|
PR TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN
|
Professional
|
Both
|
$2,344.72
|
|
|
Service Code
|
HCPCS 24358
|
| Min. Negotiated Rate |
$446.40 |
| Max. Negotiated Rate |
$1,434.85 |
| Rate for Payer: Cash Price |
$638.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$637.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$573.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$573.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$605.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$637.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$605.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$637.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$637.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$478.28
|
| Rate for Payer: Healthfirst Commercial |
$637.71
|
| Rate for Payer: Healthfirst Essential Plan |
$1,434.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$605.82
|
| Rate for Payer: Healthfirst QHP |
$637.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$446.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$637.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$542.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$446.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$637.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$478.28
|
| Rate for Payer: SOMOS Essential |
$478.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$637.71
|
|
|
PR TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR
|
Professional
|
Both
|
$2,935.24
|
|
|
Service Code
|
HCPCS 24359
|
| Min. Negotiated Rate |
$554.96 |
| Max. Negotiated Rate |
$1,783.80 |
| Rate for Payer: Cash Price |
$796.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$792.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$713.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$713.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$753.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$792.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$753.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$792.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$792.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$594.60
|
| Rate for Payer: Healthfirst Commercial |
$792.80
|
| Rate for Payer: Healthfirst Essential Plan |
$1,783.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$753.16
|
| Rate for Payer: Healthfirst QHP |
$792.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$554.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$792.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$673.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$554.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$792.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$594.60
|
| Rate for Payer: SOMOS Essential |
$594.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$792.80
|
|
|
PR TNOT FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA
|
Professional
|
Both
|
$1,928.61
|
|
|
Service Code
|
HCPCS 25290
|
| Min. Negotiated Rate |
$367.83 |
| Max. Negotiated Rate |
$1,182.31 |
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$525.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$472.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$472.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$499.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$525.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$499.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$525.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$525.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$394.10
|
| Rate for Payer: Healthfirst Commercial |
$525.47
|
| Rate for Payer: Healthfirst Essential Plan |
$1,182.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$499.20
|
| Rate for Payer: Healthfirst QHP |
$525.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$367.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$525.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$446.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$367.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$525.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$394.10
|
| Rate for Payer: SOMOS Essential |
$394.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$525.47
|
|
|
PR TOBACCO USE CESSATION INTENSIVE >10 MINUTES
|
Professional
|
Both
|
$102.31
|
|
|
Service Code
|
HCPCS 99407
|
| Min. Negotiated Rate |
$19.22 |
| Max. Negotiated Rate |
$61.78 |
| Rate for Payer: Cash Price |
$27.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.59
|
| Rate for Payer: Healthfirst Commercial |
$27.46
|
| Rate for Payer: Healthfirst Essential Plan |
$61.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.09
|
| Rate for Payer: Healthfirst QHP |
$27.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.59
|
| Rate for Payer: SOMOS Essential |
$20.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.46
|
|
|
PR TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES
|
Professional
|
Both
|
$48.48
|
|
|
Service Code
|
HCPCS 99406
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.75
|
| Rate for Payer: Healthfirst Commercial |
$13.00
|
| Rate for Payer: Healthfirst Essential Plan |
$29.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.35
|
| Rate for Payer: Healthfirst QHP |
$13.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.75
|
| Rate for Payer: SOMOS Essential |
$9.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.00
|
|
|
PR TONE DECAY TEST
|
Professional
|
Both
|
$143.61
|
|
|
Service Code
|
HCPCS 92563
|
| Min. Negotiated Rate |
$10.29 |
| Max. Negotiated Rate |
$93.96 |
| Rate for Payer: Amida Care Medicaid |
$10.29
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.32
|
| Rate for Payer: Healthfirst Commercial |
$41.76
|
| Rate for Payer: Healthfirst Essential Plan |
$93.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.67
|
| Rate for Payer: Healthfirst QHP |
$41.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.32
|
| Rate for Payer: SOMOS Essential |
$31.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.76
|
|
|
PR TONGUE BASE SUSPENSION PERMANENT SUTURE TQ
|
Professional
|
Both
|
$2,886.98
|
|
|
Service Code
|
HCPCS 41512
|
| Min. Negotiated Rate |
$539.09 |
| Max. Negotiated Rate |
$1,732.79 |
| Rate for Payer: Cash Price |
$780.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$770.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$693.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$693.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$731.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$770.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$731.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$770.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$770.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$577.60
|
| Rate for Payer: Healthfirst Commercial |
$770.13
|
| Rate for Payer: Healthfirst Essential Plan |
$1,732.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$731.62
|
| Rate for Payer: Healthfirst QHP |
$770.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$539.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$770.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$654.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$539.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$770.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$577.60
|
| Rate for Payer: SOMOS Essential |
$577.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$770.13
|
|
|
PR TONSILLECTOMY & ADENOIDECTOMY <AGE 12
|
Professional
|
Both
|
$1,257.80
|
|
|
Service Code
|
HCPCS 42820
|
| Min. Negotiated Rate |
$238.47 |
| Max. Negotiated Rate |
$766.51 |
| Rate for Payer: Cash Price |
$343.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$340.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$306.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$306.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$323.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$340.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$340.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$340.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$255.50
|
| Rate for Payer: Healthfirst Commercial |
$340.67
|
| Rate for Payer: Healthfirst Essential Plan |
$766.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$323.64
|
| Rate for Payer: Healthfirst QHP |
$340.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$238.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$340.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$289.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$238.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$340.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$255.50
|
| Rate for Payer: SOMOS Essential |
$255.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$340.67
|
|
|
PR TONSILLECTOMY & ADENOIDECTOMY AGE 12/>
|
Professional
|
Both
|
$1,322.06
|
|
|
Service Code
|
HCPCS 42821
|
| Min. Negotiated Rate |
$248.69 |
| Max. Negotiated Rate |
$799.36 |
| Rate for Payer: Cash Price |
$358.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$355.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$319.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$319.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$337.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$355.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$337.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$355.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$266.45
|
| Rate for Payer: Healthfirst Commercial |
$355.27
|
| Rate for Payer: Healthfirst Essential Plan |
$799.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$337.51
|
| Rate for Payer: Healthfirst QHP |
$355.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$248.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$355.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$301.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$248.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$355.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$266.45
|
| Rate for Payer: SOMOS Essential |
$266.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$355.27
|
|
|
PR TONSILLECTOMY PRIMARY/SECONDARY <AGE 12
|
Professional
|
Both
|
$1,164.38
|
|
|
Service Code
|
HCPCS 42825
|
| Min. Negotiated Rate |
$221.10 |
| Max. Negotiated Rate |
$710.68 |
| Rate for Payer: Cash Price |
$317.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$315.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$284.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$284.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$300.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$315.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$300.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$315.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$315.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$236.90
|
| Rate for Payer: Healthfirst Commercial |
$315.86
|
| Rate for Payer: Healthfirst Essential Plan |
$710.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$300.07
|
| Rate for Payer: Healthfirst QHP |
$315.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$221.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$315.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$268.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$221.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$315.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$236.90
|
| Rate for Payer: SOMOS Essential |
$236.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$315.86
|
|
|
PR TONSILLECTOMY PRIMARY/SECONDARY AGE 12/>
|
Professional
|
Both
|
$1,109.40
|
|
|
Service Code
|
HCPCS 42826
|
| Min. Negotiated Rate |
$209.98 |
| Max. Negotiated Rate |
$674.93 |
| Rate for Payer: Cash Price |
$302.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$299.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$269.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$269.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$284.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$299.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$284.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$299.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$299.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$224.98
|
| Rate for Payer: Healthfirst Commercial |
$299.97
|
| Rate for Payer: Healthfirst Essential Plan |
$674.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$284.97
|
| Rate for Payer: Healthfirst QHP |
$299.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$209.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$299.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$254.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$209.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$299.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$224.98
|
| Rate for Payer: SOMOS Essential |
$224.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$299.97
|
|
|
PR TOT ABD HYST W/PARAORTIC & PELVIC LYMPH NODE SAM
|
Professional
|
Both
|
$5,844.97
|
|
|
Service Code
|
HCPCS 58200
|
| Min. Negotiated Rate |
$1,098.21 |
| Max. Negotiated Rate |
$3,529.96 |
| Rate for Payer: Cash Price |
$1,583.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,568.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,411.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,411.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,490.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,568.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,490.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,568.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,568.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,176.65
|
| Rate for Payer: Healthfirst Commercial |
$1,568.87
|
| Rate for Payer: Healthfirst Essential Plan |
$3,529.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,490.43
|
| Rate for Payer: Healthfirst QHP |
$1,568.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,098.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,568.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,333.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,098.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,568.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,176.65
|
| Rate for Payer: SOMOS Essential |
$1,176.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,568.87
|
|
|
PR TOT ABD HYST W/WO RMVL TUBE OVARY W/COLPURETHRXY
|
Professional
|
Both
|
$5,396.20
|
|
|
Service Code
|
HCPCS 58152
|
| Min. Negotiated Rate |
$1,002.60 |
| Max. Negotiated Rate |
$3,222.63 |
| Rate for Payer: Cash Price |
$1,452.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,432.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,289.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,289.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,360.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,432.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,360.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,432.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,432.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,074.21
|
| Rate for Payer: Healthfirst Commercial |
$1,432.28
|
| Rate for Payer: Healthfirst Essential Plan |
$3,222.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,360.67
|
| Rate for Payer: Healthfirst QHP |
$1,432.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,002.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,432.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,217.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,002.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,432.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,074.21
|
| Rate for Payer: SOMOS Essential |
$1,074.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,432.28
|
|
|
PR TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY
|
Professional
|
Both
|
$4,415.39
|
|
|
Service Code
|
HCPCS 58150
|
| Min. Negotiated Rate |
$827.92 |
| Max. Negotiated Rate |
$2,661.19 |
| Rate for Payer: Cash Price |
$1,194.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,182.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,064.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,064.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,123.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,182.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,123.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,182.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,182.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$887.06
|
| Rate for Payer: Healthfirst Commercial |
$1,182.75
|
| Rate for Payer: Healthfirst Essential Plan |
$2,661.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,123.61
|
| Rate for Payer: Healthfirst QHP |
$1,182.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$827.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,182.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,005.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$827.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,182.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$887.06
|
| Rate for Payer: SOMOS Essential |
$887.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,182.75
|
|
|
PR TOTAL DISC ARTHRP ANT SINGLE INTERSPACE LUMBAR
|
Professional
|
Both
|
$7,787.05
|
|
|
Service Code
|
HCPCS 22857
|
| Min. Negotiated Rate |
$1,442.30 |
| Max. Negotiated Rate |
$4,635.97 |
| Rate for Payer: Cash Price |
$2,070.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,060.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,854.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,854.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,957.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,060.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,957.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,060.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,060.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,545.32
|
| Rate for Payer: Healthfirst Commercial |
$2,060.43
|
| Rate for Payer: Healthfirst Essential Plan |
$4,635.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,957.41
|
| Rate for Payer: Healthfirst QHP |
$2,060.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,442.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,060.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,751.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,442.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,060.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,545.32
|
| Rate for Payer: SOMOS Essential |
$1,545.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,060.43
|
|
|
PR TOTAL ESOPHAGECTOMY W/THORCOM W/WO PYLORPLASTY
|
Professional
|
Both
|
$15,494.15
|
|
|
Service Code
|
HCPCS 43112
|
| Min. Negotiated Rate |
$2,803.32 |
| Max. Negotiated Rate |
$9,010.69 |
| Rate for Payer: Cash Price |
$4,088.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,004.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,604.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,604.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,804.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,004.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,804.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,004.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,004.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,003.56
|
| Rate for Payer: Healthfirst Commercial |
$4,004.75
|
| Rate for Payer: Healthfirst Essential Plan |
$9,010.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,804.51
|
| Rate for Payer: Healthfirst QHP |
$4,004.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,803.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,004.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,404.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,803.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,004.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,003.56
|
| Rate for Payer: SOMOS Essential |
$3,003.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,004.75
|
|
|
PR TOTAL FACIAL NERVE DECOMPRESSION &/REPAIR
|
Professional
|
Both
|
$8,493.98
|
|
|
Service Code
|
HCPCS 69955
|
| Min. Negotiated Rate |
$1,578.33 |
| Max. Negotiated Rate |
$5,073.19 |
| Rate for Payer: Cash Price |
$2,290.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,254.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,029.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,029.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,142.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,254.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,142.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,254.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,254.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,691.06
|
| Rate for Payer: Healthfirst Commercial |
$2,254.75
|
| Rate for Payer: Healthfirst Essential Plan |
$5,073.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,142.01
|
| Rate for Payer: Healthfirst QHP |
$2,254.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,578.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,254.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,916.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,578.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,254.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,691.06
|
| Rate for Payer: SOMOS Essential |
$1,691.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,254.75
|
|
|
PR TOTAL LUNG LAVAGE UNILATERAL
|
Professional
|
Both
|
$1,356.29
|
|
|
Service Code
|
HCPCS 32997
|
| Min. Negotiated Rate |
$255.72 |
| Max. Negotiated Rate |
$821.95 |
| Rate for Payer: Cash Price |
$369.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$365.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$328.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$328.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$347.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$365.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$347.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$365.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$365.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$273.98
|
| Rate for Payer: Healthfirst Commercial |
$365.31
|
| Rate for Payer: Healthfirst Essential Plan |
$821.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$347.04
|
| Rate for Payer: Healthfirst QHP |
$365.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$255.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$365.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$310.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$255.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$365.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$273.98
|
| Rate for Payer: SOMOS Essential |
$273.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$365.31
|
|
|
PR TOTAL REPAIR TRUNCUS ARTERIOSUS
|
Professional
|
Both
|
$10,128.27
|
|
|
Service Code
|
HCPCS 33786
|
| Min. Negotiated Rate |
$1,859.50 |
| Max. Negotiated Rate |
$5,976.97 |
| Rate for Payer: Cash Price |
$2,687.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,656.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,390.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,390.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,523.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,656.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,523.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,656.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,656.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,992.32
|
| Rate for Payer: Healthfirst Commercial |
$2,656.43
|
| Rate for Payer: Healthfirst Essential Plan |
$5,976.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,523.61
|
| Rate for Payer: Healthfirst QHP |
$2,656.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,859.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,656.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,257.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,859.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,656.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,992.32
|
| Rate for Payer: SOMOS Essential |
$1,992.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,656.43
|
|
|
PR TOTAL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY
|
Professional
|
Both
|
$3,111.89
|
|
|
Service Code
|
HCPCS 60220
|
| Min. Negotiated Rate |
$581.55 |
| Max. Negotiated Rate |
$1,869.26 |
| Rate for Payer: Cash Price |
$837.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$830.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$747.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$747.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$789.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$830.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$789.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$830.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$830.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$623.09
|
| Rate for Payer: Healthfirst Commercial |
$830.78
|
| Rate for Payer: Healthfirst Essential Plan |
$1,869.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$789.24
|
| Rate for Payer: Healthfirst QHP |
$830.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$581.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$830.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$706.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$581.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$830.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$623.09
|
| Rate for Payer: SOMOS Essential |
$623.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$830.78
|
|
|
PR TOTAL THYROID LOBEC UNI W/CONTRALAT STOT LOBEC
|
Professional
|
Both
|
$4,111.21
|
|
|
Service Code
|
HCPCS 60225
|
| Min. Negotiated Rate |
$773.73 |
| Max. Negotiated Rate |
$2,486.99 |
| Rate for Payer: Cash Price |
$1,111.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,105.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$994.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$994.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,050.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,105.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,050.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,105.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,105.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$829.00
|
| Rate for Payer: Healthfirst Commercial |
$1,105.33
|
| Rate for Payer: Healthfirst Essential Plan |
$2,486.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,050.06
|
| Rate for Payer: Healthfirst QHP |
$1,105.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$773.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,105.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$939.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$773.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,105.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$829.00
|
| Rate for Payer: SOMOS Essential |
$829.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,105.33
|
|
|
PR TOT DISC ARTHRP ANT APPR DISC 2ND LEVEL CERVICAL
|
Professional
|
Both
|
$2,328.94
|
|
|
Service Code
|
HCPCS 22858
|
| Min. Negotiated Rate |
$429.35 |
| Max. Negotiated Rate |
$1,380.06 |
| Rate for Payer: Cash Price |
$615.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$613.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$552.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$552.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$582.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$613.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$582.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$613.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$613.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$460.02
|
| Rate for Payer: Healthfirst Commercial |
$613.36
|
| Rate for Payer: Healthfirst Essential Plan |
$1,380.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$582.69
|
| Rate for Payer: Healthfirst QHP |
$613.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$429.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$613.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$521.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$429.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$613.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$460.02
|
| Rate for Payer: SOMOS Essential |
$460.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$613.36
|
|
|
PR TOT DISC ARTHRP ART DISC ANT APPRO 1 NTRSPC CRV
|
Professional
|
Both
|
$7,518.95
|
|
|
Service Code
|
HCPCS 22856
|
| Min. Negotiated Rate |
$1,386.41 |
| Max. Negotiated Rate |
$4,456.31 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,980.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,782.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,782.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,881.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,980.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,881.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,980.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,980.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,485.43
|
| Rate for Payer: Healthfirst Commercial |
$1,980.58
|
| Rate for Payer: Healthfirst Essential Plan |
$4,456.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,881.55
|
| Rate for Payer: Healthfirst QHP |
$1,980.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,386.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,980.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,683.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,386.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,980.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,485.43
|
| Rate for Payer: SOMOS Essential |
$1,485.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,980.58
|
|
|
PR TOT ESOPHAGECTOMY W/O THORCOM W/WO PYLOROPLASTY
|
Professional
|
Both
|
$13,268.71
|
|
|
Service Code
|
HCPCS 43107
|
| Min. Negotiated Rate |
$2,444.13 |
| Max. Negotiated Rate |
$7,856.15 |
| Rate for Payer: Cash Price |
$3,534.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,491.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,142.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,142.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,317.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,491.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,317.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,491.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,491.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,618.72
|
| Rate for Payer: Healthfirst Commercial |
$3,491.62
|
| Rate for Payer: Healthfirst Essential Plan |
$7,856.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,317.04
|
| Rate for Payer: Healthfirst QHP |
$3,491.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,444.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,491.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,967.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,444.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,491.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,618.72
|
| Rate for Payer: SOMOS Essential |
$2,618.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,491.62
|
|
|
PR TOT ESOPHG W/O THORCOM COLON NTRPSTJ/INT RCNSTJ
|
Professional
|
Both
|
$19,801.43
|
|
|
Service Code
|
HCPCS 43108
|
| Min. Negotiated Rate |
$3,632.15 |
| Max. Negotiated Rate |
$11,674.75 |
| Rate for Payer: Cash Price |
$5,248.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,188.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,669.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,669.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,929.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,188.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,929.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,188.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,188.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,891.59
|
| Rate for Payer: Healthfirst Commercial |
$5,188.78
|
| Rate for Payer: Healthfirst Essential Plan |
$11,674.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,929.34
|
| Rate for Payer: Healthfirst QHP |
$5,188.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,632.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5,188.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4,410.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3,632.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,188.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,891.59
|
| Rate for Payer: SOMOS Essential |
$3,891.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,188.78
|
|
