|
PR RPR DURAL/CEREBROSPINAL FLUID LEAK X REQ LAM
|
Professional
|
Both
|
$4,397.79
|
|
|
Service Code
|
HCPCS 63707
|
| Min. Negotiated Rate |
$819.87 |
| Max. Negotiated Rate |
$2,635.29 |
| Rate for Payer: Cash Price |
$1,167.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,171.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,054.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,054.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,112.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,171.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,112.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,171.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,171.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$878.43
|
| Rate for Payer: Healthfirst Commercial |
$1,171.24
|
| Rate for Payer: Healthfirst Essential Plan |
$2,635.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,112.68
|
| Rate for Payer: Healthfirst QHP |
$1,171.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$819.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,171.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$995.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$819.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,171.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$878.43
|
| Rate for Payer: SOMOS Essential |
$878.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,171.24
|
|
|
PR RPR DURAL/CSF LEAK/PSEUDOMENINGOCELE W/LAM
|
Professional
|
Both
|
$5,191.52
|
|
|
Service Code
|
HCPCS 63709
|
| Min. Negotiated Rate |
$959.95 |
| Max. Negotiated Rate |
$3,085.54 |
| Rate for Payer: Cash Price |
$1,381.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,371.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,234.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,234.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,302.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,371.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,302.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,371.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,371.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,028.51
|
| Rate for Payer: Healthfirst Commercial |
$1,371.35
|
| Rate for Payer: Healthfirst Essential Plan |
$3,085.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,302.78
|
| Rate for Payer: Healthfirst QHP |
$1,371.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$959.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,371.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,165.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$959.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,371.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,028.51
|
| Rate for Payer: SOMOS Essential |
$1,028.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,371.35
|
|
|
PR RPR ENCEPHALOCELE SKULL VAULT W/CRANIOPLASTY
|
Professional
|
Both
|
$9,874.80
|
|
|
Service Code
|
HCPCS 62120
|
| Min. Negotiated Rate |
$1,804.59 |
| Max. Negotiated Rate |
$5,800.45 |
| Rate for Payer: Cash Price |
$2,613.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,577.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,320.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,320.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,449.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,577.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,449.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,577.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,577.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,933.48
|
| Rate for Payer: Healthfirst Commercial |
$2,577.98
|
| Rate for Payer: Healthfirst Essential Plan |
$5,800.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,449.08
|
| Rate for Payer: Healthfirst QHP |
$2,577.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,804.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,577.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,191.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,804.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,577.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,933.48
|
| Rate for Payer: SOMOS Essential |
$1,933.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,577.98
|
|
|
PR RPR EXTENSOR TENDON LEG PRIMARY W/O GRAFT EACH
|
Professional
|
Both
|
$1,583.96
|
|
|
Service Code
|
HCPCS 27664
|
| Min. Negotiated Rate |
$294.77 |
| Max. Negotiated Rate |
$947.48 |
| Rate for Payer: Cash Price |
$430.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$421.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$378.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$378.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$400.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$421.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$400.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$421.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$421.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$315.82
|
| Rate for Payer: Healthfirst Commercial |
$421.10
|
| Rate for Payer: Healthfirst Essential Plan |
$947.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$400.05
|
| Rate for Payer: Healthfirst QHP |
$421.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$294.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$421.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$357.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$294.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$421.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$315.82
|
| Rate for Payer: SOMOS Essential |
$315.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$421.10
|
|
|
PR RPR EXTENSOR TENDON LEG SECONDRY W/WO GRAFT EACH
|
Professional
|
Both
|
$1,829.94
|
|
|
Service Code
|
HCPCS 27665
|
| Min. Negotiated Rate |
$343.90 |
| Max. Negotiated Rate |
$1,105.40 |
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$491.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$442.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$442.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$466.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$491.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$466.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$491.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$491.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$368.47
|
| Rate for Payer: Healthfirst Commercial |
$491.29
|
| Rate for Payer: Healthfirst Essential Plan |
$1,105.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$466.73
|
| Rate for Payer: Healthfirst QHP |
$491.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$343.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$491.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$417.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$343.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$491.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$368.47
|
| Rate for Payer: SOMOS Essential |
$368.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$491.29
|
|
|
PR RPR FLEXOR TENDON LEG SECONDARY W/O GRAFT EACH
|
Professional
|
Both
|
$2,016.42
|
|
|
Service Code
|
HCPCS 27659
|
| Min. Negotiated Rate |
$385.78 |
| Max. Negotiated Rate |
$1,240.00 |
| Rate for Payer: Cash Price |
$554.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$551.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$496.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$496.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$523.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$551.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$523.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$551.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$551.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$413.33
|
| Rate for Payer: Healthfirst Commercial |
$551.11
|
| Rate for Payer: Healthfirst Essential Plan |
$1,240.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$523.55
|
| Rate for Payer: Healthfirst QHP |
$551.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$385.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$551.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$468.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$385.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$551.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$413.33
|
| Rate for Payer: SOMOS Essential |
$413.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$551.11
|
|
|
PR RPR GRF-ENTERIC FSTL
|
Professional
|
Both
|
$5,557.51
|
|
|
Service Code
|
HCPCS 35870
|
| Min. Negotiated Rate |
$1,018.71 |
| Max. Negotiated Rate |
$3,274.43 |
| Rate for Payer: Cash Price |
$1,471.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,455.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,309.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,309.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,382.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,455.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,382.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,455.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,455.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,091.47
|
| Rate for Payer: Healthfirst Commercial |
$1,455.30
|
| Rate for Payer: Healthfirst Essential Plan |
$3,274.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,382.54
|
| Rate for Payer: Healthfirst QHP |
$1,455.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,018.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,455.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,237.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,018.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,455.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,091.47
|
| Rate for Payer: SOMOS Essential |
$1,091.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,455.30
|
|
|
PR RPR HI IMPRF ANUS W/FSTL PRNL/SACROPRNL APPR
|
Professional
|
Both
|
$9,795.84
|
|
|
Service Code
|
HCPCS 46740
|
| Min. Negotiated Rate |
$1,819.25 |
| Max. Negotiated Rate |
$5,847.59 |
| Rate for Payer: Cash Price |
$2,615.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,598.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,339.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,339.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,468.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,598.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,468.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,598.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,598.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,949.20
|
| Rate for Payer: Healthfirst Commercial |
$2,598.93
|
| Rate for Payer: Healthfirst Essential Plan |
$5,847.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,468.98
|
| Rate for Payer: Healthfirst QHP |
$2,598.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,819.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,598.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,209.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,819.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,598.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,949.20
|
| Rate for Payer: SOMOS Essential |
$1,949.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,598.93
|
|
|
PR RPR HI IMPRF ANUS W/FSTL TABDL & SACROPRNL
|
Professional
|
Both
|
$11,320.47
|
|
|
Service Code
|
HCPCS 46742
|
| Min. Negotiated Rate |
$2,097.98 |
| Max. Negotiated Rate |
$6,743.50 |
| Rate for Payer: Cash Price |
$3,020.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,997.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,697.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,697.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,847.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,997.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,847.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,997.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,997.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,247.83
|
| Rate for Payer: Healthfirst Commercial |
$2,997.11
|
| Rate for Payer: Healthfirst Essential Plan |
$6,743.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,847.25
|
| Rate for Payer: Healthfirst QHP |
$2,997.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,097.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,997.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,547.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,097.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,997.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,247.83
|
| Rate for Payer: SOMOS Essential |
$2,247.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,997.11
|
|
|
PR RPR HI IMPRF ANUS W/O FISTULA CMBN APPR
|
Professional
|
Both
|
$10,333.12
|
|
|
Service Code
|
HCPCS 46735
|
| Min. Negotiated Rate |
$1,918.20 |
| Max. Negotiated Rate |
$6,165.63 |
| Rate for Payer: Cash Price |
$2,757.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,740.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,466.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,466.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,603.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,740.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,603.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,740.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,740.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,055.21
|
| Rate for Payer: Healthfirst Commercial |
$2,740.28
|
| Rate for Payer: Healthfirst Essential Plan |
$6,165.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,603.27
|
| Rate for Payer: Healthfirst QHP |
$2,740.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,918.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,740.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,329.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,918.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,740.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,055.21
|
| Rate for Payer: SOMOS Essential |
$2,055.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,740.28
|
|
|
PR RPR HI IMPRF ANUS W/O FSTL PRNL/SACROPRNL APPR
|
Professional
|
Both
|
$8,978.83
|
|
|
Service Code
|
HCPCS 46730
|
| Min. Negotiated Rate |
$1,668.12 |
| Max. Negotiated Rate |
$5,361.82 |
| Rate for Payer: Cash Price |
$2,397.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,383.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,144.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,144.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,263.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,383.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,263.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,383.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,383.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,787.27
|
| Rate for Payer: Healthfirst Commercial |
$2,383.03
|
| Rate for Payer: Healthfirst Essential Plan |
$5,361.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,263.88
|
| Rate for Payer: Healthfirst QHP |
$2,383.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,668.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,383.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,025.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,668.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,383.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,787.27
|
| Rate for Payer: SOMOS Essential |
$1,787.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,383.03
|
|
|
PR RPR HYPOPLSTC A-ARCH W/AGRFT/PROSTC W/BYPASS
|
Professional
|
Both
|
$8,158.01
|
|
|
Service Code
|
HCPCS 33853
|
| Min. Negotiated Rate |
$1,504.38 |
| Max. Negotiated Rate |
$4,835.52 |
| Rate for Payer: Cash Price |
$2,171.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,149.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,934.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,934.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,041.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,149.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,041.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,149.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,149.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,611.84
|
| Rate for Payer: Healthfirst Commercial |
$2,149.12
|
| Rate for Payer: Healthfirst Essential Plan |
$4,835.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,041.66
|
| Rate for Payer: Healthfirst QHP |
$2,149.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,504.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,149.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,826.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,504.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,149.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,611.84
|
| Rate for Payer: SOMOS Essential |
$1,611.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,149.12
|
|
|
PR RPR HYPOPLSTC A-ARCH W/AGRFT/PROSTC W/O BYPASS
|
Professional
|
Both
|
$6,235.92
|
|
|
Service Code
|
HCPCS 33852
|
| Min. Negotiated Rate |
$1,151.27 |
| Max. Negotiated Rate |
$3,700.51 |
| Rate for Payer: Cash Price |
$1,660.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,644.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,480.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,480.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,562.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,644.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,562.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,644.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,644.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,233.50
|
| Rate for Payer: Healthfirst Commercial |
$1,644.67
|
| Rate for Payer: Healthfirst Essential Plan |
$3,700.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,562.44
|
| Rate for Payer: Healthfirst QHP |
$1,644.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,151.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,644.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,397.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,151.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,644.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,233.50
|
| Rate for Payer: SOMOS Essential |
$1,233.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,644.67
|
|
|
PR RPR HYPOSPADIAS COMPLCTJS CLSR INC/EXC SIMPLE
|
Professional
|
Both
|
$2,390.43
|
|
|
Service Code
|
HCPCS 54340
|
| Min. Negotiated Rate |
$455.79 |
| Max. Negotiated Rate |
$1,465.04 |
| Rate for Payer: Cash Price |
$656.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$651.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$586.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$586.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$618.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$651.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$618.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$651.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$651.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$488.35
|
| Rate for Payer: Healthfirst Commercial |
$651.13
|
| Rate for Payer: Healthfirst Essential Plan |
$1,465.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$618.57
|
| Rate for Payer: Healthfirst QHP |
$651.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$455.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$651.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$553.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$455.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$651.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$488.35
|
| Rate for Payer: SOMOS Essential |
$488.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$651.13
|
|
|
PR RPR HYPOSPADIAS COMPLCTJS DSJ & URTP FLAP/GRF
|
Professional
|
Both
|
$4,215.23
|
|
|
Service Code
|
HCPCS 54348
|
| Min. Negotiated Rate |
$803.03 |
| Max. Negotiated Rate |
$2,581.16 |
| Rate for Payer: Cash Price |
$1,153.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,147.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,032.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,032.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,089.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,147.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,089.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,147.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,147.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$860.38
|
| Rate for Payer: Healthfirst Commercial |
$1,147.18
|
| Rate for Payer: Healthfirst Essential Plan |
$2,581.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,089.82
|
| Rate for Payer: Healthfirst QHP |
$1,147.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$803.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,147.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$975.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$803.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,147.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$860.38
|
| Rate for Payer: SOMOS Essential |
$860.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,147.18
|
|
|
PR RPR HYPOSPADIAS COMPLCTJS MOBLJ FLAPS & URTP
|
Professional
|
Both
|
$3,944.36
|
|
|
Service Code
|
HCPCS 54344
|
| Min. Negotiated Rate |
$751.21 |
| Max. Negotiated Rate |
$2,414.59 |
| Rate for Payer: Cash Price |
$1,079.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,073.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$965.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$965.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,019.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,073.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,019.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,073.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,073.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$804.86
|
| Rate for Payer: Healthfirst Commercial |
$1,073.15
|
| Rate for Payer: Healthfirst Essential Plan |
$2,414.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,019.49
|
| Rate for Payer: Healthfirst QHP |
$1,073.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$751.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,073.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$912.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$751.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,073.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$804.86
|
| Rate for Payer: SOMOS Essential |
$804.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,073.15
|
|
|
PR RPR ILEOANAL POUCH FSTL/POUCH ADVMNT CMBN APPR
|
Professional
|
Both
|
$10,021.66
|
|
|
Service Code
|
HCPCS 46712
|
| Min. Negotiated Rate |
$1,848.01 |
| Max. Negotiated Rate |
$5,940.02 |
| Rate for Payer: Cash Price |
$2,663.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,640.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,376.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,376.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,508.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,640.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,508.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,640.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,640.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,980.01
|
| Rate for Payer: Healthfirst Commercial |
$2,640.01
|
| Rate for Payer: Healthfirst Essential Plan |
$5,940.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,508.01
|
| Rate for Payer: Healthfirst QHP |
$2,640.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,848.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,640.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,244.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,848.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,640.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,980.01
|
| Rate for Payer: SOMOS Essential |
$1,980.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,640.01
|
|
|
PR RPR ILEOANAL POUCH FSTL/POUCH ADVMNT TPRNL APPR
|
Professional
|
Both
|
$5,023.73
|
|
|
Service Code
|
HCPCS 46710
|
| Min. Negotiated Rate |
$931.72 |
| Max. Negotiated Rate |
$2,994.82 |
| Rate for Payer: Cash Price |
$1,338.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,331.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,197.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,197.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,264.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,331.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,264.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,331.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,331.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$998.27
|
| Rate for Payer: Healthfirst Commercial |
$1,331.03
|
| Rate for Payer: Healthfirst Essential Plan |
$2,994.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,264.48
|
| Rate for Payer: Healthfirst QHP |
$1,331.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$931.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,331.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,131.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$931.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,331.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$998.27
|
| Rate for Payer: SOMOS Essential |
$998.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,331.03
|
|
|
PR RPR INCPLT/PRTL AV CANAL W/WO AV VALVE RPR
|
Professional
|
Both
|
$7,806.26
|
|
|
Service Code
|
HCPCS 33660
|
| Min. Negotiated Rate |
$1,437.20 |
| Max. Negotiated Rate |
$4,619.59 |
| Rate for Payer: Cash Price |
$2,074.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,053.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,847.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,847.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,950.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,053.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,950.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,053.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,053.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,539.86
|
| Rate for Payer: Healthfirst Commercial |
$2,053.15
|
| Rate for Payer: Healthfirst Essential Plan |
$4,619.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,950.49
|
| Rate for Payer: Healthfirst QHP |
$2,053.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,437.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,053.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,745.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,437.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,053.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,539.86
|
| Rate for Payer: SOMOS Essential |
$1,539.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,053.15
|
|
|
PR RPR INGUN HERNIA SLIDING ANY AGE
|
Professional
|
Both
|
$2,597.42
|
|
|
Service Code
|
HCPCS 49525
|
| Min. Negotiated Rate |
$483.99 |
| Max. Negotiated Rate |
$1,555.67 |
| Rate for Payer: Cash Price |
$694.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$691.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$622.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$622.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$656.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$691.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$656.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$691.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$691.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$518.56
|
| Rate for Payer: Healthfirst Commercial |
$691.41
|
| Rate for Payer: Healthfirst Essential Plan |
$1,555.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$656.84
|
| Rate for Payer: Healthfirst QHP |
$691.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$483.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$691.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$587.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$483.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$691.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$518.56
|
| Rate for Payer: SOMOS Essential |
$518.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$691.41
|
|
|
PR RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM
|
Professional
|
Both
|
$1,424.89
|
|
|
Service Code
|
HCPCS 12046
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$856.60 |
| Rate for Payer: Cash Price |
$383.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$380.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$342.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$342.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$361.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$380.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$361.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$380.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$380.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$285.53
|
| Rate for Payer: Healthfirst Commercial |
$380.71
|
| Rate for Payer: Healthfirst Essential Plan |
$856.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$361.67
|
| Rate for Payer: Healthfirst QHP |
$380.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$266.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$380.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$323.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$266.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$380.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$285.53
|
| Rate for Payer: SOMOS Essential |
$285.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$380.71
|
|
|
PR RPR INTRM/TRANSJ AV CANAL W/WO AV VALVE RPR
|
Professional
|
Both
|
$8,505.00
|
|
|
Service Code
|
HCPCS 33665
|
| Min. Negotiated Rate |
$1,564.87 |
| Max. Negotiated Rate |
$5,029.94 |
| Rate for Payer: Cash Price |
$2,259.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,235.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,011.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,011.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,123.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,235.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,123.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,235.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,235.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,676.65
|
| Rate for Payer: Healthfirst Commercial |
$2,235.53
|
| Rate for Payer: Healthfirst Essential Plan |
$5,029.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,123.75
|
| Rate for Payer: Healthfirst QHP |
$2,235.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,564.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,235.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,900.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,564.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,235.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,676.65
|
| Rate for Payer: SOMOS Essential |
$1,676.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,235.53
|
|
|
PR RPR LAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG
|
Professional
|
Both
|
$674.49
|
|
|
Service Code
|
HCPCS 41250
|
| Min. Negotiated Rate |
$127.45 |
| Max. Negotiated Rate |
$409.66 |
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$163.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$163.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$172.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$172.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$182.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$136.55
|
| Rate for Payer: Healthfirst Commercial |
$182.07
|
| Rate for Payer: Healthfirst Essential Plan |
$409.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$172.97
|
| Rate for Payer: Healthfirst QHP |
$182.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$127.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$182.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$154.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$127.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$136.55
|
| Rate for Payer: SOMOS Essential |
$136.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.07
|
|
|
PR RPR LAC 2.5 CM/< PST ONE-THIRD TONGUE
|
Professional
|
Both
|
$812.77
|
|
|
Service Code
|
HCPCS 41251
|
| Min. Negotiated Rate |
$152.30 |
| Max. Negotiated Rate |
$489.53 |
| Rate for Payer: Cash Price |
$218.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$217.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$195.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$195.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$217.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$217.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$163.18
|
| Rate for Payer: Healthfirst Commercial |
$217.57
|
| Rate for Payer: Healthfirst Essential Plan |
$489.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$206.69
|
| Rate for Payer: Healthfirst QHP |
$217.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$152.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$217.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$184.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$152.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$217.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$163.18
|
| Rate for Payer: SOMOS Essential |
$163.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$217.57
|
|
|
PR RPR LAC APPL TISSUE GLUE WOUND CORNEA&/SCLERA
|
Professional
|
Both
|
$2,039.42
|
|
|
Service Code
|
HCPCS 65286
|
| Min. Negotiated Rate |
$386.55 |
| Max. Negotiated Rate |
$1,242.47 |
| Rate for Payer: Cash Price |
$560.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$552.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$496.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$496.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$524.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$552.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$524.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$552.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$552.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$414.16
|
| Rate for Payer: Healthfirst Commercial |
$552.21
|
| Rate for Payer: Healthfirst Essential Plan |
$1,242.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$524.60
|
| Rate for Payer: Healthfirst QHP |
$552.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$386.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$552.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$469.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$386.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$552.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$414.16
|
| Rate for Payer: SOMOS Essential |
$414.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$552.21
|
|
