|
PR CLOSURE URETHROVAGINAL FISTULA
|
Professional
|
Both
|
$2,088.31
|
|
|
Service Code
|
HCPCS 57310
|
| Min. Negotiated Rate |
$396.12 |
| Max. Negotiated Rate |
$1,273.23 |
| Rate for Payer: Cash Price |
$572.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$565.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$509.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$509.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$537.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$565.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$537.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$565.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$565.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$424.41
|
| Rate for Payer: Healthfirst Commercial |
$565.88
|
| Rate for Payer: Healthfirst Essential Plan |
$1,273.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$537.59
|
| Rate for Payer: Healthfirst QHP |
$565.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$396.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$565.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$481.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$396.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$565.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$424.41
|
| Rate for Payer: SOMOS Essential |
$424.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$565.88
|
|
|
PR CLOSURE VESICOUTERINE FISTULA
|
Professional
|
Both
|
$3,199.81
|
|
|
Service Code
|
HCPCS 51920
|
| Min. Negotiated Rate |
$609.91 |
| Max. Negotiated Rate |
$1,960.42 |
| Rate for Payer: Cash Price |
$875.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$871.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$784.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$784.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$827.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$871.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$827.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$871.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$871.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$653.48
|
| Rate for Payer: Healthfirst Commercial |
$871.30
|
| Rate for Payer: Healthfirst Essential Plan |
$1,960.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$827.74
|
| Rate for Payer: Healthfirst QHP |
$871.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$609.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$871.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$740.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$609.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$871.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$653.48
|
| Rate for Payer: SOMOS Essential |
$653.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$871.30
|
|
|
PR CLOSURE VESICOVAGINAL FISTULA VAGINAL APPROACH
|
Professional
|
Both
|
$2,474.54
|
|
|
Service Code
|
HCPCS 57320
|
| Min. Negotiated Rate |
$458.70 |
| Max. Negotiated Rate |
$1,474.40 |
| Rate for Payer: Cash Price |
$667.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$655.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$589.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$589.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$622.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$655.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$622.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$655.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$655.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$491.47
|
| Rate for Payer: Healthfirst Commercial |
$655.29
|
| Rate for Payer: Healthfirst Essential Plan |
$1,474.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$622.53
|
| Rate for Payer: Healthfirst QHP |
$655.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$458.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$655.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$557.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$458.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$655.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$491.47
|
| Rate for Payer: SOMOS Essential |
$491.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$655.29
|
|
|
PR CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION
|
Professional
|
Both
|
$1,457.47
|
|
|
Service Code
|
HCPCS 23545
|
| Min. Negotiated Rate |
$279.33 |
| Max. Negotiated Rate |
$897.86 |
| Rate for Payer: Cash Price |
$400.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$399.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$359.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$359.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$379.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$399.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$379.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$399.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$399.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$299.29
|
| Rate for Payer: Healthfirst Commercial |
$399.05
|
| Rate for Payer: Healthfirst Essential Plan |
$897.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$379.10
|
| Rate for Payer: Healthfirst QHP |
$399.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$279.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$399.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$339.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$279.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$399.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$299.29
|
| Rate for Payer: SOMOS Essential |
$299.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$399.05
|
|
|
PR CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION
|
Professional
|
Both
|
$1,065.44
|
|
|
Service Code
|
HCPCS 23540
|
| Min. Negotiated Rate |
$204.18 |
| Max. Negotiated Rate |
$656.30 |
| Rate for Payer: Cash Price |
$292.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$291.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$262.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$262.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$277.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$291.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$277.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$291.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$291.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$218.77
|
| Rate for Payer: Healthfirst Commercial |
$291.69
|
| Rate for Payer: Healthfirst Essential Plan |
$656.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$277.11
|
| Rate for Payer: Healthfirst QHP |
$291.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$204.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$291.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$247.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$204.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$291.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$218.77
|
| Rate for Payer: SOMOS Essential |
$218.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$291.69
|
|
|
PR CLSD TX CLAVICULAR FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$1,497.09
|
|
|
Service Code
|
HCPCS 23505
|
| Min. Negotiated Rate |
$287.94 |
| Max. Negotiated Rate |
$925.51 |
| Rate for Payer: Cash Price |
$410.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$411.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$370.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$370.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$390.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$411.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$390.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$411.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$411.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$308.50
|
| Rate for Payer: Healthfirst Commercial |
$411.34
|
| Rate for Payer: Healthfirst Essential Plan |
$925.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$390.77
|
| Rate for Payer: Healthfirst QHP |
$411.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$287.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$411.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$349.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$287.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$411.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$308.50
|
| Rate for Payer: SOMOS Essential |
$308.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$411.34
|
|
|
PR CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$1,029.70
|
|
|
Service Code
|
HCPCS 23500
|
| Min. Negotiated Rate |
$199.16 |
| Max. Negotiated Rate |
$640.15 |
| Rate for Payer: Cash Price |
$282.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$284.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$256.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$256.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$270.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$284.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$270.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$284.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$284.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$213.38
|
| Rate for Payer: Healthfirst Commercial |
$284.51
|
| Rate for Payer: Healthfirst Essential Plan |
$640.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$270.28
|
| Rate for Payer: Healthfirst QHP |
$284.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$199.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$284.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$241.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$199.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$284.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$213.38
|
| Rate for Payer: SOMOS Essential |
$213.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$284.51
|
|
|
PR CLSD TX FX ORBIT EXCEPT BLOWOUT W/O MANIPULATION
|
Professional
|
Both
|
$731.96
|
|
|
Service Code
|
HCPCS 21400
|
| Min. Negotiated Rate |
$142.84 |
| Max. Negotiated Rate |
$459.13 |
| Rate for Payer: Cash Price |
$203.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$204.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$183.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$183.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$193.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$204.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$193.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$204.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$204.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$153.04
|
| Rate for Payer: Healthfirst Commercial |
$204.06
|
| Rate for Payer: Healthfirst Essential Plan |
$459.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$193.86
|
| Rate for Payer: Healthfirst QHP |
$204.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$142.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$204.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$173.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$142.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$204.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$153.04
|
| Rate for Payer: SOMOS Essential |
$153.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$204.06
|
|
|
PR CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$1,500.38
|
|
|
Service Code
|
HCPCS 24500
|
| Min. Negotiated Rate |
$287.56 |
| Max. Negotiated Rate |
$924.30 |
| Rate for Payer: Cash Price |
$412.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$410.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$369.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$369.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$390.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$410.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$390.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$410.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$410.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$308.10
|
| Rate for Payer: Healthfirst Commercial |
$410.80
|
| Rate for Payer: Healthfirst Essential Plan |
$924.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$390.26
|
| Rate for Payer: Healthfirst QHP |
$410.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$287.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$410.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$349.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$287.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$410.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$308.10
|
| Rate for Payer: SOMOS Essential |
$308.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$410.80
|
|
|
PR CLSD TX PELVIC RING FX W/MANIPULATION W/ANES
|
Professional
|
Both
|
$1,376.90
|
|
|
Service Code
|
HCPCS 27198
|
| Min. Negotiated Rate |
$261.94 |
| Max. Negotiated Rate |
$841.95 |
| Rate for Payer: Cash Price |
$372.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$374.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$336.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$336.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$355.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$374.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$355.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$374.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$374.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$280.65
|
| Rate for Payer: Healthfirst Commercial |
$374.20
|
| Rate for Payer: Healthfirst Essential Plan |
$841.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$355.49
|
| Rate for Payer: Healthfirst QHP |
$374.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$261.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$374.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$318.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$261.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$374.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$280.65
|
| Rate for Payer: SOMOS Essential |
$280.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$374.20
|
|
|
PR CLSD TX PELVIC RING FX W/O MANIPULATION
|
Professional
|
Both
|
$588.53
|
|
|
Service Code
|
HCPCS 27197
|
| Min. Negotiated Rate |
$109.49 |
| Max. Negotiated Rate |
$351.94 |
| Rate for Payer: Cash Price |
$159.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$156.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$140.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$140.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$148.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$156.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$148.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$156.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$117.31
|
| Rate for Payer: Healthfirst Commercial |
$156.42
|
| Rate for Payer: Healthfirst Essential Plan |
$351.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$148.60
|
| Rate for Payer: Healthfirst QHP |
$156.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$109.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$156.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$132.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$109.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$156.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$117.31
|
| Rate for Payer: SOMOS Essential |
$117.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$156.42
|
|
|
PR CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES
|
Professional
|
Both
|
$1,818.22
|
|
|
Service Code
|
HCPCS 23655
|
| Min. Negotiated Rate |
$345.87 |
| Max. Negotiated Rate |
$1,111.72 |
| Rate for Payer: Cash Price |
$496.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$494.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$444.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$444.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$469.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$494.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$469.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$494.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$494.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$370.57
|
| Rate for Payer: Healthfirst Commercial |
$494.10
|
| Rate for Payer: Healthfirst Essential Plan |
$1,111.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$469.39
|
| Rate for Payer: Healthfirst QHP |
$494.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$345.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$494.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$419.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$345.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$494.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$370.57
|
| Rate for Payer: SOMOS Essential |
$370.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$494.10
|
|
|
PR CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES
|
Professional
|
Both
|
$1,352.12
|
|
|
Service Code
|
HCPCS 23650
|
| Min. Negotiated Rate |
$259.20 |
| Max. Negotiated Rate |
$833.13 |
| Rate for Payer: Cash Price |
$370.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$370.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$333.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$333.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$351.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$370.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$351.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$370.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$370.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$277.71
|
| Rate for Payer: Healthfirst Commercial |
$370.28
|
| Rate for Payer: Healthfirst Essential Plan |
$833.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$351.77
|
| Rate for Payer: Healthfirst QHP |
$370.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$259.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$370.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$314.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$259.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$370.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$277.71
|
| Rate for Payer: SOMOS Essential |
$277.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$370.28
|
|
|
PR CLSD TX STERNOCLAVICULAR DISLC W/O MANIPULATION
|
Professional
|
Both
|
$1,069.88
|
|
|
Service Code
|
HCPCS 23520
|
| Min. Negotiated Rate |
$207.94 |
| Max. Negotiated Rate |
$668.36 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$297.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$267.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$267.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$282.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$297.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$282.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$297.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$297.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$222.79
|
| Rate for Payer: Healthfirst Commercial |
$297.05
|
| Rate for Payer: Healthfirst Essential Plan |
$668.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$282.20
|
| Rate for Payer: Healthfirst QHP |
$297.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$207.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$297.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$252.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$207.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$297.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$222.79
|
| Rate for Payer: SOMOS Essential |
$222.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$297.05
|
|
|
PR CLSR 1 VENTRICULAR SEPTAL DEFECT W/WO PATCH
|
Professional
|
Both
|
$8,207.57
|
|
|
Service Code
|
HCPCS 33681
|
| Min. Negotiated Rate |
$1,514.31 |
| Max. Negotiated Rate |
$4,867.43 |
| Rate for Payer: Cash Price |
$2,184.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,163.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,946.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,946.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,055.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,163.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,055.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,163.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,163.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,622.47
|
| Rate for Payer: Healthfirst Commercial |
$2,163.30
|
| Rate for Payer: Healthfirst Essential Plan |
$4,867.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,055.14
|
| Rate for Payer: Healthfirst QHP |
$2,163.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,514.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,163.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,838.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,514.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,163.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,622.47
|
| Rate for Payer: SOMOS Essential |
$1,622.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,163.30
|
|
|
PR CLSR ANAL FSTL W/RCT ADVMNT FLAP
|
Professional
|
Both
|
$2,433.45
|
|
|
Service Code
|
HCPCS 46288
|
| Min. Negotiated Rate |
$460.63 |
| Max. Negotiated Rate |
$1,480.61 |
| Rate for Payer: Cash Price |
$660.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$658.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$592.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$592.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$625.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$658.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$625.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$658.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$658.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$493.54
|
| Rate for Payer: Healthfirst Commercial |
$658.05
|
| Rate for Payer: Healthfirst Essential Plan |
$1,480.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$625.15
|
| Rate for Payer: Healthfirst QHP |
$658.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$460.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$658.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$559.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$460.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$658.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$493.54
|
| Rate for Payer: SOMOS Essential |
$493.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$658.05
|
|
|
PR CLSR CH WALL FLWG OPN FLAP DRG EMPYEMA
|
Professional
|
Both
|
$4,013.38
|
|
|
Service Code
|
HCPCS 32810
|
| Min. Negotiated Rate |
$744.23 |
| Max. Negotiated Rate |
$2,392.18 |
| Rate for Payer: Cash Price |
$1,073.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,063.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$956.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$956.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,010.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,063.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,010.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,063.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,063.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$797.39
|
| Rate for Payer: Healthfirst Commercial |
$1,063.19
|
| Rate for Payer: Healthfirst Essential Plan |
$2,392.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,010.03
|
| Rate for Payer: Healthfirst QHP |
$1,063.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$744.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,063.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$903.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$744.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,063.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$797.39
|
| Rate for Payer: SOMOS Essential |
$797.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,063.19
|
|
|
PR CLSR ENTEROENTERIC/ENTEROCOLIC FSTL
|
Professional
|
Both
|
$6,379.38
|
|
|
Service Code
|
HCPCS 44650
|
| Min. Negotiated Rate |
$1,178.30 |
| Max. Negotiated Rate |
$3,787.40 |
| Rate for Payer: Cash Price |
$1,702.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,683.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,514.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,514.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,599.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,683.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,599.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,683.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,683.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,262.47
|
| Rate for Payer: Healthfirst Commercial |
$1,683.29
|
| Rate for Payer: Healthfirst Essential Plan |
$3,787.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,599.13
|
| Rate for Payer: Healthfirst QHP |
$1,683.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,178.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,683.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,430.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,178.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,683.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,262.47
|
| Rate for Payer: SOMOS Essential |
$1,262.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,683.29
|
|
|
PR CLSR ENTEROVES FSTL W/INTESTINE&/BLADDER RESCJ
|
Professional
|
Both
|
$6,809.15
|
|
|
Service Code
|
HCPCS 44661
|
| Min. Negotiated Rate |
$1,263.26 |
| Max. Negotiated Rate |
$4,060.49 |
| Rate for Payer: Cash Price |
$1,815.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,804.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,624.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,624.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,714.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,804.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,714.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,804.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,804.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,353.49
|
| Rate for Payer: Healthfirst Commercial |
$1,804.66
|
| Rate for Payer: Healthfirst Essential Plan |
$4,060.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,714.43
|
| Rate for Payer: Healthfirst QHP |
$1,804.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,263.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,804.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,533.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,263.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,804.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,353.49
|
| Rate for Payer: SOMOS Essential |
$1,353.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,804.66
|
|
|
PR CLSR ENTEROVES FSTL W/O INTSTINAL/BLADDER RESCJ
|
Professional
|
Both
|
$5,804.51
|
|
|
Service Code
|
HCPCS 44660
|
| Min. Negotiated Rate |
$1,088.56 |
| Max. Negotiated Rate |
$3,498.93 |
| Rate for Payer: Cash Price |
$1,575.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,555.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,399.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,399.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,477.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,555.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,477.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,555.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,555.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,166.31
|
| Rate for Payer: Healthfirst Commercial |
$1,555.08
|
| Rate for Payer: Healthfirst Essential Plan |
$3,498.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,477.33
|
| Rate for Payer: Healthfirst QHP |
$1,555.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,088.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,555.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,321.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,088.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,555.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,166.31
|
| Rate for Payer: SOMOS Essential |
$1,166.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,555.08
|
|
|
PR CLSR ESOPHAGOSTOMY/FSTL CRV APPR
|
Professional
|
Both
|
$4,387.01
|
|
|
Service Code
|
HCPCS 43420
|
| Min. Negotiated Rate |
$822.09 |
| Max. Negotiated Rate |
$2,642.42 |
| Rate for Payer: Cash Price |
$1,185.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,174.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,056.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,056.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,115.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,174.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,115.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,174.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,174.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$880.81
|
| Rate for Payer: Healthfirst Commercial |
$1,174.41
|
| Rate for Payer: Healthfirst Essential Plan |
$2,642.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,115.69
|
| Rate for Payer: Healthfirst QHP |
$1,174.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$822.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,174.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$998.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$822.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,174.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$880.81
|
| Rate for Payer: SOMOS Essential |
$880.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,174.41
|
|
|
PR CLSR ESOPHAGOSTOMY/FSTL TTHRC/TABDL APPR
|
Professional
|
Both
|
$6,439.27
|
|
|
Service Code
|
HCPCS 43425
|
| Min. Negotiated Rate |
$1,188.98 |
| Max. Negotiated Rate |
$3,821.72 |
| Rate for Payer: Cash Price |
$1,714.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,698.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,528.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,528.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,613.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,698.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,613.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,698.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,698.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,273.90
|
| Rate for Payer: Healthfirst Commercial |
$1,698.54
|
| Rate for Payer: Healthfirst Essential Plan |
$3,821.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,613.61
|
| Rate for Payer: Healthfirst QHP |
$1,698.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,188.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,698.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,443.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,188.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,698.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,273.90
|
| Rate for Payer: SOMOS Essential |
$1,273.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,698.54
|
|
|
PR CLSR LACRIMAL PUNCTUM PLUG EACH
|
Professional
|
Both
|
$481.67
|
|
|
Service Code
|
HCPCS 68761
|
| Min. Negotiated Rate |
$91.64 |
| Max. Negotiated Rate |
$294.57 |
| Rate for Payer: Cash Price |
$132.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$130.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$117.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$117.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$124.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$130.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$124.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$98.19
|
| Rate for Payer: Healthfirst Commercial |
$130.92
|
| Rate for Payer: Healthfirst Essential Plan |
$294.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$124.37
|
| Rate for Payer: Healthfirst QHP |
$130.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$91.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$130.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$111.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$91.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$130.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$98.19
|
| Rate for Payer: SOMOS Essential |
$98.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.92
|
|
|
PR CLSR LACRIMAL PUNCTUM THERMOCAUT LIG/LASER
|
Professional
|
Both
|
$601.93
|
|
|
Service Code
|
HCPCS 68760
|
| Min. Negotiated Rate |
$115.71 |
| Max. Negotiated Rate |
$371.93 |
| Rate for Payer: Cash Price |
$166.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$165.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$148.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$148.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$157.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$165.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$157.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$123.97
|
| Rate for Payer: Healthfirst Commercial |
$165.30
|
| Rate for Payer: Healthfirst Essential Plan |
$371.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$157.03
|
| Rate for Payer: Healthfirst QHP |
$165.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$115.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$165.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$140.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$115.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$165.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$123.97
|
| Rate for Payer: SOMOS Essential |
$123.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$165.30
|
|
|
PR CLSR NEPHROVISCERAL FISTULA W/VISC RPR ABDL APPR
|
Professional
|
Both
|
$6,657.18
|
|
|
Service Code
|
HCPCS 50525
|
| Min. Negotiated Rate |
$1,232.68 |
| Max. Negotiated Rate |
$3,962.18 |
| Rate for Payer: Cash Price |
$1,773.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,760.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,584.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,584.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,672.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,760.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,672.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,760.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,760.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,320.73
|
| Rate for Payer: Healthfirst Commercial |
$1,760.97
|
| Rate for Payer: Healthfirst Essential Plan |
$3,962.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,672.92
|
| Rate for Payer: Healthfirst QHP |
$1,760.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,232.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,760.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,496.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,232.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,760.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,320.73
|
| Rate for Payer: SOMOS Essential |
$1,320.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,760.97
|
|
