$889.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$800.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$800.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$845.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$889.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$845.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$889.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$889.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$667.14
|
| Rate for Payer: Healthfirst Commercial |
$889.52
|
| Rate for Payer: Healthfirst Essential Plan |
$2,001.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$845.04
|
| Rate for Payer: Healthfirst QHP |
$889.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$622.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$889.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$756.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$622.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$889.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$667.14
|
| Rate for Payer: SOMOS Essential |
$667.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$889.52
|
|
|
PR RPR AA HERNIA 1ST 3-10 CM REDUCIBLE
|
Professional
|
Both
|
$2,588.92
|
|
|
Service Code
|
HCPCS 49593
|
| Min. Negotiated Rate |
$478.39 |
| Max. Negotiated Rate |
$1,537.69 |
| Rate for Payer: Cash Price |
$688.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$683.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$615.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$615.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$649.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$683.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$649.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$683.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$683.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$512.57
|
| Rate for Payer: Healthfirst Commercial |
$683.42
|
| Rate for Payer: Healthfirst Essential Plan |
$1,537.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$649.25
|
| Rate for Payer: Healthfirst QHP |
$683.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$478.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$683.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$580.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$478.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$683.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$512.57
|
| Rate for Payer: SOMOS Essential |
$512.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$683.42
|
|
|
PR RPR AA HERNIA 1ST < 3 CM NCRC8/STRANGULATED
|
Professional
|
Both
|
$2,153.41
|
|
|
Service Code
|
HCPCS 49592
|
| Min. Negotiated Rate |
$398.06 |
| Max. Negotiated Rate |
$1,279.48 |
| Rate for Payer: Cash Price |
$571.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$568.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$511.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$511.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$540.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$568.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$540.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$568.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$568.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$426.50
|
| Rate for Payer: Healthfirst Commercial |
$568.66
|
| Rate for Payer: Healthfirst Essential Plan |
$1,279.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$540.23
|
| Rate for Payer: Healthfirst QHP |
$568.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$398.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$568.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$483.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$398.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$568.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$426.50
|
| Rate for Payer: SOMOS Essential |
$426.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$568.66
|
|
|
PR RPR AA HERNIA 1ST < 3 CM REDUCIBLE
|
Professional
|
Both
|
$1,544.27
|
|
|
Service Code
|
HCPCS 49591
|
| Min. Negotiated Rate |
$285.58 |
| Max. Negotiated Rate |
$917.93 |
| Rate for Payer: Cash Price |
$411.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$407.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$367.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$367.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$387.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$407.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$387.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$407.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$407.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$305.98
|
| Rate for Payer: Healthfirst Commercial |
$407.97
|
| Rate for Payer: Healthfirst Essential Plan |
$917.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$387.57
|
| Rate for Payer: Healthfirst QHP |
$407.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$285.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$407.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$346.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$285.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$407.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$305.98
|
| Rate for Payer: SOMOS Essential |
$305.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$407.97
|
|
|
PR RPR AA HERNIA RECR > 10 CM NCRC8/STRANGULATED
|
Professional
|
Both
|
$5,593.56
|
|
|
Service Code
|
HCPCS 49618
|
| Min. Negotiated Rate |
$1,038.03 |
| Max. Negotiated Rate |
$3,336.53 |
| Rate for Payer: Cash Price |
$1,485.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,482.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,334.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,334.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,408.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,482.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,408.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,482.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,482.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,112.17
|
| Rate for Payer: Healthfirst Commercial |
$1,482.90
|
| Rate for Payer: Healthfirst Essential Plan |
$3,336.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,408.76
|
| Rate for Payer: Healthfirst QHP |
$1,482.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,038.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,482.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,260.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,038.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,482.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,112.17
|
| Rate for Payer: SOMOS Essential |
$1,112.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,482.90
|
|
|
PR RPR AA HERNIA RECR > 10 CM REDUCIBLE
|
Professional
|
Both
|
$3,986.43
|
|
|
Service Code
|
HCPCS 49617
|
| Min. Negotiated Rate |
$739.63 |
| Max. Negotiated Rate |
$2,377.39 |
| Rate for Payer: Cash Price |
$1,059.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,056.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$950.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$950.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,003.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,056.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,003.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,056.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,056.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$792.47
|
| Rate for Payer: Healthfirst Commercial |
$1,056.62
|
| Rate for Payer: Healthfirst Essential Plan |
$2,377.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,003.79
|
| Rate for Payer: Healthfirst QHP |
$1,056.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$739.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,056.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$898.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$739.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,056.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$792.47
|
| Rate for Payer: SOMOS Essential |
$792.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,056.62
|
|
|
PR RPR AA HERNIA RECR 3-10 CM NCRC8/STRANGULATED
|
Professional
|
Both
|
$3,884.62
|
|
|
Service Code
|
HCPCS 49616
|
| Min. Negotiated Rate |
$716.16 |
| Max. Negotiated Rate |
$2,301.95 |
| Rate for Payer: Cash Price |
$1,031.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,023.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$920.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$920.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$971.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,023.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$971.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,023.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,023.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$767.32
|
| Rate for Payer: Healthfirst Commercial |
$1,023.09
|
| Rate for Payer: Healthfirst Essential Plan |
$2,301.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$971.94
|
| Rate for Payer: Healthfirst QHP |
$1,023.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$716.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,023.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$869.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$716.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,023.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$767.32
|
| Rate for Payer: SOMOS Essential |
$767.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,023.09
|
|
|
PR RPR AA HERNIA RECR 3-10 CM REDUCIBLE
|
Professional
|
Both
|
$2,889.01
|
|
|
Service Code
|
HCPCS 49615
|
| Min. Negotiated Rate |
$532.87 |
| Max. Negotiated Rate |
$1,712.79 |
| Rate for Payer: Cash Price |
$766.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$761.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$685.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$685.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$723.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$761.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$723.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$761.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$761.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$570.93
|
| Rate for Payer: Healthfirst Commercial |
$761.24
|
| Rate for Payer: Healthfirst Essential Plan |
$1,712.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$723.18
|
| Rate for Payer: Healthfirst QHP |
$761.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$532.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$761.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$647.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$532.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$761.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$570.93
|
| Rate for Payer: SOMOS Essential |
$570.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$761.24
|
|
|
PR RPR AA HERNIA RECR < 3 CM NCRC8/STRANGULATED
|
Professional
|
Both
|
$2,583.35
|
|
|
Service Code
|
HCPCS 49614
|
| Min. Negotiated Rate |
$476.74 |
| Max. Negotiated Rate |
$1,532.38 |
| Rate for Payer: Cash Price |
$685.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$681.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$612.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$612.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$647.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$681.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$647.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$681.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$681.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$510.80
|
| Rate for Payer: Healthfirst Commercial |
$681.06
|
| Rate for Payer: Healthfirst Essential Plan |
$1,532.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$647.01
|
| Rate for Payer: Healthfirst QHP |
$681.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$476.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$681.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$578.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$476.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$681.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$510.80
|
| Rate for Payer: SOMOS Essential |
$510.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$681.06
|
|
|
PR RPR AA HERNIA RECR < 3 CM REDUCIBLE
|
Professional
|
Both
|
$1,899.52
|
|
|
Service Code
|
HCPCS 49613
|
| Min. Negotiated Rate |
$350.83 |
| Max. Negotiated Rate |
$1,127.65 |
| Rate for Payer: Cash Price |
$505.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$501.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$451.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$451.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$476.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$501.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$476.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$501.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$501.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$375.88
|
| Rate for Payer: Healthfirst Commercial |
$501.18
|
| Rate for Payer: Healthfirst Essential Plan |
$1,127.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$476.12
|
| Rate for Payer: Healthfirst QHP |
$501.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$350.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$501.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$426.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$350.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$501.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$375.88
|
| Rate for Payer: SOMOS Essential |
$375.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$501.18
|
|
|
PR RPR/ADVMNT FLXR TDN N/Z/2 W/FR GRAFT EA TENDON
|
Professional
|
Both
|
$3,693.52
|
|
|
Service Code
|
HCPCS 26352
|
| Min. Negotiated Rate |
$682.96 |
| Max. Negotiated Rate |
$2,195.24 |
| Rate for Payer: Cash Price |
$992.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$975.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$878.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$878.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$926.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$975.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$926.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$975.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$975.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$731.75
|
| Rate for Payer: Healthfirst Commercial |
$975.66
|
| Rate for Payer: Healthfirst Essential Plan |
$2,195.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$926.88
|
| Rate for Payer: Healthfirst QHP |
$975.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$682.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$975.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$829.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$682.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$975.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$731.75
|
| Rate for Payer: SOMOS Essential |
$731.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$975.66
|
|
|
PR RPR/ADVMNT FLXR TDN N/Z/2 W/O FR GRAFT EA TENDON
|
Professional
|
Both
|
$3,303.30
|
|
|
Service Code
|
HCPCS 26350
|
| Min. Negotiated Rate |
$613.49 |
| Max. Negotiated Rate |
$1,971.92 |
| Rate for Payer: Cash Price |
$893.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$876.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$788.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$788.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$832.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$876.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$832.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$876.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$876.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$657.31
|
| Rate for Payer: Healthfirst Commercial |
$876.41
|
| Rate for Payer: Healthfirst Essential Plan |
$1,971.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$832.59
|
| Rate for Payer: Healthfirst QHP |
$876.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$613.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$876.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$744.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$613.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$876.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$657.31
|
| Rate for Payer: SOMOS Essential |
$657.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$876.41
|
|
|
PR RPR/ADVMNT FLXR TDN ZONE 2 W/FR GRAFT EA TENDON
|
Professional
|
Both
|
$4,359.08
|
|
|
Service Code
|
HCPCS 26358
|
| Min. Negotiated Rate |
$820.98 |
| Max. Negotiated Rate |
$2,638.87 |
| Rate for Payer: Cash Price |
$1,180.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,172.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,055.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,055.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,114.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,172.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,114.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,172.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,172.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$879.62
|
| Rate for Payer: Healthfirst Commercial |
$1,172.83
|
| Rate for Payer: Healthfirst Essential Plan |
$2,638.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,114.19
|
| Rate for Payer: Healthfirst QHP |
$1,172.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$820.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,172.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$996.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$820.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,172.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$879.62
|
| Rate for Payer: SOMOS Essential |
$879.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,172.83
|
|
|
PR RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON
|
Professional
|
Both
|
$3,510.43
|
|
|
Service Code
|
HCPCS 26356
|
| Min. Negotiated Rate |
$664.63 |
| Max. Negotiated Rate |
$2,136.31 |
| Rate for Payer: Cash Price |
$952.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$949.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$854.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$854.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$902.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$949.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$902.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$949.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$949.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$712.10
|
| Rate for Payer: Healthfirst Commercial |
$949.47
|
| Rate for Payer: Healthfirst Essential Plan |
$2,136.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$902.00
|
| Rate for Payer: Healthfirst QHP |
$949.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$664.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$949.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$807.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$664.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$949.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$712.10
|
| Rate for Payer: SOMOS Essential |
$712.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$949.47
|
|
