|
PR CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$2,044.35
|
|
|
Service Code
|
HCPCS 25535
|
| Min. Negotiated Rate |
$388.63 |
| Max. Negotiated Rate |
$1,249.18 |
| Rate for Payer: Cash Price |
$559.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$555.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$499.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$499.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$527.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$555.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$527.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$555.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$555.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$416.39
|
| Rate for Payer: Healthfirst Commercial |
$555.19
|
| Rate for Payer: Healthfirst Essential Plan |
$1,249.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$527.43
|
| Rate for Payer: Healthfirst QHP |
$555.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$388.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$555.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$471.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$388.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$555.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$416.39
|
| Rate for Payer: SOMOS Essential |
$416.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$555.19
|
|
|
PR CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$1,091.09
|
|
|
Service Code
|
HCPCS 25530
|
| Min. Negotiated Rate |
$211.62 |
| Max. Negotiated Rate |
$680.22 |
| Rate for Payer: Cash Price |
$300.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$302.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$272.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$272.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$287.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$302.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$287.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$302.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$302.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$226.74
|
| Rate for Payer: Healthfirst Commercial |
$302.32
|
| Rate for Payer: Healthfirst Essential Plan |
$680.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$287.20
|
| Rate for Payer: Healthfirst QHP |
$302.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$211.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$302.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$256.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$211.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$302.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$226.74
|
| Rate for Payer: SOMOS Essential |
$226.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$302.32
|
|
|
PR CLOSE MEDIAN STERNOTOMY SEP W/WO DEBRIDEMENT SPX
|
Professional
|
Both
|
$3,021.17
|
|
|
Service Code
|
HCPCS 21750
|
| Min. Negotiated Rate |
$559.87 |
| Max. Negotiated Rate |
$1,799.60 |
| Rate for Payer: Cash Price |
$806.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$799.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$719.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$719.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$759.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$799.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$759.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$799.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$799.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$599.87
|
| Rate for Payer: Healthfirst Commercial |
$799.82
|
| Rate for Payer: Healthfirst Essential Plan |
$1,799.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$759.83
|
| Rate for Payer: Healthfirst QHP |
$799.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$559.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$799.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$679.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$559.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$799.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$599.87
|
| Rate for Payer: SOMOS Essential |
$599.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$799.82
|
|
|
PR CLOSURE ATRIOVENTRICULAR VALVE SUTURE/PATCH
|
Professional
|
Both
|
$7,651.07
|
|
|
Service Code
|
HCPCS 33600
|
| Min. Negotiated Rate |
$1,410.95 |
| Max. Negotiated Rate |
$4,535.21 |
| Rate for Payer: Cash Price |
$2,037.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,015.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,814.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,814.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,914.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,015.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,914.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,015.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,015.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,511.74
|
| Rate for Payer: Healthfirst Commercial |
$2,015.65
|
| Rate for Payer: Healthfirst Essential Plan |
$4,535.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,914.87
|
| Rate for Payer: Healthfirst QHP |
$2,015.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,410.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,015.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,713.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,410.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,015.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,511.74
|
| Rate for Payer: SOMOS Essential |
$1,511.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,015.65
|
|
|
PR CLOSURE CYSTOSTOMY SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,962.10
|
|
|
Service Code
|
HCPCS 51880
|
| Min. Negotiated Rate |
$373.74 |
| Max. Negotiated Rate |
$1,201.30 |
| Rate for Payer: Cash Price |
$540.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$533.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$480.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$480.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$507.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$533.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$507.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$533.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$533.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$400.43
|
| Rate for Payer: Healthfirst Commercial |
$533.91
|
| Rate for Payer: Healthfirst Essential Plan |
$1,201.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$507.21
|
| Rate for Payer: Healthfirst QHP |
$533.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$373.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$533.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$453.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$373.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$533.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$400.43
|
| Rate for Payer: SOMOS Essential |
$400.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$533.91
|
|
|
PR CLOSURE ENTEROSTOMY LG/SMALL INTESTINE
|
Professional
|
Both
|
$3,829.53
|
|
|
Service Code
|
HCPCS 44620
|
| Min. Negotiated Rate |
$710.42 |
| Max. Negotiated Rate |
$2,283.48 |
| Rate for Payer: Cash Price |
$1,023.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,014.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$913.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$913.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$964.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,014.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$964.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,014.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,014.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$761.16
|
| Rate for Payer: Healthfirst Commercial |
$1,014.88
|
| Rate for Payer: Healthfirst Essential Plan |
$2,283.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$964.14
|
| Rate for Payer: Healthfirst QHP |
$1,014.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$710.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,014.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$862.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$710.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,014.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$761.16
|
| Rate for Payer: SOMOS Essential |
$761.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,014.88
|
|
|
PR CLOSURE EXSTROPHY BLADDER
|
Professional
|
Both
|
$6,829.73
|
|
|
Service Code
|
HCPCS 51940
|
| Min. Negotiated Rate |
$1,296.03 |
| Max. Negotiated Rate |
$4,165.81 |
| Rate for Payer: Cash Price |
$1,863.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,851.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,666.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,666.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,758.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,851.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,758.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,851.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,851.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,388.60
|
| Rate for Payer: Healthfirst Commercial |
$1,851.47
|
| Rate for Payer: Healthfirst Essential Plan |
$4,165.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,758.90
|
| Rate for Payer: Healthfirst QHP |
$1,851.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,296.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,851.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,573.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,296.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,851.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,388.60
|
| Rate for Payer: SOMOS Essential |
$1,388.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,851.47
|
|
|
PR CLOSURE GASTROCOLIC FISTULA
|
Professional
|
Both
|
$7,105.56
|
|
|
Service Code
|
HCPCS 43880
|
| Min. Negotiated Rate |
$1,344.22 |
| Max. Negotiated Rate |
$4,320.70 |
| Rate for Payer: Cash Price |
$1,935.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,920.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,728.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,728.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,824.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,920.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,824.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,920.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,920.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,440.23
|
| Rate for Payer: Healthfirst Commercial |
$1,920.31
|
| Rate for Payer: Healthfirst Essential Plan |
$4,320.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,824.29
|
| Rate for Payer: Healthfirst QHP |
$1,920.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,344.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,920.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,632.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,344.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,920.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,440.23
|
| Rate for Payer: SOMOS Essential |
$1,440.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,920.31
|
|
|
PR CLOSURE GASTROSTOMY SURG
|
Professional
|
Both
|
$3,191.20
|
|
|
Service Code
|
HCPCS 43870
|
| Min. Negotiated Rate |
$590.72 |
| Max. Negotiated Rate |
$1,898.75 |
| Rate for Payer: Cash Price |
$851.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$843.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$759.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$759.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$801.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$843.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$801.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$843.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$843.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$632.92
|
| Rate for Payer: Healthfirst Commercial |
$843.89
|
| Rate for Payer: Healthfirst Essential Plan |
$1,898.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$801.70
|
| Rate for Payer: Healthfirst QHP |
$843.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$590.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$843.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$717.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$590.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$843.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$632.92
|
| Rate for Payer: SOMOS Essential |
$632.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$843.89
|
|
|
PR CLOSURE INTESTINAL CUTANEOUS FISTULA
|
Professional
|
Both
|
$6,201.72
|
|
|
Service Code
|
HCPCS 44640
|
| Min. Negotiated Rate |
$1,148.88 |
| Max. Negotiated Rate |
$3,692.84 |
| Rate for Payer: Cash Price |
$1,655.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,641.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,477.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,477.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,559.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,641.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,559.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,641.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,641.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,230.94
|
| Rate for Payer: Healthfirst Commercial |
$1,641.26
|
| Rate for Payer: Healthfirst Essential Plan |
$3,692.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,559.20
|
| Rate for Payer: Healthfirst QHP |
$1,641.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,148.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,641.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,395.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,148.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,641.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,230.94
|
| Rate for Payer: SOMOS Essential |
$1,230.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,641.26
|
|
|
PR CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/<
|
Professional
|
Both
|
$621.64
|
|
|
Service Code
|
HCPCS 40830
|
| Min. Negotiated Rate |
$118.73 |
| Max. Negotiated Rate |
$381.62 |
| Rate for Payer: Cash Price |
$168.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$169.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$152.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$152.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$161.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$169.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$161.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$127.21
|
| Rate for Payer: Healthfirst Commercial |
$169.61
|
| Rate for Payer: Healthfirst Essential Plan |
$381.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$161.13
|
| Rate for Payer: Healthfirst QHP |
$169.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$118.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$169.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$144.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$118.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$169.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$127.21
|
| Rate for Payer: SOMOS Essential |
$127.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$169.61
|
|
|
PR CLOSURE LACERATION VESTIBULE MOUTH > 2.5 CM/CPL
|
Professional
|
Both
|
$855.47
|
|
|
Service Code
|
HCPCS 40831
|
| Min. Negotiated Rate |
$163.91 |
| Max. Negotiated Rate |
$526.86 |
| Rate for Payer: Cash Price |
$232.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$234.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$210.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$210.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$222.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$234.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$222.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$234.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$234.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$175.62
|
| Rate for Payer: Healthfirst Commercial |
$234.16
|
| Rate for Payer: Healthfirst Essential Plan |
$526.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$222.45
|
| Rate for Payer: Healthfirst QHP |
$234.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$163.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$234.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$199.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$163.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$234.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$175.62
|
| Rate for Payer: SOMOS Essential |
$175.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$234.16
|
|
|
PR CLOSURE LACRIMAL FISTULA SPX
|
Professional
|
Both
|
$2,581.78
|
|
|
Service Code
|
HCPCS 68770
|
| Min. Negotiated Rate |
$491.43 |
| Max. Negotiated Rate |
$1,579.59 |
| Rate for Payer: Cash Price |
$709.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$702.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$631.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$631.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$666.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$702.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$666.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$702.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$702.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$526.53
|
| Rate for Payer: Healthfirst Commercial |
$702.04
|
| Rate for Payer: Healthfirst Essential Plan |
$1,579.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$666.94
|
| Rate for Payer: Healthfirst QHP |
$702.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$491.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$702.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$596.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$491.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$702.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$526.53
|
| Rate for Payer: SOMOS Essential |
$526.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$702.04
|
|
|
PR CLOSURE MULTIPLE VENTRICULAR SEPTAL DEFECTS
|
Professional
|
Both
|
$8,761.34
|
|
|
Service Code
|
HCPCS 33675
|
| Min. Negotiated Rate |
$1,610.91 |
| Max. Negotiated Rate |
$5,177.93 |
| Rate for Payer: Cash Price |
$2,327.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,301.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,071.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,071.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,186.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,301.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,186.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,301.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,301.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,725.97
|
| Rate for Payer: Healthfirst Commercial |
$2,301.30
|
| Rate for Payer: Healthfirst Essential Plan |
$5,177.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,186.24
|
| Rate for Payer: Healthfirst QHP |
$2,301.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,610.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,301.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,956.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,610.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,301.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,725.97
|
| Rate for Payer: SOMOS Essential |
$1,725.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,301.30
|
|
|
PR CLOSURE MULTIPLE VSD W/REMOVAL ARTERY BAND
|
Professional
|
Both
|
$9,341.99
|
|
|
Service Code
|
HCPCS 33677
|
| Min. Negotiated Rate |
$1,717.75 |
| Max. Negotiated Rate |
$5,521.34 |
| Rate for Payer: Cash Price |
$2,481.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,453.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,208.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,208.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,331.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,453.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,331.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,453.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,453.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,840.45
|
| Rate for Payer: Healthfirst Commercial |
$2,453.93
|
| Rate for Payer: Healthfirst Essential Plan |
$5,521.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,331.23
|
| Rate for Payer: Healthfirst QHP |
$2,453.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,717.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,453.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,085.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,717.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,453.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,840.45
|
| Rate for Payer: SOMOS Essential |
$1,840.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,453.93
|
|
|
PR CLOSURE MULTIPLE VSD W/RESECTION
|
Professional
|
Both
|
$9,000.71
|
|
|
Service Code
|
HCPCS 33676
|
| Min. Negotiated Rate |
$1,653.88 |
| Max. Negotiated Rate |
$5,316.05 |
| Rate for Payer: Cash Price |
$2,389.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,362.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,126.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,126.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,244.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,362.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,244.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,362.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,362.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,772.02
|
| Rate for Payer: Healthfirst Commercial |
$2,362.69
|
| Rate for Payer: Healthfirst Essential Plan |
$5,316.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,244.56
|
| Rate for Payer: Healthfirst QHP |
$2,362.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,653.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,362.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,008.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,653.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,362.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,772.02
|
| Rate for Payer: SOMOS Essential |
$1,772.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,362.69
|
|
|
PR CLOSURE NEPHROCUTANEOUS/PYELOCUTANEOUS FISTULA
|
Professional
|
Both
|
$5,252.94
|
|
|
Service Code
|
HCPCS 50520
|
| Min. Negotiated Rate |
$972.73 |
| Max. Negotiated Rate |
$3,126.62 |
| Rate for Payer: Cash Price |
$1,399.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,389.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,250.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,250.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,320.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,389.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,320.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,389.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,389.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,042.21
|
| Rate for Payer: Healthfirst Commercial |
$1,389.61
|
| Rate for Payer: Healthfirst Essential Plan |
$3,126.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,320.13
|
| Rate for Payer: Healthfirst QHP |
$1,389.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$972.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,389.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,181.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$972.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,389.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,042.21
|
| Rate for Payer: SOMOS Essential |
$1,042.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,389.61
|
|
|
PR CLOSURE POSTAURICULAR FISTULA MASTOID SPX
|
Professional
|
Both
|
$2,891.91
|
|
|
Service Code
|
HCPCS 69700
|
| Min. Negotiated Rate |
$537.63 |
| Max. Negotiated Rate |
$1,728.11 |
| Rate for Payer: Cash Price |
$782.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$768.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$691.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$691.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$729.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$768.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$729.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$768.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$768.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$576.04
|
| Rate for Payer: Healthfirst Commercial |
$768.05
|
| Rate for Payer: Healthfirst Essential Plan |
$1,728.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$729.65
|
| Rate for Payer: Healthfirst QHP |
$768.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$537.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$768.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$652.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$537.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$768.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$576.04
|
| Rate for Payer: SOMOS Essential |
$576.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$768.05
|
|
|
PR CLOSURE RECTOURETHRAL FISTULA
|
Professional
|
Both
|
$5,765.06
|
|
|
Service Code
|
HCPCS 45820
|
| Min. Negotiated Rate |
$1,067.49 |
| Max. Negotiated Rate |
$3,431.20 |
| Rate for Payer: Cash Price |
$1,534.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,524.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,372.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,372.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,448.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,524.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,448.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,524.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,524.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,143.73
|
| Rate for Payer: Healthfirst Commercial |
$1,524.98
|
| Rate for Payer: Healthfirst Essential Plan |
$3,431.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,448.73
|
| Rate for Payer: Healthfirst QHP |
$1,524.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,067.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,524.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,296.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,067.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,524.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,143.73
|
| Rate for Payer: SOMOS Essential |
$1,143.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,524.98
|
|
|
PR CLOSURE RECTOURETHRAL FISTULA W/COLOSTOMY
|
Professional
|
Both
|
$6,945.12
|
|
|
Service Code
|
HCPCS 45825
|
| Min. Negotiated Rate |
$1,284.23 |
| Max. Negotiated Rate |
$4,127.90 |
| Rate for Payer: Cash Price |
$1,848.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,834.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,651.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,651.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,742.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,834.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,742.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,834.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,834.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,375.96
|
| Rate for Payer: Healthfirst Commercial |
$1,834.62
|
| Rate for Payer: Healthfirst Essential Plan |
$4,127.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,742.89
|
| Rate for Payer: Healthfirst QHP |
$1,834.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,284.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,834.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,559.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,284.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,834.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,375.96
|
| Rate for Payer: SOMOS Essential |
$1,375.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,834.62
|
|
|
PR CLOSURE RECTOVESICAL FISTULA
|
Professional
|
Both
|
$5,750.50
|
|
|
Service Code
|
HCPCS 45800
|
| Min. Negotiated Rate |
$1,065.06 |
| Max. Negotiated Rate |
$3,423.42 |
| Rate for Payer: Cash Price |
$1,530.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,521.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,369.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,369.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,445.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,521.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,445.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,521.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,521.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,141.14
|
| Rate for Payer: Healthfirst Commercial |
$1,521.52
|
| Rate for Payer: Healthfirst Essential Plan |
$3,423.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,445.44
|
| Rate for Payer: Healthfirst QHP |
$1,521.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,065.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,521.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,293.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,065.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,521.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,141.14
|
| Rate for Payer: SOMOS Essential |
$1,141.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,521.52
|
|
|
PR CLOSURE SALIVARY FISTULA
|
Professional
|
Both
|
$1,543.26
|
|
|
Service Code
|
HCPCS 42600
|
| Min. Negotiated Rate |
$291.14 |
| Max. Negotiated Rate |
$935.80 |
| Rate for Payer: Cash Price |
$420.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$415.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$374.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$374.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$395.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$415.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$395.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$415.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$415.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$311.93
|
| Rate for Payer: Healthfirst Commercial |
$415.91
|
| Rate for Payer: Healthfirst Essential Plan |
$935.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$395.11
|
| Rate for Payer: Healthfirst QHP |
$415.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$291.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$415.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$353.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$291.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$415.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$311.93
|
| Rate for Payer: SOMOS Essential |
$311.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$415.91
|
|
|
PR CLOSURE SEMILUNAR VALVE AORTIC/PULM SUTURE/PATCH
|
Professional
|
Both
|
$7,427.84
|
|
|
Service Code
|
HCPCS 33602
|
| Min. Negotiated Rate |
$1,370.71 |
| Max. Negotiated Rate |
$4,405.86 |
| Rate for Payer: Cash Price |
$1,978.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,958.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,762.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,762.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,860.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,958.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,860.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,958.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,958.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,468.62
|
| Rate for Payer: Healthfirst Commercial |
$1,958.16
|
| Rate for Payer: Healthfirst Essential Plan |
$4,405.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,860.25
|
| Rate for Payer: Healthfirst QHP |
$1,958.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,370.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,958.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,664.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,370.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,958.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,468.62
|
| Rate for Payer: SOMOS Essential |
$1,468.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,958.16
|
|
|
PR CLOSURE URETEROCUTANEOUS FISTULA
|
Professional
|
Both
|
$3,686.24
|
|
|
Service Code
|
HCPCS 50920
|
| Min. Negotiated Rate |
$701.91 |
| Max. Negotiated Rate |
$2,256.14 |
| Rate for Payer: Cash Price |
$1,008.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,002.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$902.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$902.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$952.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,002.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$952.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,002.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,002.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$752.05
|
| Rate for Payer: Healthfirst Commercial |
$1,002.73
|
| Rate for Payer: Healthfirst Essential Plan |
$2,256.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$952.59
|
| Rate for Payer: Healthfirst QHP |
$1,002.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$701.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,002.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$852.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$701.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,002.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$752.05
|
| Rate for Payer: SOMOS Essential |
$752.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,002.73
|
|
|
PR CLOSURE URETEROCUTANEOUS FISTULA W/VISC RPR
|
Professional
|
Both
|
$4,596.90
|
|
|
Service Code
|
HCPCS 50930
|
| Min. Negotiated Rate |
$872.69 |
| Max. Negotiated Rate |
$2,805.07 |
| Rate for Payer: Cash Price |
$1,254.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,246.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,122.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,122.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,184.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,246.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,184.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,246.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,246.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$935.02
|
| Rate for Payer: Healthfirst Commercial |
$1,246.70
|
| Rate for Payer: Healthfirst Essential Plan |
$2,805.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,184.37
|
| Rate for Payer: Healthfirst QHP |
$1,246.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$872.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,246.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,059.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$872.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,246.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$935.02
|
| Rate for Payer: SOMOS Essential |
$935.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,246.70
|
|
